Vol. 195 No. 1
asked the Minister for Health whether the statutory obligation imposed on health authorities under section 14 of the Health Act, 1953 to provide ophthalmic, dental and aural treatment and appliances without charge to holders of medical cards is being fulfilled; and, if not, if he will state the reason.
9.
asked the Minister for Health whether the statutory obligation imposed on health authorities by section 21 of the Health Act, 1953 to provide dental, ophthalmic and aural services for the persons therein specified is being fulfilled; and, if not, if he will state the reason.
With your permission, a Cheann Comhairle, I propose to take Questions Nos. 8 and 9 together.
In general, health authorities are fulfilling, to the best of their ability, within their available resources, their obligations under section 14 of the Health Act, 1953, to provide ophthalmic, dental and aural treatment and appliances for eligible persons.
It should be borne in mind that the possession of a Medical Card entitling the holder to free general medical services does not automatically entitle that person to free dental, ophthalmic and aural services from the health authority. The health authority must be satisfied that the services applied for are necessary for the particular applicant and that he is unable to provide them from his resources. For example, an applicant, although the holder of a Medical Card, may be qualified as an insured employee to obtain free dental services or a grant towards the cost of dentures or ophthalmic or aural services under one of the Benefit Schemes administered by the Department of Social Welfare. If he is qualified for a free service or can meet his portion of the cost of services under these Schemes, he is not eligible for free services from the local health authority because he can get the services he needs otherwise.
Regarding the health authority ophthalmic service, I understand that in all but a few health authority areas the services for eligible persons are reasonably satisfactory. In these few areas there are waiting lists; but the health authorities concerned have taken steps to improve the position in this respect.
Regarding health authority aural services, aural treatment is provided, where necessary, by health authorities for eligible persons; but hearing aids are at present provided only on a limited scale, mainly for children whose education is being handicapped by defective hearing and for adults dependent on such appliances to earn their livelihood. As I announced when introducing the Vote for Health on 10th April, 1962, the National Organisation for Rehabilitation is, with my approval, arranging for the establishment of a hearing aid service to cater for the needs of persons recommended for hearing aids by their local health authority. This service will improve considerably the position regarding the supply of hearing aids and permit of desirable expansion.
Because of the limited amount of funds and dental personnel available to local health authorities, it has been the policy to recommend to health authorities that they should concentrate mainly on providing dental treatment for children who are entitled to free dental treatment under the School Health and Child Welfare Services, as children stand to benefit most from such treatment. This means that only a limited dental service is available in most areas for adults in the lower income groups. In particular, dentures are provided only on a restricted basis in many areas.
Section 21 of the Health Act, 1953, provides that a health authority shall, in accordance with Regulations, make available dental, ophthalmic and aural treatment and dental, optical and aural appliances for persons in the middle income group. The necessary Regulations have not been made and consequently there is no statutory obligation on health authorities to provide services under Section 21 of the Act.
In view of the need to concentrate available resources on the classes already statutorily entitled to the services I do not consider that Regulations giving effect to this provision of the Act should be made at present.
I have already mentioned that one of the classes specified in Section 21 of the Act, that is, insured persons, can obtain dental, ophthalmic and aural services under the Department of Social Welfare Benefit Schemes.
Does the Minister's reply, in effect, mean that holders of medical cards must be satisfied with whatever services there are and that, in relation to the middle income group, although these services were provided for in the 1953 Health Act, the Minister has not yet made regulations providing for their initiation?
I do not know what the Deputy means by the phrase "must be satisfied with whatever services there are". If he means to cast a reflection on those services, my reply is that they are satisfactory and that they work satisfactorily.
The Minister knows I am referring to the fact that a poor person with bad teeth or with no teeth has no opportunity of getting dentures.
Yes, he has, within the limits for which the Deputy indicated a few weeks ago he was willing to provide the money.
Is it the position in relation to the middle income group that the Minister has not yet made regulations about the initiation of these services?
That is so.
Why?
Because the Deputy and his Party are not prepared to provide the funds.
Is the Minister not aware that it is difficult for any applicant to obtain a hearing aid, as all applications are subject to the Minister's approval? I am speaking of applicants who are the holders of medical cards. Would the Minister be prepared to relax that regulation?
The Deputy is correct. The provision of hearing aids has been subject to a certain amount of supervision because not all people benefit from the hearing-aid appliances, unless they are properly fitted and people are instructed in the use of them. In addition, the appliance is an extremely expensive article. As I have announced, the National Organisation for Rehabilitation is arranging for the establishment of a hearing-aid service to cater for persons recommended for hearing aids by their local authorities.
The cases I have in mind are ones in which the medical officer has recommended the provision of a hearing aid. These people have been medically certified and I do not see why the laymen in the Department should interfere with such certificates.
We have more than laymen in the Department; we carry a highly skilled specialised staff.
