This debate has been going on for some time and many aspects of health have already been dealt with. The Minister's brief was very comprehensive and his statistics informative. Whatever shortage of money there may be in the Department nobody can deny that the Minister has a compassionate mind. Those with the best interests of the health service at heart, regardless of the side of the House to which they belong would not deny the compliment to the Minister that he has high motives. There are aspects of the Department's work which I could criticise, I suppose any other Deputy could, but I hope in doing that also to express some constructive ideas.
The other night I looked through the report of the Irish Hospitals Trust and also, in a very cursory manner through Dr. Hensey's very informative book on the health system. I was very edified in glancing through the Irish Hospitals Trust booklet to see the progress we had made by means of funds provided by Irish Hospitals Trust since its foundation. When it comes to discussing health there is not sufficient reference to this side of the subject because, without doubt, a large number of our voluntary hospitals would already be closed if they were solely dependent on patients' fees and on the State. Funds provided by the Irish Hospitals Trust have been the means of keeping hospitalisation to the fore. We are always highly critical of our hospitals, sometimes of the staff and sometimes of the manpower in health, but we are not always so ready to extend to those who work in hospitals the praise I believe is rightly due to them.
The total Vote for Health is roughly £250 million which is an enormous amount of money when one considers that even at the present time a person who controls £1 million is known as a millionaire. This should bring home to people the colossal expenditure on health. I suppose this is the case because health is a very large employer of manpower. It is a labour intensive organisation and when labour costs increase even slightly this is reflected in increased health expenditure. As politicians we differ in our approach on the methods of providing those moneys. The first time the Minister said that he hoped to be able, at some stage, to provide a free health service I said that he would never be able to do it, that we would not be able to raise the necessary finance. I shall return to this subject when I refer later to a scheme recently proposed by the medical profession for a health insurance scheme. We have a voluntary health insurance scheme but they have come up with the idea of a compulsory scheme to which I shall return later.
Reviewing the health system in general from the Famine onwards, one can see the terrible problems encountered and, bad as the poor law system which brought us up to the beginning of this century was, it had certain good features. Like the curate's egg, it had good and bad spots. I want to make the point that the Irish Hospitals Trust have provided £109 million towards hospital improvement since its foundation in the thirties towards the betterment of hospitals. That is an enormous investment and an enormous amount of money, and I think it made us hospital-minded and brought us up to the stage when led by the Department of Health, we could consider the betterment of our hospital system in general.
I do not want to name the institutions in Dublin which improved standards by means of funds from the Irish Hospitals Trust, but there is hardly a hospital in Dublin or outside that did not share the allocation of those funds. Some of our hospitals, the very oldest of them which we have preserved, shall we say, today present a very pleasing picture, not merely from the medical end but also from the architectural point of view. Admittedly some of them could be vastly improved by the investment of more funds, more medical appliances and so on. However, is it not grand to be able to say that we have hospitals which were built in the 17th century and which are going strong today? I pose the question to this House that, but for this constant income down the years, where would some of our leading hospitals be today?
Regarding this total of £109 million, this was raised not merely in relation to hospitals but in relation to foreign earnings by the Irish Hospitals Trust and by the activities of the Irish Hospitals Trust from an employer's point of view. I want to refer to this very pointedly in relation to foreign earnings. The Irish Hospitals Trust is a large employer of labour and to this extent provides a very useful service to the community. Those are a few points which, even at this late stage, should be made in recognition of the work done down the years by the Irish Hospitals Trust.
I come to other matters related to health and I want to deal very briefly with an argument which is going on in my own constituency in regard to hospitalisation. As I said, long before we were able as an organisation, either local or central, to provide sufficient funds for capital development in hospitals we had this aid by moneys raised by the Irish Hospitals Trust which led us on to the stage about 1968 when the book known as the brown book on hospitalisation was published. As those of us who acted on the Select Committee on Health in the early 1960s are aware—and I think the Minister for Health was one of the personnel of that committee then— most of the recommendations made by the FitzGerald Council, or Committee as it was called at that time, sprang from the ramifications of that Select Committee on Health which was assembled away back in the early 1960s. Regrettably the report of that committee was never published or laid before the House, nor were the public ever made aware fully of the content of the report of that committee. I would say in all there were over 60 meetings of it held and I attended nearly all of the 60. I improved considerably my education regarding medical matters, and I was hopeful at that time that something very special would emerge from that all-party committee. Nothing emerged at that stage, but in 1968 the FitzGerald Committee presented this report, a report by 18 doctors, some of them surgeons, more of them physicians, some of them on a county basis, more on a regional basis and from voluntary hospitals. The committee was chaired by Doctor Patrick FitzGerald, at that time head surgeon at St. Vincent's Hospital. The report proposed, and I think rightly so in view of the fact that county boundaries were no longer able to contain units which would serve the higher interest of medicine, especially from a surgical point of view, that the hospitals of the future should be constructed on a regional basis, and I think at that stage it set out the concentration of 12 areas for hospitalisation. That was all very well. The report was accepted by the Government. Regrettably, in the interval the moneys necessary for investment in large-scale hospitalisation were not readily available.
At any rate I come to the point where the present Tánaiste and Minister for Health asked Comhairle na n-Ospidéal to consider some amendment of the FitzGerald Report on the grounds that some parts of it, while logical, might not be easily accomplished from a practical point of view. He therefore asked the Comhairle to set out guidelines for the regions, which were disagreed, mainly on the locations or the proposed locations of some of those hospitals. At any rate, in regard to the Midland Health Board the Minister published his report on 21st October, 1975, and he called it the general hospital development plan. In that he set out very briefly certain ideas which would suit the Midland Health Board when it came to hospitalisation. The House will be aware that we have had various arguments, even on the floor of this House, regarding the provision of hospitalisation for the county of Longford and we had what developed into an argument here between a former Minister for Health and myself on this issue. Longford County could not afford a modern scale hospital. The county boundaries are too small and the money necessary to build such a unit would not be easily forthcoming. Therefore, we have always looked to our neighbouring county, Westmeath and the hospital located in Mullingar as a means of providing a surgical service for the County of Longford. Towards that end the Midland Health Board set up a working party to consider the Minister's proposal. The Minister's proposal was that instead of one large scale hospital we have at least two. The large scale hospital thought of at the time was one in Tullamore which was mentioned only in passing in the FitzGerald Report. In the nature of things, Mullingar entered the picture as a large county hospital and the only surgical one on the road between Sligo and Dublin. At the other end of the scale Portlaoise came into the picture as being the largest hospital providing surgery facilities between Limerick and Dublin.
The Midlands Health Board held a series of meetings on the matter, studied the Minister's plan and the plan put forward by their own representatives. In that context the health board came up with the idea of upgrading the hospitals in Mullingar and Portlaoise. The conditions laid down then were that there would be two minimum scale surgical hospitals in each of those areas. It was visualised that Mullingar Hospital, if upgraded and extended, should be able to provide the necessary beds for Longford.
That was a scheme of which our county health committee approved as did also the committees for Westmeath and Laois. At a meeting of the Midland Health Board previous plans were rescinded and the new plan adopted by a three-to-one vote. That was done on the grounds of it being in the best interests of the patients. The old plan provided that no patient should be more than sixty miles from a fairly large hospital. The new plan provided that no patient be further than 30 miles from a reasonably good hospital and the board, on the advice of its committees, so decided.
It is now being contended by certain people who write to local newspapers that there is some rethinking taking place in respect of this matter, not at ministerial level, but that certain politicians are alleged to have said that there should be one hospital only in the area and that that should be located in Tullamore. I want to say straightaway on the floor of this House, that I do not see any Minister rescinding a decision arrived at by a health board, representing approximately 100,000 people spread over the midlands, on the advice of its representatives from every corner of that region. I do not see any Minister for Health putting any pressure on any health board to rescind a motion of that kind, be he past, present or future. That is a decision arrived at in a purely democratic fashion, based on the best possible demographic and medical opinion and designed to cater for the highest interests in medicine, which is what we are after.
Therefore, I would say to those people engaged in trying to promote a controversy between the various interests in the Midlands to stop writing to newspapers but rather to inform themselves fully of the facts and progress from there. Health cannot always be made a political football. It should not be a political football. We, as representatives in this House, should be careful, whether at local or central level, not to make a political football of health. Health is too precious to the community to be brought down to that level—that it be kicked around and that people, by abusing one another, hope to gain something from it. I am sure that everybody in the Midlands who has the best interests not merely of surgery but all other medical matters at heart would agree with the decision of the health board. That does not mean that there should be downgrading of any hospital but rather an upgrading. Were the hospitals mentioned in a position to cater for the requisite number of patients, we would be progressing fairly well.
I was reading the Medical Times some time ago. My reading is somewhat sketchy, but, at any rate, I noticed a tendency on behalf of general practitioners to send nearly all of their maternity patients to hospitals rather than nursing homes. I wondered about this matter and I asked one or two doctors who came up with the old chestnut that the patient is much safer in a hospital. I do not contend that point but I am contending that hospital beds are scarce and dear. Perhaps I might ask the Minister why this sudden change in the system because I think it is a sudden change. Early on we were asked to subscribe to the view that the service should provide first-class maternity homes and, to that end, various communities of nuns and others invested heavily in nursing homes to find now that their capacity is not being taken up. At the same time, in the course of the last six or seven months, I have come across patients awaiting elective surgery for anything up to eleven months because they could not get beds. The administration seems to be somewhat out of joint or, perhaps, there is abuse at some level.
I read in the British Medical Journal in 1970 about a doctor aged 85 years who got the blue ribband of the year in England. He was interviewed on the BBC and was asked to explain why he qualified for the blue ribband. He was a very humble man and was very learned. He said he lived in one of the shires and that he knew all his patients. He also said: “I knew their fathers and mothers and in a good deal of cases their grandfathers and grandmothers.” He also told his interviewer: “I may not, in that case, have needed as much pathology as other medical practitioners.”
Are some of the doctors inclined to get away from their patients instead of getting near them? We believe that a doctor should follow his patient through the nursing home and if consultation is required it is available. Why have we now the switch to hospitalisation when beds are scarce? I will not delay long on this because I am not as well informed as I would like to be. That is the reason I ask: why have we under-utilisation of capacity in nursing homes? The people in charge of those homes have invested heavily to provide a very necessary service not merely to one section of the community but to humanity as well. It is a pity, when we have overloading in hospitals, that we have under-utilisation of nursing homes.
We have much less money this year for medical research. Everybody knows that, no matter how much money is provided, we will never be able to provide enough. However, when we have inflation it is a pity that we should have to have less money available for research. We are not like other countries because we have not any great share of private wealth to endow the various institutions engaging in research. It is a pity that we should have to trim our sails in relation to research. Medical research is a fact finding service in the interest of humanity and deserves the very highest praise and encouragement.
Eligibility for general medical services is a great bone of contention to many people. It is all very fine to say: "We will raise the level of eligibility from £2,250 to £3,000", but if we have not the organisation provided to meet a change like that there is no point in doing it. Several statements about the raising of eligibility were made in recent years. They are not getting us anywhere because there is not enough money available to provide the service we have in mind.
A great step in health in recent years is the reduction of the mortality rate especially in infant care and also the elimination of some of the more serious and more deadly killer diseases. It is regrettable, in relation to cancer, that we are not making greater in-roads towards cutting down this deadly disease. Every unfortunate patient who enters a hospital dreads this disease. I should like to pay a tribute to the agencies dealing with cancer, especially the Cancer Society and hospitals like St. Luke's and Hume Street who are doing such wonderful work which deserves very high praise from everybody.
We are heavily committed to geriatric care in all counties at the moment. There are various units in every county for the treatment of geriatrics, which can be very costly. However, when one looks at the aged and the fact that we are living longer one must also realise that people become geriatrics at an earlier age than 15 or 20 years ago due to the higher standards of living, less activity and so forth. The rate of progress in caring for the aged at home and in institutions is good. I want to pay a special tribute to religious organisations, whether they be Sisters of Mercy, Sisters of Charity, French Sisters of Charity, or from whatever order they come. Were it not for the investment which those religious organisations put into health we would not be able to do half the work we do in regard to care of the aged. Many of those Sisters who entered the nursing profession put back into the service a great deal more than their salaries in looking after the older people in the community.
Similarly, we have made good progress in preventive medicine. The levels of social welfare are losing the race with inflation. The aim of social welfare was to provide care for those who needed it. That is being done now. It is admitted at local level that there is no one in the country in need of either food or shelter. It is also admitted that in some cases some of these services are abused. In the nature of things that is bound to happen.
The more we do for preventive medicine the better. This will save money in other directions, for example if we can keep people who are mobile in their own homes. It is easier for them to be comfortable at home than in an institution.
Regrettably there are too many such people in institutions but that springs from another problem which I will not go into here. Due to the previous movement of people through emigration, we are left with the residue of an aging population, with more geriatrics and with more people to cater for. If the health bill is heavy in that regard, let us not complain but try to shoulder it. In good or bad times, we should try to help those people in a practical way.
Earlier I referred very briefly to the cost of providing and servicing medicine. This brings us back to the old chestnut, whether we will ever be able to provide a completely free health service for all people. I do not think we will ever reach that stage, which is a pity. It is bad enough to be sick, but it is twice as bad to have to start worrying about what you will be charged for the service and what you will have to pay to get well. This brings us to the burning question of what would be the best plan. Will it be an insurance plan, part State and part insurance, or a voluntary plan, and so on?
The voluntary health scheme works very well here. Anybody who knows anything about health knows this to be true. The voluntary health organisation have been run at a very low cost. All the contributions have gone to the betterment of the patient who needs treatment. In this way, we have come to recognise that there is something very genuine in a voluntary effort. You do not have to drive people there; they go themselves. They go in whatever direction suits them. They will invest in voluntary health if they think they will be adequately covered. The numbers in voluntary health, although, regrettably, not high in relation to our total population, indicate that that organisation is providing a good service.
I did not have time to study the plan the doctors put to the Minister for health coverage. They had in mind something along the voluntary health scheme coupled with the State spear-heading such a campaign. I wonder if that would succeed. If one looks at the British scheme one will see that, while it was a humane aim, it could very quickly wind up draining the Exchequer. It would be a praiseworthy move if the opinion of the experts in the Department of Health was sought—I have no doubt they have all the statistical information they require so that they could evaluate the doctors' plan and have it distributed to the Members of this House, members of health boards and so on. We would then see the proposals and have dialogue on them.
I have tried to convince young people starting out of the desirability of joining the vountary health scheme in case their children get sick. I am speaking now of people who are outside the scope of the general medical services scheme. I am not speaking of hospitalisation, but of the general medical services scheme. It is often said that there should be preventive medicine as well as in- or out-patient medicine. It is a boon to a family to know that if a member falls sick he will be fully covered and immunised against financial hardship.
I should like to have had more time to study the Minister's statistical information. Regrettably I did not and, therefore, must confine myself to the few matters I mentioned. The Health Vote of £250 million is enormous and 75 to 80 per cent of that amount goes on hospitalisation. This makes it more important than ever that the question of hospitalisation be restudied. If we come up with a plan we should try to put money behind the plan to make it operative. The Midland Health Board have come up with a plan for hospitalisation and I request the Minister to put the money behind the plan to make it a reality.