When I reported progress, I was endeavouring to show the Minister how he could save and, at the same time, provide better health services. I propose now to continue on those lines. I was very glad to see that the Minister in his opening statement referred to geriatrics. This is a very important matter at the moment because the percentage of old people here is higher than it is in any other country in Europe. Not everything in the 1953 Act was bad. One of the good provisions was that where-under the Department of Health made provision for the payment of disabled persons' allowances. That payment has been extremely beneficial in keeping people out of county homes or, as they are now called in these modern days, St. Something or other. I suggest to the Minister that there are at the moment a great many people in county homes who really ought not to be there. They are there of necessity more than anything else.
To maintain a patient in a county home costs anything from £14 to £18 a week, depending on the amount of attention the patient requires. A great number of people throughout the country have had to go into these homes because there was nobody available to look after them. Because of the changing circumstances of our society, young relatives of elderly people in the working class community, or in the indigent classes, if you like so to describe them, the poorer sections, are now securing an education and getting jobs as typists, or secretaries, and so forth, and very often they go away into employment. In other days, these people stayed at home and looked after these old people. Today, they are not available. The result is that aged relatives no longer have anybody to look after them and, therefore, they have no option except to go into the county home, where they cost the State or the local authority anything from £14 to £18 a week. If some form of statutory allowance were provided to compensate relatives who would be prepared to come home and look after these old people, a great deal of public expenditure could be avoided. One could not expect these young people to give up jobs in which they earn possibly £6 a week as typists and come home to look after elderly relatives, getting nothing in return.
I appreciate the fact that some county councils pay a specific allowance as a matter of routine, but that is not the case in my own county, and I know of quite a number of people in the county home in Wexford who have really no desire to be there. They are costing the State quite a large amount of money. This is an avenue the Minister could well explore and make some provision for the payment of allowances to these people. If he does so, he will save a great deal of money. Another point is that, once a person enters the county home, he or she stays there forever. The Minister's job should be to try to stop people going there. I respectfully submit he should consider my suggestion.
The Minister referred to mentally retarded children. It is not satisfactory that we should have two Ministries dealing with retarded children and it is because of that that we have never really got down to dealing effectively with this problem. The policy up to this seems to have been to build very expensive establishments. When there is a problem as acute as this problem, it is essential to deal with it as expeditiously as possible. I suggest the Minister should examine any available buildings, in conjunction with the local authorities, and get down to opening them as quickly as possible, if only on a temporary basis. After all, if we are to have medical officers on a temporary basis in dispensaries for ten and 15 years, there is no reason why we should not have these institutions springing up all over the country on a temporary basis to deal with this problem.
I can assure the Minister it is one of the most acute problems in the country today. It is very injurious to the health and social outlook of the children concerned who are in the same family as severely retarded children. It is also extremely hard on the parents and very injurious to their health. I know of cases of parents literally worn out trying to look after these children.
They are at it all the time and in several instances I know of, they have finished up in mental institutions themselves as a result of the trial, the strain and the great forbearance shown by them in trying to look after these cases.
It is high time we had drug control in this country. Heretofore, as far as I know we have relied on the British Pharmacopoeia codex. That means we had imported into this country all sorts of drugs over which we have no specific control ourselves. I do not say anybody has been poisoned or anything like that, but we have drugs circulating here for which the full price is charged by the retail chemists—it is no fault of theirs because the drugs have been supplied to them by the wholesalers or manufacturers—and these drugs are under strength and are not up to the proper percentage. This is a matter that was discussed on the National Health Council when I was a member. I left before they finalised their proposals. I hope they now have proposals before the Minister to have a pharmacopoeia codex of our own so that the present state of affairs will not continue.
Several years ago there was a recommendation to the then Minister for Health, now Deputy MacEntee, that he should deal in some way with the ambulance service and turn it into a national service rather than to have prevailing the conditions we have at present. That recommendation from the same body was subsequently made to the Minister's immediate predecessor. It was made on the basis of the fact that, although statistics may be produced to show that on, say, 600 occasions when an ambulance is sent for it leaves from the point of call within five or seven minutes, there are from time to time cases where an ambulance is not available. Those are the cases in which there is less of life. For that reason I do not think that an ambulance service on a county to county basis is satisfactory. I do not even feel that the extension now of medical services on a regional basis is going to meet the case.
I think you want a definite ambulance centre. Perhaps four or five of them would be sufficient for the entire country. You want some place where you can phone for an ambulance and be sure of getting one. I know myself, having been in practice in the past, that you meet the occasional emergency in which it is just impossible to get an ambulance. You ring one hospital and you are told the ambulance is gone to Dublin. Then you ring another one; maybe the ambulance there is gone also, and you have to ring a third. I suggest you should have an ambulance centre where you have a staff control there whose job it is to get an ambulance. All the person concerned has to do is to ring that centre. They have a direct line to the other phones where the ambulances are in existence.
The position that obtains today in many parts of rural Ireland is this. The ambulance man attached to the district hospital in many cases does not live on the premises. He does in some cases, but he may be out at the pictures. He is entitled to his free time. It may be a considerable time before he is reached. That means there is a delay and the doctor or civic guard who has run for the ambulance does not know whether it is coming or not. I have repeatedly seen this happen. It does not happen in many cases, but it does in a small percentage. I may be unlucky. On two occasions recently driving along the road I have come on accidents. Ambulances were looked for and there was waiting for a considerable period. That would be obviated by having a centre with somebody directly responsible and in direct contact with the ambulances in an up-to-date service.
This problem becomes more pressing every day. Today we have far more accidents on the roads than we ever had before. Every night one switches on the news one hears of fatal accidents in different parts of the country. That system obtains in other parts of the world and I do not see why we should not have it here. I admit that, if the regional system is adopted, with the disappearance of the county boundaries, which have no meaning so far as the service is concerned, you will have a better ambulance service but, as against that, you will still be up against the problem of the overworked doctor or matron looking for an ambulance having to hang about on the telephone. Nobody need tell me it is easy to get through on the telephone in rural Ireland. I know the Minister has no responsibility for this. There has been some improvement but you have to wait sometimes for ten minutes to get through. That could mean the question of the survival or not of an injured person.
I want to say a word about medical cards. I have always felt that the system by which medical cards are allocated is a bad one. I will try to tell the House why I think so. The old system of free treatment which fell into disrepute was carried out by the Boards of Guardians, who issued red tickets. We did away with the red tickets and called them medical cards. I suppose it sounded more up-to-date. But the Boards of Guardians who issued the red tickets to those entitled to free treatment were people who lived in the area. They were fully conversant with all the affairs of their neighbours, their finances and requirements and they were in a position to decide whether a card was needed or not.
An applicant for a medical card today has to go through the ordinary channels and apply to the local authority. When he does so the matter is then relegated to the home assistance officer group, or whatever they are called today. That is sent out for investigation. The investigation takes place and it may be a matter of weeks before the result comes back. I know of many people who are refused medical cards. I know a typical case of people earning £9 a week with six or seven children being refused a card. How in the face of all that is reasonable can anybody earning that money be expected to pay a doctor's bill? It is totally out of the question. The system is a bad one. The more home assistance officers can cut down expenses, the more likely they are to be promoted. They cannot have the interests of the particular individual at heart.
That brings up the question of the entire future of the medical services. I sympathised with the Minister at the outset, but he has not really indicated today what is the future of the Irish medical services. We had the very elaborate White Paper issued by his predecessor about 12 months ago which, analysed and worked out, really comes to nothing. There is no indication in it when these health services are going to be implemented. I am long enough on the road now, politically. medically and otherwise, to know there is a great deal of that White Paper which will never be implemented. In other words, it is only a dream. The Minister, when replying, should indicate what his intentions are. Will he issue a White Paper? Above all, and this seems most germane to the whole issue, will he extend medical services to cover general practice?
I have tried to show the House that, in my opinion, the Health Act of 1953 involves costs that will climb to an extraordinary height because it throws the greater load all the time on hospitalisation. It will build up. Charges for hospitalisation are not going down. The cost of living generally, wages, rates, heating, lighting and everything concerned is going higher. The cost of hospitalisation has increased almost phenomenally. Weekly charges have increased by nearly 300 per cent. The Minister should indicate whether he intends to produce a White Paper. To give him a bit of friendly advice before sitting down, I advise him that the best thing to do is scrap the existing White Paper, or declaration of intention by his predecessor, and produce his own White Paper taking into consideration some of the things I have tried to put before him this afternoon as a means of saving money and promoting better relationship between doctor and patient and providing better health services to the degree we can afford.
