Wednesday, 14 July 1954
Dáil Éireann Debate
Dr. Ryan: On this Resolution, I want to refer to a few points. First of all, I should like to refer to this question of priority for public assistance classes. They are, as we are all aware, now entitled to free medical services of every kind. The Minister in the debate last week made very frequent references to the danger of depriving that class of the priority they now enjoy. At column 1324 of the Official Debates of the 7th July, 1954, the Minister said:—
“One of the applicants is a poor person unable to provide for himself; the other is a farmer of £45 valuation. There is a temptation there, particularly by reason of the impact on the rates, to prefer the person who can pay even £2 2s. a week.”
In his speeches here last Wednesday and Thursday the Minister referred many times to the public assistance class, to the fact that they have priority in hospitals under local authorities at the moment and to the further fact that, if the Act of 1953 were to be implemented, that priority would disappear. In fact, he became so enthusiastic that he referred to them on one occasion as “the impoverished poor”.
The National Health Council passed a resolution and it also was based largely on consideration for the present public assistance class or what is referred to in the 1953 Health Act as “the lower income group.” As I say, the Minister gave a great deal of time to this as being one of his greatest difficulties in implementing the Act. When I was speaking after his introductory speech I made the suggestion that if the Minister were seriously troubled on this matter he could bring in a simple Act extending or continuing that priority. I should like to make it clear that, personally, I have no fear on that score. However, the Minister does appear to have fear on that score and when the Minister was concluding on Thursday evening he said, as reported at column 1583 of the Official Report:—
“Deputy Dr. Ryan also said: ‘Well, why does not the Minister come in here, not with this sort of Bill but with a Bill giving to the poor of this country a priority?’ That again, is the kind of illogical  approach that I just cannot understand from Fianna Fáil. I thought the Health Act was trumpeted around the country as being a measure which was abolishing the term ‘public assistance’ and the old poor law class and all the rest of it, and that never again would you have a red ticket or anything of that kind. Nevertheless, this reasonable measure is countered by Deputy Dr. Ryan by saying: ‘Why do you not bring in a measure in effect to restore the priorities that existed under the public assistance code?’ I do not know whether that appeals as good sense to anyone. It certainly does not to me.”
The Minister made an appeal for co-operation. He appealed also for a cutting-out of political rancour, but is that type of reception of a suggestion calculated to elicit from the Opposition the co-operation the Minister asked for? When the 1953 Health Bill was being piloted through this House, we spent months here, not days, defending that Bill against Fine Gael. We had to withstand the most bitter and persistent opposition of that Party. If, in an effort to save that Act from destruction or sabotage, I make a suggestion not by reason of my own fears but by reason of the fears of the Minister—if I make a suggestion to allay the Minister's fears on a particular line— I am met with ridicule. If the Minister adopts that attitude here and wants to steamroll his Bill through, irrespective of any argument that may be put up, and if we make a suggestion to allay his fears—not ours—we do not expect to be met with ridicule of this kind.
It was very ironical that the Minister should appeal to this side of the House to cut out the political rancour and then give the type of reception he gave to a suggestion which we made to allay his fears on a particular line. Of course, it may be that the Minister has not an argument to the point which I made—and we all know that ridicule or abuse is the best substitute for an argument. The Minister gave us no allay the Minister's fears and it would appear that he had no argument to answer it.
 Surely we on this side of the House must get credit for being more particular about the implementation of the 1953 Health Act than the Deputies who are now sitting on the Government Benches. We spent months here in 1953 trying to put that Act through. We were met by months of opposition, and if we were both sincere—if we were sincere in putting the Bill through and if the other side were sincere in opposing it—surely the responsibility for seeing the Act through now must rest on those who now sit on this side of the House, not on the other.
I still think it is absurd to say that the public assistance class will suffer if the 1953 Health Act is implemented. I do not think a guarantee is necessary. However, I want to say that if the Minister asks for co-operation and if he gets co-operation even in that small way he should not reject it in that way. He should deal with it reasonably and tell us why, in his view, it is not acceptable. If two people are arguing a case, and if they are anxious to find a solution, I think it is natural enough for one person to say to the other: “I see no grounds for your anxiety but, if you are anxious, here is a suggestion that might get over it. I see no grounds for anxiety myself but I give this suggestion as a way of getting over it.” In such a discussion between two persons who are anxious to find a solution, the other person would at least give a reason why, in his view, the suggestion should not be accepted. The same would apply to suggestions for the insertion of a date beyond which the implementation of the Act should not be delayed.
I still maintain that the appointed date of 1st August should have been adhered to. Again, if the Minister is sincere—and he said he is sincere— about implementing the 1953 Health Act he should be in a position to name a date. If, in our anxiety to get this Act implemented, we try to clutch at the wreckage so as not to let the whole thing go, and if we say: “If you will not do it on 1st August, give us a date anyway” surely that is not to be taken as a proof that the 1st August is impossible?  It is not impossible. I think any reasonable person will agree, before this Bill leaves the House, that it is not impossible.
I want to clear up another matter on the subject of the advice of officials. I said, in a speech that was partially quoted by the Minister—I asked him to quote the whole lot of it because I think it might help in the education of some of the members opposite, but the Minister did not do so:—
“with the Department, whose officers were in a position to give an formed and objective opinion, and I was advised that it would be quite feasible to operate the main portions of the Act on July 1st.”
Whether or not the Deputy may include the matter he is dealing with on this Resolution it is very difficult to say but I do not think it is relevant. I have given the Deputy a good deal of time with regard to the matter which he is raising and if he is nearly finished I will not stop him but——
Dr. Ryan: I could not say that, Sir, but I should like to submit that if I want to give reasons why I think this money should not be voted I have to give reasons why I think this Bill is unnecessary. I would also like to remind you, a Cheann Comhairle, that when the main Act was under discussion it took four days to discuss the Money Resolution.
An Ceann Comhairle: That Money Resolution is finished. The only Money  Resolution under consideration here, as far as I know, is in respect of money that will have to be voted out of the Exchequer to meet the expense of a service that will not be in operation if this Bill is passed. I do not know whether the Minister would agree with that.
An Ceann Comhairle: A certain service will not be in operation if this Bill is passed, and it is in order to meet that that money has to be provided out of the Central Fund. Therefore, the only matter under discussion is the money to be voted in respect of that particular service.
Mr. T.F. O'Higgins: It is an even more net point than that, because the only charge on the Exchequer will arise under the provision in the Bill deleting temporarily the right to charge 6/- a day in respect of insured workers, and the cost to the Exchequer in the portion of the year concerned would be approximately £44,000.
An Ceann Comhairle: Deputy Dr. Ryan was relevant up to a point, and if he proceeds to discuss the Resolution in that way he may do so, but I would not allow him another Second Reading speech covering the whole approach to the Bill.
Mr. McQuillan: Might I ask the Minister if it is suggested that certain sections of the 1953 Health Act are to be brought into operation at a later stage, and this Bill is to delay their implementation, how does money become necessary to prevent services from coming into operation?
Mr. T.F. O'Higgins: I do not mean to be offensive to the Deputy, but I  do not think that he appreciates that there is no section of the 1953 Health Act that will not come into operation either on August 1st or on dates already ordered. The whole Act comes into operation.
Mr. Traynor: For the guidance of the House would it be possible for you to show us the limits of this debate? My own recollections are that on Money Resolutions there has been a general debate—that a Bill has been discussed on a Money Resolution almost in the same manner as on the Second Stage—so for the guidance of Deputies who might like to intervene in this debate I would request you to show us the limitations to this debate.
An Ceann Comhairle: Deputy Traynor is right, but not altogether. A Second Reading debate is not in order on a Money Resolution, and this is a very limited Money Resolution. The Money Resolution in respect of the Health Act which was introduced in 1953 and which is now an Act was passed by this House. The only Money Resolution now before the House is a Money Resolution in respect of what might be described as the 6/- a day group. That is the only matter that is in question now—whether money should be provided by the Central Fund in respect of these cases which would have to pay to get treatment if this Act is suspended.
Mr. Briscoe: Could I ask the Minister to tell us what was the amount of money envisaged in the original Money Resolution when the 1953 Act was being passed compared with the estimated amount involved now?
Mr. T.F. O'Higgins: The figure there is £600,000 odd for the eight months—that is of course the Central Fund's half. Another half goes on the rates. The half on the Central Fund would include, or rather would be based on, a contribution of 6/- a day in respect of these particular classes.
Mr. O'Donovan: I submit that it is impossible to answer Deputy Briscoe's question in view of the fact that the 1st August was not envisaged at the time when the Health Bill, 1953, was going through, and therefore the question is impossible to answer.
Mr. T.F. O'Higgins: What might assist Deputy Briscoe is that in the original Money Resolution, if I might call it that, in connection with the Health Act, 1953, there was no provision in relation to this sum because a section provided that 6/- a day could  be charged in these cases of insured workers. We are now proposing to remove that charge and we have to provide the 6/- a day, which totals £44,000.
Mr. McQuillan: Do I understand that the position the Minister has outlined to Deputy Briscoe is that this £44,000 does not include the total amount in connection with the insured workers, or is there a further sum to be added to that from the local authorities?
Dr. Ryan: I think this point should be made clear as it is a great pity that there should be any misunderstanding in this House by any Deputy regarding  the advice that officials give a Minister. Deputy Larkin did, I think, try to impress the House here with the futility, if you like, of advice from departmental officials if, as he said, they gave me one advice and gave the present Minister another advice. I will quote Deputy Larkin because I do not want to be unfair. He said:—
and that the advice the present Minister had received from the officials, whose advice had been incorporated in my speech, was that it would be impossible to implement the services fully. Deputy Larkin, speaking at column 1368, Volume 146, No. 11 on July 7th went on in a fairly clever and tedious process of reasoning to come to the conclusion that their advice had no better value in one case than the other. Well of course it all depends on the approach. It should be understood that a Minister decides policy. Officials may help him to decide policy, in the sense of putting the facts before him, and officials will help a Minister to carry out his policy. If that is fully understood, it explains everything, because there is an apparent conflict in this matter, but the situation is very plain and very easy to understand if it is understood that the officals are only advising the Minister on how to carry out his policy. For instance, if I were to say to the Department: “I believe in the Health Act of 1953. I believe the Act is very urgent and should be brought into operation as quickly as possible. The Government have provided the finances and everything is ready, so far as that is concerned,” and, on that basis, I get the advice that it can come into operation on 1st July. If another Minister comes along to the same officials and says: “I must operate the Act——”
Dr. Ryan: I may say that I did go back and have a look at the debate on the Money Resolution in connection with the main Act. I found that the Opposition had kept it going for four days and I said to myself that it meant we could have a fairly general discussion.
Mr. Briscoe: I came here with a good deal of material, material which has a great deal of relevancy to the discussions which have already taken place. I now find myself in a very serious difficulty with regard to the discussion. The Chair is ruling that the difference between this Money Resolution and the Money Resolution on the main Act is that the latter was a large Money Resolution, providing money for the entire purposes of the Act, whereas this is only a small Resolution affecting only certain sections of it.
Mr. Briscoe: The Minister made no contribution whatever in moving the Money Resolution and perhaps he would oblige us at this stage by explaining the extent of the Money Resolution. The Minister gave no explanatory statement but merely  moved it formally. The extent to which this Bill alters the 1953 Act is a matter of opinion—as to whether it is a major or a minor operation. The view I take is that it is a major operation, so major that it is fatal to the 1953 Act, and that the Act will expire as a result of it. It is on that basis I approach it and consequently it is very hard to limit one's discussion of the matter to something on which one cannot put one's finger.
Mr. Briscoe: Therefore, we can, I take it, deal with the sections which are affected. The Minister, in his introductory speech and in his reply, properly stated that it would be a serious and improper thing if people were to deceive the beneficiaries of health services. I agree with that statement, but I want to ask now who is perpetrating the deception. I have sought seriously all the information I could possibly get with regard to the effect on those sections of the community in the City of Dublin who are affected by this Bill. I do not pretend for one moment that I can deal with the Bill in so far as it affects rural Ireland.
Mr. T.F. O'Higgins: May I say again that the only question involved in the Money Resolution is whether it is proper to provide money to pay £2 2s. per week for the treatment of insured workers in hospital, or whether they should pay it themselves? That is the net point in the Money Resolution.
Mr. Briscoe: What I cannot understand is the approach to this. I will obey the Chair's ruling and I do not propose to argue this in any spirit of hostility or disobedience to the Chair, but we are faced with a situation in which this Bill is to amputate from the 1953 Act those parts which are essential for its life, and, in the doing of that, the 1953 Act is not to be nourished any more by money provided under the previous Money Resolution. We are now to be asked to discuss the matter of the reimposition of a certain limited amount of money because the Act is being executed.
Mr. Briscoe: I must take one more look at my notes before I give in. The approach to this Money Resolution is  that the State will now have to contribute, as well as local authorities, towards the £2 2s. per week to the hospitals in respect of the treatment of patients who are insured and nobody else. Is it not a fact that that position exists at present under social welfare, that in fact there is no money being spent at all because it is merely a matter of a transfer from social welfare to the Department of Health; and that social welfare will save the exact amount of money that will now be spent by the Department of Health? Is that not the position? Perhaps the Minister could explain it. Might I ask the Minister if this is the position? At the present moment insured workers get some benefit from social welfare?
Mr. T.F. O'Higgins: At the moment —when I say at the moment I mean before August 1st—the insured worker does not pay anything for hospital treatment. If the Act is not amended by this House, on and after August 1st he may be charged 6/- a day, which is two guineas a week. The purpose of the amending Bill is to wipe out that charge of two guineas a week. It may be a bookkeeping entry but it has to be made anyway. The amount that would have been collected by charging the insured worker two guineas a week must be voted out of the Central Fund. That amount is estimated at £44,000 in this particular year.
Mr. Briscoe: Therefore, we can bring it down to this, that if it is decided  that these people who under the Act might be liable to a charge of up to 6/- are not to be charged anything, there might be no necessity for a Money Resolution at all. Consequently, what we are doing here is pure shadow-boxing.
Mr. Briscoe: There is before us a Money Resolution which may cost nothing to the Exchequer. It is put before the House for endorsement in order that certain amendments to the 1953 Act will be passed. If the 1953 Act is affected to the extent that I believe it is being affected by these amendments, then the 1953 Act is being slaughtered here and this Money Resolution is bringing about the burial, for our time anyway, of the 1953 Health Act.
Mr. Kennedy: Under the present arrangement the Exchequer pays the bills for the insured worker to the hospital and the effect of this Money Resolution will be to transfer half the cost to the local authority. Who will, in fact, bear half these costs—the people for whom we have been making arrangements that they should come under the health Act, 1953, the forgotten men, the small farmers, the men with little or no income and who compose the majority of the Minister's constituents? They are flung to the wolves and what do they get now? They get the responsibility of paying 50 per cent. of the cost for the insured worker. Let them be in Mullingar Hospital, Roscommon Hospital or any hospital you like, as a result of the passing of this Money Resolution they get no benefit whatsoever.
If that Money Resolution was never introduced the status quo would remain, the Department of Social Welfare paying the cost which would be subvented by the Department of Finance. Now we suspend the Health Act of 1953, like Mahomet's coffin and we do not know if it will ever come into effect. Having listened to the  Minister the last day, I was convinced by what I believed was his sincerity but from his winding up speech, his equivocation about the whole matter and from his speech in the country over the week-end, I am convinced beyond yea or nay that the Health Act of 1953 will never be operated with the principles that are embodied in it and in the particular sections that are suspended under this particular Bill.
I contend that the passing of this Resolution will make the health position, as far as rural Ireland is concerned, far worse than it was before. It will throw the responsibility on the local rates of 50 per cent. of the cost of the administration of the benefits of the Act that will accrue to the insured worker and it will leave that unfortunate man to whom I referred in my speech on the last day, and to whom many Deputies have referred, the small farmer, without any benefits. As a Deputy mentioned here, he is always at the giving end but never at the receiving end. There are no trade union hours for him. He gets up at daybreak and until the sun goes down he struggles with poor or middling land; it is very seldom good land. It is important to remember that the density of our population is regulated by the poorness of the land. The poorer the land the more population we have on it. Take my own constituency. When you come to the Killucan electoral area, where the land is very valuable, you can get on horseback and ride a square mile without seeing a habitation, but when you get back to Clonyheigue, where you have half bog and badly drained land, you find the dense population. There you have the ratepayers who will have to keep up the insured worker.
The Minister was very eloquent and very solicitous about the insured worker. The insured worker can earn £12 a week; he can earn up to £600 a year. If the man on the £10 valuation holding in the areas to which I have referred saw £12 a week he would think he was in fairyland. He never saw an income like that and never will. People propound theories in various magazines about the small farmer. Here is a chance of doing something for the small farmer. Here is a chance, by not  passing this Money Resolution, of taking an inequitable burden off his shoulders. The insured workers in the city and urban areas come into the benefit of it. The insured workers all over the State—I think there are 450,000 of them—receive benefit from it.
Take our farming population—we have approximately 330,000 farmers and 74 per cent. of them are on valuations of £20 and under. I am amused to hear professional people, city people and townspeople saying that the countryman has everything—eggs, butter and so on. They do not go down to live in the country or to live on a 20 acre farm. To a countryman £1 is 240 pennies and every penny is to be looked at ten times before it is spent. It is not so many sheaves of oats to dish out, as many think who are in the category of insured worker with £10 and £12 a week. On that man's shoulder you are putting half the cost of the administration of the limited scheme under the 1953 Act.
Mr. Kennedy: If the Deputy's Party made a small charge on the insured worker, it gave free hospital service to all his family. The Deputy's Party under the 1953 Act took the shadow of death from the small-holder in Ireland by giving him free medical services—of which he cannot avail now. He is afraid to avail of them because of the Shylocks in the Irish Medical Association.
Mr. Kennedy: In spite of the Minister's protestations about sincerity, I approach this because I come of a small people and I am proud of them and proud to be related to small farmers all over the north of Westmeath. It is their interests I have at heart and if they disappear from the country, as I said they were doing, it means the disappearance of characters that made up the book Knocknagow—Mat the thresher and the rest of them. I stand for the preservation of those people and when they disappear from rural Ireland, rural Ireland has gone. What I am against in this Money Resolution is that these people are being burdened now for 50 per cent. of the cost, under this Money Resolution, and therefore I am going to vote against it.
Mr. McQuillan: It is a significant feature in legislation here that if groups are organised outside this House, whether through trade unions or professional groups, once they are strongly organised and have funds at their disposal and have spokesmen in this House, they can get facilities for their members that are not available to the sections of our community which are unorganised. When I refer to the sections of our community which are unorganised, I emphasise the small farmers who are really the backbone of this country. If the small farmers and the self-employed men all over the country were well organised and had funds at their disposal and had their spokesmen in this House to act in unison, I wonder if we would find a Money Resolution of this nature before the House, which would leave them out of the reckoning for services under the Health Act and burden them at the same time with, part of the cost of the insured workers' hospital facilities.
The sum that is needed in this Money Resolution is £44,000. That is being borne by the Central Exchequer, but  that is only half the amount. If this £44,000 is to be expended this year, then another £44,000 must be added to it, and that other £44,000 will be supplied by the local authorities and will be raised by an imposition on the rates. Now we have the extraordinary position that the small farmer and the self-employed man who cannot be described as coming under the public assistance group will have to pay through the rates portion of the cost of hospitalisation of the insured worker. I have no desire whatever to make the insured worker pay the 6/- per day. I merely want to give the same facilities to the people I represent as are being given to the insured worker.
I would like the Minister, when replying, to make reference to the situation as he found it in rural areas. The Minister may say to me and to other Deputies that the section of the community which we represent—and which he represents himself—will still get the benefit of the 1953 Act, in spite of this amending legislation he has now introduced. I say that the majority of those people in the rural areas cannot get the benefits unless they can prove that they are in the public assistance group. when I say “benefits,” I am not referring to the hospital treatment: I am referring to the reduction in the charges and to the payment of specialist fees. The people we are interested in here, the small farmer and the self-employed worker, are getting the health services, in my area at any rate, but the question of payment is what is worrying us. This £44,000 from the Exchequer and the £44,000 to come from the rates is going to safeguard the interests of the insured worker at the expense of the group to which I am referring.
I cannot widen the scope of this debate and I have no wish to do so, because the points that I wish to raise will be, I hope, relevant on the various amendments to the Bill which are to come before us. Under the circumstances, I propose to make my position clear in this way, that while I have no desire to put any obstruction in the way of the insured worker getting his rights, I resent most strongly the fact that the small farmers in the West of Ireland,  and indeed those in the rest of Ireland, are now going to be burdened with the cost of paying portion of the insured workers' hospital maintenance and treatment, while at the same time those small farmers will have to pay the full cost, in many cases, for similar services. There is no use in the Minister or any other Deputy referring to the group that I am speaking about now as the “farmers with the £50 valuation.” The group I am referring to, in the five counties of Connaught and in Kerry, Clare and Donegal, have between them a total of 107,000 holdings under £10 valuation—and that, mark you, out of a total of 380,000 holdings in the entire country.
I would like to ask the Minister if he is serious in suggestion that there is going to be a rush for services by the £50 valuation farmer in the West of Ireland, and by those close to that valuation, and that they are going to occupy all the beds in all the public institutions and local authority hospitals. The majority of the people in the West of Ireland, particularly those in the three counties to which I have referred, live on holdings under £10 valuation. That does not mean, however, that they come under what is known as the third group, the public assistance group. If a small farmer living on a holding of £10 valuation has to meet a hospital bill of £70 for maintenance and treatment, he will have to undergo a rigorous means test, far more rigorous than that imposed under the Social Welfare Act in connection with old age pensions. It is most unjust to treat those men who are the backbone of this country in that way and I want to register the strongest protest I can in relation to that on this Money Resolution.
I do not want it to be taken that I am a party to depriving the insured worker of benefits. I hold that the insured worker's benefits and the cost of his treatment should be borne by the Exchequer out of the Central Fund; that is in relation to the £88,000. The £44,000 for which the rates will be liable should not be raised through the medium of the rates and should not be imposed on the small man in the rural areas. My attitude on this matter is  founded on the ground that I resent the fact that the small farmer and the self-employed worker with an income of less that £600 per year in the rural areas will now be asked to pay portion of the hospital cost for the insured worker. I want to make it clear to the Minister that I oppose this Money Resolution on those grounds.
Mr. Allen: Last week, when the Minister introduced this Bill he gave as one of the main reasons why it was not possible to operate the Health Act, 1953, the fact that local authorities had made no financial provision for operating the Act. That was one of the Minister's arguments.
Mr. Allen: Lo and behold! one week later, he introduces his Financial Resolution. I wondered what the necessity was for such a Resolution, but now I know that he is asking the House to vote an extra £44,000 from the Exchequer. I know that following on that Vote of £44,000 by this House the local authorities will be mulcted in the present financial year for another £44,000. Assuming that the Minister will not be able to fix a date for the full implementation of the 1953 Act he will have to introduce another amending Bill before 1st April next; we can take it that there will not be any change. The Minister could not give a date last week. In a full financial year, therefore, it will cost local authorities £100,000 and I suggest that that £100,000 is the price the Minister had to pay the Labour Party for their support in order to get their agreement to the introduction of this measure.
Mr. Allen: I suggest that is the price Fine Gael had to pay; and the taxpayers will have to pay £200,000 annually for the privilege of having this Bill introduced to postpone the operation of the Health Act, 1953. A price has to be paid all the time, and the Fine Gael group in the Government had to agree to pay this £100,000 annually. A good many sums have already been paid. First, we had £1,250,000——
An Leas-Cheann Comhairle: It is not in order. I have already pointed out to Deputy Allen that there can be no discussion on that point. The net point at issue is the question of the 6/- per day mentioned in the Resolution.
Mr. Allen: That amounts to £44,000 for the remainder of this financial year and it will amount to £88,000 in a full financial year. There is no harm in mentioning that this concession to the Labour group of the Coalition is costing £44,000; otherwise, I am sure they would not have agreed to the postponement of the Health Act passed by an overwhelming majority in this House last year. There is no harm in reminding the Minister that his colleagues, and possibly he himself, campaigned a few weeks ago in the month of May —this is the middle of July—against the cost of the Health Act in relation to local authorities and local rates. They probably left some impression on the minds of ratepayers as a result of that campaign. Six weeks later they come along and put a new burden on local ratepayers in order to postpone the Health Act.
There should be some honesty in public life. We expect honesty from  the Government. The Government should give a lead in honesty all along the line. One should not suggest to people in the month of May that if so-and-so is elected local rates and taxation will be reduced and then in the month of July confront the country with extra taxation and extra charges on local rates. As was pointed out there, by both Deputy Kennedy and Deputy McQuillan, those charges in the main will be borne by people from whom concessions will be taken under Sections 1 and 2 of the Bill. It is they who will have to pay this £44,000. As ratepayers they will have to pay another £44,000 in the present year.
These are the small farmers, the self-employed tradesmen, the fishermen and all the people for whom it was proposed to cater under the Health Act of 1953. That Act was passed by this House. The very groups from whom the right to free hospital treatment will be taken under this Bill are now being forced by the Minister and the Government to pay something extra for that section of the community already fully provided for as insured persons. There seems to be neither reason nor justification in this proposal. This Money Resolution is one that should not be accepted, and it is one against which we must register an emphatic protest.
Mr. McGrath: I am against this Money Resolution because it is being used for the postponement of very important sections of the 1953 Health Act. There were some reasons given by the Minister and others for the postponement of that Act. One of the chief reasons was that the Minister's predecessor had made no arrangements.
Mr. McGrath: I accept your ruling. I suppose I will be able to get in what I have to say on the amendments. As a member of a board of management of a  voluntary hospital, I want to know what effect this Resolution will have on that institution. Is the Minister going to make any preparations for the financing of these institutions when they are asked to pay the honorary members of the staff as outlined in a letter from the secretary of the I.M.A. of the 3rd May, 1954? That letter, which was addressed to each voluntary hospital, pointed out that at the next meeting of the joint committee representing the governing authority, one of the items on the agenda would be concerned with the question of the remuneration of the visiting staffs.
Mr. McGrath: I want to point out the reason why I am against the Money Resolution. My reason is that it is being used to postpone the 1953 Health Act. The arguments which were used for postponing it were that no provision had been made for the carrying out of that Act. I maintain, and I have  proof, that there were plenty of arrangements made by the local authorities.
Mr. McGrath: There is the 6/- per day which will have to be provided now if the 1953 Act is postponed. That Act has not been postponed yet. There are plenty of amendments down to this Bill, but I maintain that this Money Resolution is to postpone the 1953 Act. However, if the Chair objects, I suppose, like other Deputies, I shall have to wait until the amendments come on to make my point.
Mr. Bartley: I do not know if the Minister has made it quite clear as to how this money is to be expended. He mentioned that we are now discussing the provision of a sum of £44,000 to meet part of the hospital charges for the treatment of insured workers. Is that the position?
Mr. T.F. O'Higgins: Yes. The position under the Health Act was that insured workers were charged 6/- a day. This wipes out the charge for the time being, and this Resolution is necessary to make up the difference.
Mr. Bartley: Is the Minister not implying that he is now providing £44,000 to assist an insured man to pay his hospital bills, and that this is new money? Is that not so? Does the present position lack this £44,000? How is an insured patient's position in hospital affected by the fact that this money is not at present available? Would the Minister explain that? I may be a bit obtuse about this, but I think that there are others on his own side who are just as obtuse. I would be very glad if the Minister would explain that.
We are discussing the desirability of authorising such payments out of moneys provided by the Oireachtas as are necessary to give effect to any Act of the session to amend the Health Act. Surely that is a good deal wider than this £44,000.
Mr. Bartley: The 1954 Health Bill which proposes to abrogate the greater  part of the 1953 Health Act, or, in fact, any Bill going through this House, cannot be implemented unless the Dáil passes the necessary Money Resolution. We all know that to be the position. A point was made by one of the speakers here, a pertinent one, that will require a good deal of explanation outside. I think that we have the duty here of getting from the fount of authority— the Minister for Health—the reason for asking for a considerable sum of money if, in fact, the necessity for money for the payment of benefits is being removed. We, on this side, are not satisfied at all that the money is necessary. There is an onus on the Minister to tell us quite definitely in language that the average man will understand what, in fact, is the purpose for which he is asking the Dáil to give him this £44,000. He tells me that the insured worker gets his hospital bills paid for him at the present time. Is not that so? If he does, how can £44,000 now be required to pay these same bills?
Mr. Bartley: The Minister says he is not abrogating the 1953 Act. Is that so? I want information quite genuinely. Is it the position that the Minister is not abrogating the 1953 Act? I want information for the people outside.
Mr. Bartley: If Deputy Murphy would allow this little interchange between the Minister and myself, we  might get somewhere. Any of the Deputy's interruptions that I have experienced have been always calculated to throw a little more confusion into the situation. He must give his own Minister, whom he has backed so enthusiastically for the last six weeks, a chance now to explain.
Mr. Bartley: I want information from the Minister. Here is the question. Let us take a concrete case. Somebody outside asks: “Why do you want money? Why did you pass a Money Resolution in the Dáil if you have been suspending indefinitely the benefits of the Health Act of 1953?” If the Minister maintains that we are not suspending the Health Act, 1953, will he explain to me the parts of the 1953 Act which will, after the passing of this Bill, require to be financed by the Resolution which we are now discussing?
Mr. T.F. O'Higgins: I would like to deal with the matters that have been raised in two ways. I place those that have been raised in a genuine way of seeking information in one category and in that category I include the points made by Deputy Bartley. The other contributions were of a very unhelpful kind and in that category I include Deputy Allen and, of course, Deputy McGrath. I will first of all deal with Deputy Bartley.
Under the existing health legislation, either in accordance with the social welfare code or public assistance provisions, every insured worker who is in benefit and who gets sick and who requires hospital treatment has the right to get such treatment in any hospital with which the Department of Social Welfare have an agreement, that is, for all practical purposes, all local authority hospitals and all voluntary hospitals. Such insured worker gets that treatment without being charged a penny. He leaves hospital at the end of the period for which treatment is provided or necessary without having to pay a single penny in respect of his treatment. On and after August 1st, if the Health Act, unamended, went into operation, such insured worker could be charged by a local health authority in the area a sum in respect of hospital treatment not exceeding 6/- per day which totals in the week £2 2s. 0d. That is, in relation to treatment provided by the health authority in a health authority hospital, a charge of 6/- per day may be made. In addition, after August 1st, under the Health Act, such insured worker, if he decides to select a hospital and is not satisfied to go to the health authority hospital but prefers to go to a voluntary hospital, in that voluntary hospital must pay for public ward treatment, if he elects to have that, £2 2s. 0d. a week, and so on; if he decides to go into a private ward, the health authority would make a contribution but he would be liable for the balance.
 Now, under this Bill, it is proposed, for such period as may be decided by the Minister, to maintain the existing position and, in order to do that, to remove for the time being the right of a health authority to impose any charge on an insured worker, so that, henceforth, after August 1st and until such time as the Minister may determine to the contrary, no charge of 6/- per day may be made by the health authority in respect of treatment in any hospital. Accordingly, just as now, insured workers, or anyone else for whom the services are provided, will get them without any charge at all.
Deputy Bartley asked how is it necessary to ask for a vote of money for this purpose. The reason, of course, is—it is merely a bookkeeping one but it is nevertheless there—the difference between the normal hospital payment now being made by health authorities to voluntary hospitals, now being made by social welfare to health authorities and voluntary hospitals. The normal payment is £5 12s. per week. Under the Health Act £2 2s. of that £5 12s. could have been charged and, of course, would have been charged on insured workers. Therefore, in relation to insured workers a health authority would have to provide a sum of £3 10s. The charge would have been £3 10s., of which half would have been borne by the rates and half by the Central Fund. Therefore, notionally, it is necessary to provide that sum of £44,000 by voting this money. In fact, of course, as far as the rates are concerned, there will not be any charge at all on rates—any extra charge—in relation to this Vote because the cost this year so far as rates are concerned will be less than was anticipated and it has been already provided in the average by all health authorities. That is a difficult matter I appreciate. It is quite difficult for Deputies who have not had to live for the last six weeks with health legislation to appreciate the exact problem involved but I hope that what I have said has explained to Deputy Bartley and others the purpose for which the money is required.
I would like to pass from that to a few other things and to deal with  Deputy McGrath's category. There is no doubt that there is no political Party in the world as capable of manufacturing, repeating and disseminating political propaganda as Fianna Fáil is. We heard Deputy Kennedy and Deputy McGrath weeping crocodile tears because the health finances now have to be borne half by the rates. You would imagine I was the person who was doing it and that under this amending Bill—an insignificant little measure—all this ruin and desolation was going to fall on the ratepayers of Ireland. In fact, the charge for all hospital treatment for insured workers, for public assistance, and for anyone else who many benefit under the Act, which up to this used to be borne by the Central Fund, will by the action of Deputy Kennedy and his Party, and by the action of Deputy McGrath and his Party, from the 1st August next fall on the poor small farmers in Deputy McQuillan's constituency and on the poor small farmers for whom Deputy Kennedy had so much to say here to-day. He did it. Deputy McGrath's Party did it, and no one else; and it does, indeed, test my patience unduly when I am blamed by the men who charged the rates with hospital provision for the people that used to be paid out of the Central Fund. I am blamed by the very people who did it. That charge on rates is incorporated in the Act.
Mr. T.F. O'Higgins: Reference was made to £40,000, and listening to the speeches, I was beginning to imagine that in fact I might have been doing something unfair to the ratepayers of this country. In this House we are quite accustomed to wiping off £40,000 as if it was a bit of dust on the shoulder. Of course it is quite a considerable sum of money, but when you are dealing with health provisions running into £5,000,000, £6,000,000 or £7,000,000, £40,000 begins to pale into insignificance. But all that £40,000, according to some of the Deputies who spoke here, seems to be going as a visitation on Westmeath, Galway and Roscommon. I can assure the Deputies it will not. A very large section of it, in fact, quite a big portion of it, will be the responsibility of the Dublin ratepayers and there are very few small farmers in Dublin unless they are passing through or spending a holiday there.
So far as the rest of the country is concerned, the sum involved will be very small indeed, but in any event, everywhere in relation to this sum, provision has already been made so that in fact there will be no charge at all on the rates in respect of this sum this year.
Mr. T.F. O'Higgins: Yes. Of course, it varied, and I do not think it was as low as 6d. or 8d. anywhere. It is hard to estimate but for the limited services envisaged this year the rates would already have provided about threequarters of the money necessary. In fact, the charge on the rates will not be as large as was anticipated.
 I want to say one other thing. Really I do beg of Deputies in these matters to try to be realistic and I am speaking through the Chair to Deputy McQuillan. There is no farmer in any health authority area I have been able to find—and I have made a very full examination of it—who would be described as a small farmer by Deputies McQuillan and Kennedy, having in or about £10 valuation, that is not getting full free hospital treatment already.
Mr. T.F. O'Higgins: Deputy McQuillan and I were discussing another matter. In fact, the small farmers mentioned by the different Deputies can at the moment get free treatment, both medical and hospital. But from what Deputies have said here, you would imagine that every one of them has to pay his way. He has not. In one county at the moment—and I think I see one of the Deputies here—a farmer up to £50 valuation gets full free treatment and that was long before the Health Act of 1953 was passed. Down in Deputy McGrath's county—although Deputy McGrath is in the built-up part of it— farmers up to £25 valuation get free hospital and other treatment. In different parts of the country—there is no set standard in some places and no rigid rules in a lot of places—but,  generally speaking, and I have taken the trouble to get a survey——
Mr. T.F. O'Higgins: Well, what has that to do with what we are discussing? We are surely discussing whether, in fact, farmers whose valuation may be £10, £15 or £20 have to be crippled with hospital bills. They have not and they are not. They are not charged. They got free treatment up to this and the cost of their treatment was provided by the rates and taxation.
Mr. T.F. O'Higgins: I would suggest to Deputy McGrath that if he does not want to listen to me, he might leave the House because there are some Deputies who are interested in what we are discussing. Deputy McGrath is not. He is interested only in making a nuisance of himself. I would suggest to Deputies when they are discussing the position of small farmers that they should bear in mind that in most counties the poorer farmers on whose behalf they speak here—because not one of them will admit that they are speaking on behalf of the £40 or £50 farmer but I fear a lot of them are interested only in the better-off farmers; I am not referring to Deputy McQuillan——
Mr. T.F. O'Higgins: I am endeavouring to answer some of the reasons that were advanced by Deputy Bartley's colleagues as to why this money should not be voted. I am merely walking down the same  passages as Deputy Bartley's friends travelled. There is no question in this Resolution of small farmers being denied services and being asked to pay for insured workers because, in fact, generally speaking, throughout the country all such farmers get services free themselves. It is true of course that the better-off farmer, in so far as he is a ratepayer, will be asked to contribute in rates to the services provided for the poorer farmers, the smaller men and for insured workers. I must say my heart is not bleeding unduly——
Mr. Bartley: On a point of order. The Minister is traversing the case made last week about small farmers but I was here when the Ceann Comhairle was present and he ruled out any reference except to matters connected with the provision of this £44,000, in respect to insured workers.
An Leas-Cheann Comhairle: The Minister has just pointed out that he is answering some points made by other Deputies in the course of the discussion but may I point out that many of these Deputies were informed by the Chair that these points were not relevant to the Resolution before the House.
Mr. T.F. O'Higgins: I do not think Deputy Bartley was here when the argument was addressed to the Chair. The argument addressed to the Chair, of course, was perfectly in order, that it was unfair to provide money to cover the removal of the charge of 6/- a day in respect to insured workers, as part of that would have to be met by small farmers who, they allege, would get no benefit. That is the argument with which I was dealing. I do not think there is anything further I have to say on this Resolution.
|Barrett, Stephen D.
Beirne, John. Byrne, Thomas.
Dillon, James M.
Dockrell, Henry P.
Donegan, Patrick S.
Doyle, Peadar S.
Esmonde, Anthony C.
Glynn, Brendan M.
Hession, James M.
Kyne, Thomas A.
Burke, James J.
Byrne, Alfred. Larkin, James.
Lindsay, Patrick J.
Murphy, Michael P.
O'Higgins, Michael J.
O'Higgins, Thomas F.
O'Sullivan, Denis J.
Palmer, Patrick W.
Pattison, James P.
Burke, Patrick J.
Calleary, Phelim A.
Childers, Erskine H.
Collins, James J.
Crowley, Honor M.
Davern, Michael J.
de Valera, Eamon.
de Valera, Vivion.
Kennedy, Michael J.
Moher, John W.
Ó Briain, Donnchadh.
Ryan, Mary B.
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