Ceisteanna—Questions. Oral Answers. - Free Trade Area: Swedish Proposals.
Ceisteanna—Questions. Oral Answers. - Financial Assistance for Wicklow Industry.
Ceisteanna—Questions. Oral Answers. - Industrial Undertakings in Limerick City.
Ceisteanna—Questions. Oral Answers. - E.S.B., C.I.E. and Bord na Móna.
Ceisteanna—Questions. Oral Answers. - Compensation for Former Dundalk Employees of G.N.R.
Ceisteanna—Questions. Oral Answers. - Rural Electrification in Fintown (Donegal) Area.
Ceisteanna—Questions. Oral Answers. - Joint Health Areas.
Ceisteanna—Questions. Oral Answers. - Garden of Remembrance.
Ceisteanna—Questions. Oral Answers. - Increases in Old Age Pensions, Widows' Pensions and Unemployment Assistance.
Ceisteanna—Questions. Oral Answers. - Prize Bonds Scheme.
Ceisteanna—Questions. Oral Answers. - Customs and Excise Revenue.
Ceisteanna—Questions. Oral Answers. - Beer and Spirits for Home Consumption.
Ceisteanna—Questions. Oral Answers. - Kerry Minor Employment and Rural Improvement Schemes.
Ceisteanna—Questions. Oral Answers. - Nuclear Disarmament.
Ceisteanna—Questions. Oral Answers. - Bovine T.B. Eradication Scheme.
Ceisteanna—Questions. Oral Answers. - Acquisition of Kildare Lands.
Ceisteanna—Questions. Oral Answers. - Purchase of Farms.
Ceisteanna—Questions. Oral Answers. - Acquisition of Land in Offaly.
Ceisteanna—Questions. Oral Answers. - Payment for Tipperary Land.
Ceisteanna—Questions. Oral Answers. - Limerick Housing Scheme.
Ceisteanna—Questions. Oral Answers. - Cost of Agricultural Grants.
Ceisteanna—Questions. Oral Answers. - Radio Éireann Talk on Handknitting Industry.
Ceisteanna—Questions. Oral Answers. - Letterkenny Postal Deliveries.
Ceisteanna—Questions. Oral Answers. - Churchtown (Dublin) District Post Office.
C.I.E. Stock Issue. - Statement by Minister for Industry and Commerce.
C.I.E. Stock Issue. - Order of Business.
Private Business. - Institution of Civil Engineers of Ireland (Charter Amendment) Bill, 1959: Report from Examiner of Private Bills.
Public Business. - Local Government Bill, 1959—First Stage.
Public Business. - Road Fund (Grants and Advances) (Temporary Provisions) Bill, 1959—First Stage.
Public Business. - Estimates for Public Services 1959-60.
Committee on Finance. - Vote 57—Defence (Resumed).
Committee on Finance. - Vote 58—Army Pensions.
Committee on Finance. - Defence Forces (Pensions) (Amendment) Scheme, 1959—Motion of Confirmation.
Committee on Finance. - Estimates for Public Services, 1959-60.
Committee on Finance. - Vote 64—Health.
Written Answers. - Six and Seven Days' Licensed Premises.
 Do chuaigh an Ceann Comhairle i gceannas ar 3 p.m.
Mr. Russell: asked the Minister for Industry and Commerce if he will state this country's attitude to the Swedish proposals for a smaller free trade area.
Sir Anthony Esmonde: asked the Minister for Industry and Commerce if he has noted that fresh discussions relative to the free trade area have been initiated by Sweden to cover the United Kingdom, the Scandinavian countries, Switzerland, Austria and Portugal; and whether Ireland is privy to such consultations so that no agreement may be reached by this block of seven nations without our interests being considered.
Minister for Industry and Commerce (Mr. S. Lemass): With the permission of the Ceann Comhairle, I propose to take Questions 1 and 2 together.
The aim of the discussions on the establishment of a European Free Trade Area, which were conducted under the auspices of the OEEC, was to secure a multilateral agreement for associating the other OEEC countries, including Ireland, with the European Economic Community.
The Government participated fully in these discussions, firstly because Ireland is a member of OEEC and also because we considered that Ireland should support the efforts being made to prevent the trade divisions  which threatened to arise in Europe if the European Economic Community were not associated with the other OEEC countries on a basis acceptable to all seventeen members.
Although the negotations for the establishment of a European Free Trade Area have been suspended, it cannot be said that the idea of a multilateral arrangement between the countries concerned has yet been abandoned. An arrangement on those lines would be more favourable from the point of view of this country than any alternative likely to emerge, such as the creation of separate trading blocs in Western Europe. Accordingly, our attitude since the suspension of the Paris negotiations has been governed by a desire not to engage in any action which might prejudice work towards the eventual conclusion of a multilateral agreement between all OEEC countries.
Among developments which have taken place since the suspension of the Free Trade Area negotiations last December are the discussions between a number of other countries (including Britain) outside the European Economic Community on the possibility of establishing a free trade area comprising certain countries outside the Community. These discussions were not carried out under the auspices of OEEC and the Government have insufficient information on the progress of the discussions on the proposals reported to have been put forward by Swedish interests and on the attitude of Governments towards them. One of the purposes of my forthcoming talk with the British Paymaster General is to clarify the status of these proposals and to discuss their possible effects on future trading relationships between the two countries.
Mr. Norton: Will the Minister say whether this country was invited to participate in the discussions, apparently initiated by the Swedish Government, or whether it was intimated to the conveners of the talks that we did not desire to participate?
Mr. S. Lemass: I have stated that our attitude in relation to these talks  has been prompted by the conclusion that the best interests of this country are to be served by a multilateral agreement covering all O.E.E.C. countries. We have not participated in any action which might prejudice or delay the emergence of such an agreement.
Mr. Norton: Arising out of what the Minister has now said, the British Paymaster-General has been intimating that so far as Britain is concerned, she desires an inclusive trade agreement covering all of Europe, but, presumably, the British participation in the Swedish talks has not been in any way with the object of frustrating a more comprehensive agreement. I take it therefore that equally our participation would have nothing to do with frustrating the possibility of arriving at a comprehensive settlement between all O.E.E.C. countries. I take it these countries sent representatives as a result of an invitation—they did not all just arrive there out of some sort of feeling that they would all meet. I take it invitations were issued. Did we get an invitation or an intimation of the meeting beforehand?
Mr. S. Lemass: I do not know if invitations were issued; certainly, we received no invitation. There is considerable doubt as to the status of these proposals. It is not yet clear that they have been considered at Cabinet level by any of the countries concerned.
Mr. Cosgrave: Have the Paris talks been suspended indefinitely or is there an arrangement to reconvene the meeting?
Mr. S. Lemass: In December last, the arrangement was to reconvene the Council of O.E.E.C. in January. That meeting did not take place and there is no information as to when it may take place.
Mr. Sweetman: Does the Minister not consider, now that the Common Market is in existence, that the multilateral agreement to which he referred will more than likely arise out of the amalgamation of smaller agreements rather than that those outside the  Common Market will all join in a multilateral agreement at a later stage?
Mr. S. Lemass: I should not like to express a view on that at this stage.
Mr. Sweetman: Will the Minister not agree that it is a view that should be kept in mind, at any rate?
Mr. Norton: Could the Minister say if he has any information as to whether the discussions initiated by the Swedish Government, and now taking place, are confined to free trade in the industrial field and whether they include free trade arrangements in which agriculture will also be included?
Mr. S. Lemass: No definitive statement on the proposals has been published, so far as I know, but the information available to us suggests they relate only to the industrial field.
Mr. Russell: asked the Minister for Industry and Commerce if he will state the form of financial assistance which he recently granted to a Wicklow industry.
Mr. S. Lemass: For reasons which the Deputy will, no doubt, appreciate, it is not the practice to disclose information relating to the activities and intentions of private commercial concerns. However, it can be stated that an application from the company mentioned in the Question for a guarantee under the Trade Loans (Guarantee) Acts, 1939-1954, has been approved.
Mr. Russell: asked the Minister for Industry and Commerce if he will state the number of proposals for new industrial undertakings in Limerick city which came before his Department during 1957 and 1958.
Mr. S. Lemass: Four proposals for the establishment of new industrial concerns or the extension of existing concerns in Limerick City came to  notice in the years 1957 and 1958.
Mr. Larkin: asked the Minister for Industry and Commerce if he will state in respect of each of the following, viz. Electricity Supply Board, Córas Iompair Éireann and Bord na Móna (a) the statute under which it  was established, and (b) the names of the present members of the Board, the date of their appointment, their term of office, and the amount of remuneration payable to each.
Mr. S. Lemass: As the reply is in the form of a tabular statement I propose, with the permission of An Ceann Comhairle, to have it circulated with the Official Report.
|Name of Body||Statute under which established||Names of Present Members||Date of Present Appointment||Present Term of Office||Annual Rate of Remuneration at present|
|Electricity Supply Board||Electricity (Supply) Act, 1927||R.F. Browne, Chairman||1st May, 1957||Three years||£4,200|
|H. Kennedy||do.||Five years||£500|
|Córas Iompair Éireann||Transport Act, 1950||Dr. C.S. Andrews, Chairman||1st September, 1958||Five years||£4,500|
|Bord na Móna||Turf Development Act, 1946||R.C. Barton, Chairman||21st June, 1956||Four years||£750|
|D.C. Lawlor, Managing Director||5th September, 1958||Five years||£3,500|
|A. O'Rahilly||21st June, 1956||Three years||£500|
|A. Woods||21st June, 1957||Five years||£500|
|Dr. T.S. Wheeler||21st June, 1958||do.||£500|
|P.P. Wilkinson||21st June, 1956||do.||£500|
|W. Sweeney||21st June, 1956||do.||£500|
Mr. Coburn: asked the Minister for Industry and Commerce whether ex-employees of the Great Northern Railway Works, Dundalk, who take up employment elsewhere, will be entitled to compensatory sums if they are not recalled to employment by Dundalk Engineering Works; what is the expected date of the announcement of the names of those who will be entitled to compensatory lump sums for loss of employment with Dundalk Engineering Works; and when the development work in the latter works will be completed.
Mr. S. Lemass: The eligibility for severance pay of a redundant worker of the Dundalk Engineering Works will not be affected by his acceptance of employment elsewhere. I am not in a position to give the other information sought by the Deputy.
Mr. O'Donnell: asked the Minister for Industry and Commerce if in view of the fact that Rosses Stone Company have now decided to set up an industry in Fintown, County Donegal, the Electricity Supply Board will now supply rural electrification to the Fintown area.
Mr. S. Lemass: I am informed by the Electricity Supply Board that the Fintown rural area will be reconsidered by the Board in the early  future and the additional fixed charge revenue likely to be derived from a proposed industry will be taken into account in calculating the returns for the area.
Mr. Russell: asked the Minister for Health when he proposes to introduce the necessary legislation to provide for the setting up of joint health areas.
Minister for Health (Mr. MacEntee): I cannot say definitely when this legislation may be introduced but I hope to be in a position to introduce it after the Summer Recess.
Mr. S. Brady: asked the Minister for Health if he will state the present position regarding the Garden of Remembrance.
Mr. MacEntee: The temporary hospital units occupying the site of the proposed Garden of Remembrance are at present being removed. The Rotunda Hospital Authorities should therefore be in a position to hand over the vacated site to the Commissioners of Public Works not later than the end of June.
It has been ascertained that the Commissioners of Public Works hope to invite tenders within the next few weeks for work on laying out the Garden.
Mr. Larkin: asked the Minister for Social Welfare if he will state the cost in the current year of the increases announced in the Budget in respect of (a) old age pensions, (b) widows' pensions and (c) unemployment assistance.
Parliamentary Secretary to the Minister for Social Welfare (Mr. Kennedy): The estimated costs in the current financial year of the increased social assistance payments announced by the  Minister for Finance in his Budget statement are as follows:—
|(a) Old age pensions||£694,500|
|(b) Widows' (Non-contributory) pensions||£108,500|
|(c) Unemployment assistance||£57,000|
Dr. Browne: asked the Minister for Finance if in view of the success of the Prize Bonds scheme, and in order to facilitate participation by persons who cannot afford £5 for a bond, he will extend the scheme by making available bonds priced at £1 each.
Minister for Finance (Dr. Ryan): Having regard to the terms and conditions on which Prize Bonds have been issued, it would not be possible to extend the existing scheme to include £1 as well as £5 units.
The provision of £1 units would require a new series of Prize Bonds with a commensurate scale of prizes. The administrative cost of such a second series would not, it is considered, be justified by the likely volume of support it would receive.
I may add that, under the existing scheme, it is possible for two persons jointly, or for any number of persons to form themselves into an association, to purchase a single bond, thus enabling a person who can invest only a smaller sum than £5 to do so.
Mr. Larkin: asked the Minister for Finance if he will state the estimated customs and/or excise revenue from (a) tobacco, (b) petrol and oil, (c) beer, (d) spirits and (e) motor cars, etc., for 1959-60.
Dr. Ryan: The answer is in the form of a tabular statement which, with the permission of the Ceann Comhairle, I propose to circulate with the Official Report.
Following is the statement:—
|Head of Duty||Estimated revenue for 1959-60||Total|
|Mineral Hydro-carbon Light Oil (ii) (iii)||11,300,000||—||11,300,000|
|Hydrocarbon Oil, Other Sorts (iii)||1,925,000||4,000||1,929,000|
|Motor Vehicles and parts||2,340,000 (iv)||340,000 (v)||2,680,000|
(i) Includes an amount of £100,000 as the approximate yield of the additional duty of 2½d. per lb. of leaf tobacco effectively payable only by manufacturers taking advantage of the optional scheme for deferment of payment of tobacco duty, operative from the 1st May, 1959 and particulars of which were given in the Financial Statement of the Minister for Finance on the 15th April, 1959.
(ii) The revenue from petrol is not separately recorded, but is included under the heading “Mineral Hydrocarbon Light Oil”. Approximately 99% of the receipts under this heading are derived from petrol.
(iii) At present the whole of the revenue from petrol and almost all the revenue from other oils comes from the customs duties and the estimated revenue is shown for convenience on that basis. When supplies from the new refinery at Whitegate become available excise revenue will gradually replace customs revenue in the case of these items.
(iv) The estimated customs revenue includes £2,050,000 from motor vehicles and parts liable to duty at Reference Number 154 of the Customs & Excise Tariff, £270,000 from Special Import Levies on vehicles and parts, and £20,000 from parts coming under separate protective duties, viz. Tariff Reference Numbers 1 (Accumulators), 12/1 (Axles & Springs), 161/2 (Number Plates), 180/5 (Power-take-off units, etc.), 206 (Sparking Plugs), 207/1 (Sparking Plug Parts), 228/1 (Coil Springs) and 264/2 (Windscreens).
(v) Revenue from the excise duty on motor vehicle tyres.
Mr. Larkin: asked the Minister for Finance if he will state the quantities of beer and spirits retained  for home consumption in the financial years 1958 and 1959.
Dr. Ryan: I propose, with the permission of the Ceann Comhairle, to circulate with the Official Report a tabular statement giving the required information.
Following is the statement:—
NET duty-paid quantities retained for home consumption.
|Year ended 31st March|
|Standard Barrels||Standard Barrels|
|Proof Gallons||Proof Gallons|
Mr. Moloney: asked the Minister for Finance if he will state (1) the number of (a) minor employment and (b) rural improvement schemes carried out in County Kerry in each of the past five financial years in respect of each rural and urban district, (2) the total amount of expenditure for each year on each category of these schemes, and (3) the average number of men employed per week during the period of operation of such schemes.
Parliamentary Secretary to the Minister for Finance (Mr. Bartley): As the reply contains a number of tabular statements I propose with the permission of the Ceann Comhairle to have it circulated with the official report.
Following is the statement:—
1 (a).—Numbers and amounts of Minor Employment Schemes allocated in County Kerry:—
|Overheads (Holiday Pay, Workman's Compensation, Insurance, etc.)||1,428||1,163||1,094||1,157||1,199|
1 (b).—Numbers and amounts of Rural Improvements Schemes allocated in County Kerry:—
The above figures include overheads.
NOTE.—No Minor Employment Schemes or Rural Improvement Schemes are carried out in urban areas.
2.—Expenditure figures are available only for the County as a whole and are as follows:—
|Year||Minor Employment Schemes||Rural Improvement Schemes|
NOTE.—Due to the normal time-lag in carrying out schemes the expenditure figures shown above do not coincide with the total amounts allocated in the same years, as given in the tables at Section (1).
3.—The average number of men employed per week is also available only for the County as a whole and the figures for each year are as follows:—
|Year||Minor Employment Schemes||Rural Improvement Schemes|
NOTE.—Minor Employment Schemes are in operation only in the period November to March inclusive each year and the above averages relate to that period. Rural Improvements Schemes are in operation throughout the year.
Mr. Donnellan: I am sure Kerry will get their share anyhow.
Dr. Browne: asked the Minister for External Affairs whether the Irish proposals for nuclear disarmament made recently at the United Nations General Assembly and to which he referred recently were withdrawn after only one preambular paragraph had been voted upon; and, if so, if he will indicate why the Assembly was not afforded an opportunity of voting on the resolution as a whole.
Minister for External Affairs (Mr. Aiken): After the paragraph in the resolution which recognised the danger of the further dissemination of nuclear weapons had been adopted by thirty-seven votes to nil, with forty-four abstentions, I decided to withdraw the resolution to which the Deputy refers, for the reasons indicated in my speech in the General Assembly on 4th November, 1958. These reasons were briefly as follows:—
First, because the primary purpose of our initiative had been attained by the vote which recognised the danger of disseminating nuclear weapons; secondly, because, having secured the adoption of this principle, it would have been wrong to create an artificial division by forcing a vote on a mere question of machinery—that of how the matter should be further studied and reported on; thirdly, because a new Disarmament Commission had been established which could deal with the proposals; and, fourthly, because I felt that many Governments had not had time to study the proposals fully and there was thus a danger of their voting against them, and so compromising the prospects of final agreement, if the resolution as a whole had there and then been put to a vote.
Dr. Browne: Would the Minister have been permitted by protocol to leave the resolution there until Governments had had an opportunity of considering the implications of it?
Mr. Aiken: There is nothing to prevent the matter being put on the Agenda for the coming session.
Dr. Browne: Is it proposed to put the resolution on the Agenda?
Mr. Aiken: I certainly have it in mind to do so.
Mr. Moher: asked the Minister for Agriculture if he will state (a) the total cost to the last accounting date of the bovine tuberculosis eradication scheme in (i) all areas, (ii) the western clearance area, (iii) Cavan, Monaghan and Longford, (iv) the Leinster counties, excluding Counties Kilkenny and Longford and (v) the Munster counties with Kilkenny and excluding Clare, (b) the overall average price paid per cow and the average loss per cow on sale to factories, (c) the total fees paid to veterinary practitioners for official tuberculosis testing in the areas mentioned, and the number of veterinary practitioners operating the scheme in areas (ii), (iii), (iv) and (v), (d) the number of reactors identified in each area and the average time lag between identification and removal in each area, (e) what percentage of reactors identified in Cork and Limerick over the past twelve months have been removed since identification, (f) whether every ear tag on animals exported as 14-day tested cattle is directly relatable to the veterinary practitioner who made the test, and (g) in respect of how many animals exported as 14-day tested cattle complaints have been received from the British authorities; if such complaints have been received, whether the information available indicates insufficient care in testing on the part of particular veterinary practitioners; and, if so, how many veterinary practitioners are involved; and what action, if any, has been taken.
Minister for Agriculture (Mr. Smith): As the reply is of a very lengthy nature, I propose, with your permission, a Cheann Comhairle, to have it furnished in the Official Report.
The following is the statement:—
(a) The total cost, excluding administrative expenses, of the Scheme in all areas to 31st March, 1959, was £4,183,040. Particulars as to the cost in the individual areas mentioned are  not readily available and the expense and official time which would be involved in their compilation would not, in my opinion, be justified.
(b) The average price paid for cow reactors purchased by my Department to 31st March, 1959, is £39 16s. 2d., and the average loss £12 14s. 10d.
(c) The total fees paid to veterinary practitioners in all areas to 31st March, 1959, amounted to £1,081,791. Particulars as to the aggregate fees paid to veterinary practitioners in the other areas mentioned are not readily available and the expense and official time which would be involved in their compilation would not, in my opinion be justified.
The number of veterinary practitioners operating as principals in the areas mentioned are:—
(ii)—114, (iii)—44, (iv)—153, (v)—219.
Some of these practitioners operate in more than one area.
(d) The number of cow reactors identified in each area mentioned is:—
(i)—236,050, (ii)—56,866, (iii)—6,600, (iv)—21,669, (v)—150,915.
In the Clearance Area where the eradication measures are compulsory, the average time lag in the case of reactors taken up by my Department is approximately three to four weeks. In the other areas the Scheme is still on a voluntary basis and the herd-owner suits himself as to the time of removal.
(e) As the Scheme is on a voluntary basis in Cork and Limerick, my Department has no information as to the percentage of the reactors which may have been removed privately by herd-owners. The number of cow reactors taken up by my Department over the past twelve months is not significant.
(f) The answer is “Yes”.
(g) Since the 14-day test arrangement in connection with the export of cattle came into operation in 1953, close liaison has been maintained with the British authorities and where a  retest in Britain shows an unduly high incidence the matter is reported to my Department and is investigated. Where there has been an irregularity on the part of a practitioner suitable action is taken by my Department including, if appropriate, the withdrawal of authority to carry out the 14-day test. Such authority has already been withdrawn in one case and others are presently under investigation..
Mr. Norton: asked the Minister for Lands what lands, if any, in the vicinity of Sallins, County Kildare, have been acquired by the Land Commission for division; whether proceedings are in progress for the acquisition of any lands in the area; and, if so, if he will state the name and the location of the lands in question.
Minister for Lands (Mr. Childers): In this district, the lands on hands aggregate to 380 acres in the townlands of Turnings Upper, Eadestown, Mullacash Middle and Clane, on the Mills, Shiels, O'Connor and O'Neill properties. Proceedings are in progress for two other estates, namely H.T. O'Neill estate, Clane, and Malone Estate, Fleshtown.
The special effort to dispose of lands on hands in Kildare, as elsewhere, is continuing. During the past two financial years, a total area of 2,777 acres was allotted in Kildare, and a further 538 acres were allotted last month.
Mr. Norton: May I take it from the Minister's reply that there are no proposals on hands for the acquisition of lands in Sallins?
Mr. Childers: The question refers to the district of Sallins. If the Deputy reads the reply, I think he will find all the information there.
Mr. Norton: It is a pretty long walk from some of the places mentioned to Sallins.
Mr. MacEntee: A walk might do the Deputy good.
Mr. Norton: The Minister could not be allowed out for a walk without a keeper.
Mr. Donnellan: asked the Minister for Lands whether in view of the increase in the purchase of large farms by foreigners and by persons not interested in farming such lands to maximum production, and the discontent felt by uneconomic landholders who cannot get adequately sized holdings, steps will be taken to enable the Land Commission to purchase speedily any farms offered for sale which would be suitable for settling thereon agricultural families and for the relief of local congestion, with particular reference to the lands, now for sale, of Lochpark Farm owned by Lady Cusack Smith.
Mr. Childers: The reports of large scale purchases by aliens are without foundation and are largely spread by sensational Sunday newspapers.
With a single exception no specific complaints have been made to the Land Commission and I would ask Deputies to inform their constituents that no conditions have arisen which would necessitate any special action.
I would refer the Deputy to the Taoiseach's reply of 21st November, 1957, and my reply of 25th February, 1959, to questions about the purchase of lands by non-nationals. As the Deputy is aware, the Land Commission have wide acquisition powers. It has been the policy to acquire suitable lands, from non-nationals as well as nationals, where the lands are not giving adequate production and employment, and are required for the relief of congestion.
This policy continues unchanged and every effort is being made to expedite the investigation of all suitable lands coming to the notice of the Land Commission, including the lands in question.
Mr. Donnellan: The Minister states the policy is unchanged and that it has been the policy for a long time. Does the Minister not accept my view that the policy should be changed and that it is time it was changed? The lands in question have been purchased by a foreigner. Does the Minister not think it is time that that policy should be abolished and the Land Commission  should take over the lands for the relief of about 40 congests in that area?
Mr. Childers: I have just informed the Deputy that the matter is being considered.
Mr. Donnellan: What?
An Ceann Comhairle: Question No. 19.
Mr. Donnellan: Just a moment, Sir. I want a reply to my question.
An Ceann Comhairle: I am doubtful that it is a question.
Mr. Donnellan: You put it on the Order Paper.
An Ceann Comhairle: I am speaking of the Deputy's Supplementary Question.
Mr. Donnellan: We shall hear more about this, of course. It will be like Banagher.
Mr. K.P. Egan: asked the Minister for Lands if he will state for the years 1956/57, 1957/58 and 1958/59 the total area of land acquired by the Land Commission in County Offaly, and the total area allotted.
Mr. Childers: The total area taken over by the Land Commission in County Offaly in each of the three financial years mentioned was 1,165 acres, 694 acres and 2,488 acres respectively. The total area allotted in each of the three years was 220 acres, 269 acres and 1,682 acres respectively. There will be no avoidable delay in the disposal of lands on hands in the county.
Mr. Beirne: Will the Minister segregate these figures and let us know how much of the land is bog?
Mr. Childers: If the Deputy puts down another question, a reply will be given.
Mr. Beirne: Most of it must be bog.
Mr. Tierney: asked the Minister for Lands why Mr. W. Maher, Richmond, Templemore, County Tipperary,  has not got payment for land which was taken over by his Department some years ago; and when payment will be made.
Mr. Childers: Allocation of purchase money in this case will be put in hands when rulings on title issued by the Examiner have been discharged on behalf of owner. The Land Commission are not responsible for any delay in this matter which, it is understood, is being expedited.
Mr. Tierney: That means that something is not in order. My information is that everything has been in order so far as his part is concerned and he has been waiting for the past two years.
Mr. Childers: The Deputy should make further inquiries. My information is that this is not a matter for the Land Commission. I understand the matter is now being expedited, not by the Land Commission, but by the representatives of the owners.
Mr. Tierney: Would the Minister say when the land was taken over?
Mr. Childers: The estate was compulsorily acquired. I have not got the particulars with me.
Mr. Tierney: Is it not a fact that the land has been acquired for some years?
Mr. Childers: Yes, it is a fact.
Mr. Tierney: At various stages, this man has made application for payment but payment has not been made.
Mr. Russell: asked the Minister for Local Government if he has received proposals for a housing scheme at Carey's Road, Limerick; and when he hopes to give a decision in the matter.
Minister for Local Government (Mr. Blaney): Revised plans for a scheme of 78 houses at Upper Carey's Road were received in my Department from Limerick Corporation on the 7th instant. The Corporation were informed on the 14th instant that the plans were  generally in order but they were also advised to give careful consideration to certain aspects of the plans which appeared likely to have an adverse effect on the efforts to secure substantial economies in the cost of the scheme.
Mr. Moloney: asked the Minister for Local Government if he will state the total cost to the Exchequer each year over the past ten years of the payment of agricultural grants under the Rates on Agricultural Land (Relief) Acts, 1939 to 1956.
Mr. Blaney: As the reply is in the form of a tabular statement, I propose, with your permission, A Cheann Comhairle, to circulate it with the Official Report.
Following is the statement:—
|Year ended 31st March||Amount of Agricultural Grant|
Mr. O'Donnell: asked the Minister for Posts and Telegraphs if he is aware that during the course of a topical talk from Radio Éireann at 1.40 p.m. on 5th May, 1959, on the subject of the handknitting industry there was an advertisement for one particular Donegal firm, and that grave resentment is felt as a result by other Donegal handknitting industrials; and, if so, if he will ensure that such talks are not so used to the benefit of one manufacturer over that of his competitors.
Minister for Posts and Telegraphs (Mr. Ormonde): I understand that the Topical Talk to which the Deputy  refers was specifically concerned with hand-knitting in Ardara, as an example of what is going on in other parts of the county also. Whilst it would certainly be undesirable in a broadcast of this kind to advertise an individual firm, it does not seem likely that the mention of one family in this talk could be taken to constitute an advertisement or to be injurious to the interests of other people engaged in the handknitting industry.
Mr. O'Donnell: asked the Minister for Posts and Telegraphs if he is aware that postal delivery takes place in the town of Letterkenny between 7 a.m. and 8 a.m. before business premises open, and again between 1 p.m. and 2 p.m. when business premises are closed for lunch; and that if the deliveries include registered letters or packets, these are returned to the post office by the delivering postman, and will be handed out to addressees only on being called for and on payment of 3d. per letter or registered packet; and, if so, if he will take immediate steps to have this unsatisfactory state of affairs rectified, and to discontinue the disruption of the business routine of the townspeople.
Mr. Ormonde: The Deputy appears to have been misinformed about the times of postal deliveries in Letterkenny. The first delivery occupies from 7.30 a.m. to 10 a.m. and the second from 1.15 p.m. to 3.30 p.m. When a registered or other item not deliverable into a letter box cannot be disposed of on a delivery, the Postman concerned leaves a form of notification to that effect with a request that someone be in attendance to accept the item on the next delivery. Alternatively, the item may be collected at the Post Office on payment of the usual fee of 3d.
There are no exceptional features in these arrangements. I am unable to agree that they are unsatisfactory or harmful to the interests of the local business community and am not aware of any general desire amongst any particular section of the townspeople for their revision.
Mr. Norton: asked the Minister for Posts and Telegraphs what is the cause of the delay in erecting a new district post office at Churchtown, Dublin; and when the work on the new office will commence.
Mr. Ormonde: A contract for the erection of a new District Sorting Office at Churchtown is being arranged at present and it is hoped building operations will be commenced in the near future.
Mr. Norton: Do I take it that the contract has been accepted?
Mr. Ormonde: It has actually been accepted, yes.
Mr. Norton: The contractor is prepared to sign the contract?
Mr. Ormonde: Yes.
Minister for Industry and Commerce (Mr. S. Lemass): I wish to inform the House that a new Transport Stock issue by C.I.E. will open for subscription on Monday next, the 25th May. This stock, in common with previous Transport Stock issues, will be guaranteed as to principal and interest by the Minister for Finance.
The issue will be for £3,000,000 of which the Minister for Finance is taking up £500,000 for Departmental Funds. The balance of £2,500,000 will be available for subscription by the public and will be fully underwritten by the Irish banks. The rate of interest will be 5 per cent. per annum on the nominal value and the issue price £96 for each £100 stock purchased. The yield to final redemption date is £5 7s 7d. The stock will be redeemed at par not later than 1975 and may be redeemed any time from 30th June, 1970. Investors who hold their stock to redemption stand to make a capital gain of £4 for every £100 of stock which will be tax free to the ordinary investor. The purchase price may be paid in instalments but investors who wish to pay in advance of the due dates will be entitled to a discount. Interest will be paid without deduction of income tax, though, of course, assessable to tax in the hands of recipients.
The objects of the stock issue are to provide C.I.E. with capital required for the provision of additional diesel  locomotives, rolling stock, road transport vehicles, the acquisition of new plant and machinery, and equipment including containers, for the mechanical handling of goods; the improvement and extension of buildings and for other purposes properly chargeable to capital. The new diesel locomotives and rolling stock to be financed out of the new Stock issue will enable C.I.E. to extend the operation of services by diesel traction on the former G.N.R. lines and to replace the obsolete rolling stock on these lines with modern stock. This should result in substantial economies to C.I.E.
The success of the C.I.E. drive to attract new business depends on the provision of efficient services and modern facilities. The capital now being sought is necessary for the provision of an up-to-date efficient and self-supporting public transport system. There is no need for me to stress the importance of such a transport system in the national interest. Subscribers to the new stock can, therefore, rest assured that they are contributing to the economic development of the country while at the same time enjoying an attractive return on their capital in a safe investment.
I confidently ask for the full and active support of every Deputy for the issue.
Mr. Sweetman: On behalf of the Fine Gael Party, I should like to support the appeal which the Minister has made. To all intents and purposes, this stock is a Government issue inasmuch as it is guaranteed, both as regards principal and interest, by the resources of the State. Having regard to that, the issue price of 96 for a stock bearing five per cent. interest is, in present circumstances, generous, and I hope that it will appeal. We have always been in favour of productive capital investment by the State and from what the Minister has just said, it appears that this forms part of that pattern and we support it.
Mr. Norton: I should like to support the appeal which the Minister has made for a generous public response to this appeal for funds to enable C.I.E.  to carry out further schemes of capital development. As he rightly said, C.I.E. can succeed in paying their way only by the provision of efficient and attractive services. I am glad to see and to say that C.I.E. are at present doing their best in that field. Some new developments indicate that imagination has been stirred at top level and that an effort is being made to woo the public back to the railways and in particular to woo freight back to the railways.
This House has set C.I.E. a very stiff and stern task. It is the job of this House so to help C.I.E. finances as to enable them to raise the necessary capital for the worthwhile schemes of capital development which are ahead. The proposed stock issue offers very attractive terms to investors and, at the same time, it will enable a very valuable national concern, employing close on 20,000 persons, not only to retain these people in employment but also to ensure that their employment is of a permanent and regular nature. I hope, therefore, that according to their resources, all sections of the community will subscribe as generously as possible to the issue.
An Tánaiste: It is proposed to take business in the following order; Nos. 1, 2, 3, 12—Votes 57 and 58—and 4 and then back to No. 12—Votes 64 and 65. It is not proposed to interrupt Public Business to take Private Members' Business.
Mr. Norton: Last week, we were told that the Minister for Industry and Commerce was anxious to have his Estimate taken this week. With that co-operation which is so characteristic of the Opposition, we decided to facilitate him in the matter before he takes up his new appointment. Yesterday, quite suddenly, without any explanation we were told there had been a change and that the Minister would not be ready until after 27th May. That is all right, but I certainly think somebody ought to be consulted when a thing like that happens. I understand the Minister has to go away.
An Tánaiste: I regret any inconvenience that may have been caused  by the change, but it is due to the fact that, as Deputies are aware, it will not be possible for me to be here on Tuesday next and it was felt that it would be undesirable to take the Estimate to-day and then to have to interpose some other Estimate at that stage. I would indeed be anxious to get the Estimate for the Department of industry and Commerce fairly soon and I hope it will be possible to do so next week.
Mr. Norton: Do we take it on Wednesday of next week? There is no sitting on Thursday next.
An Tánaiste: The intention will be to take it on Wednesday, but whatever Estimate is under discussion on to-morrow evening, will continue until it has been completed. In other words, I do not think we should interrupt the discussion on some other Estimate to bring in the Estimate for the Department of Industry and Commerce. Assuming that position can be arranged, the Estimate for the Department of Industry and Commerce will be taken on Wednesday next.
Mr. Norton: But if another Estimate is under consideration, it will fall behind the other Estimate?
An Tánaiste: That would be so. In other words, the Estimate for the Department of Industry and Commerce will not be taken after Questions. It will be taken after the discussion on whatever business is then in progress.
Mr. Norton: The Health Estimate is before it.
An Tánaiste: That will be starting to-day.
Mr. Norton: That might not finish for a month.
An Tánaiste: Do not be so pessimistic.
Mr. Sweetman: Am I to take it that the Estimates will be taken according to the order in which they appear on the Order Paper, subject to the Tánaiste being away for the Estimate for the Department of Industry and Commerce?
An Tánaiste: If the Health Estimate should finish by to-morrow, or Tuesday, I think we will put in the Estimate for the Board of Works to keep business going.
Mr. Sweetman: Are we not taking the Estimate for Social Welfare after the Health Estimate.?
An Tánaiste: No. I gather there is a request from the Labour Party to postpone it.
Mr. Norton: Social Welfare will be all right for next week, but, before finalising this arrangement, I suggest we might have another talk about the order of these Estimates.
An Tánaiste: That can be arranged.
Mr. Sweetman: Is it intended to put Public Works before Posts and Telegraphs?
An Tánaiste: Yes.
Report from the Examiner of Private Bills that, in the case of the application for leave to introduce the Institution of Civil Engineers of Ireland (Charter Amendment) Bill, 1959, proof of publication as required by the resolution of Dáil Éireann of the 11th March, 1959, has now been given.
An Leas-Cheann Comhairle: I move:—
That the Report do lie upon the Table.
Mr. Sweetman: What happens to it now?
An Tánaiste: It lies on the Table, I suppose.
General Mulcahy: It will be left until the week after next.
An Leas-Cheann Comhairle: On a similar Report being made to the Seanad, the Bill will be deemed to be read a First Time in that House.
 Agreed and ordered accordingly.
Leave granted to introduce a Bill entitled an Act to repeal in part subsection (4) of section 52 of the Local Government Act, 1946, and to amend the Athlone Bridge Order, 1956.— (Minister for Local Government.)
Mr. Sweetman: When will it be circulated?
Mr. Blaney: Almost immediately.
General Mulcahy: Will it take precedence over the Estimate for the Department of Industry and Commerce?
An Tánaiste: I do not think so.
Second Stage ordered for Wednesday, 27th May, 1959.
Leave granted to introduce a Bill entitled an Act to make temporary provisions for grants and advances to the Road Fund.—(Minister for Local Government.)
Mr. Sweetman: Is this necessary to complete the announcement already made?
Mr. Blaney: Yes.
Mr. Sweetman: There is nothing new in it?
Mr. Blaney: No.
Second Stage ordered for Wednesday, 27th May, 1959.
The Dáil, according to order, went into Committee on Finance and resumed consideration of Estimates for Public Services for the year ending 31st March, 1960.
D'athógadh an diospóireacht ar an dtairiscint seo a leanas:
 Go ndeonfar suim nach mó ná £4,482,600 chun slánaithe na suime is gá chun ioctha an mhuirir a thiocfaidh chun bheith iníoctha i rith na bliana dar críoch an 31ú lá de Mhárta, 1960, chun Oglaigh na hÉireann (lena n-áiritear Deontais-i-gCabhair áirithe) faoin Acht Cosanta, 1954 (Uimh. 18 de 1954), agus chun Costas áirithe riaracháin i ndáil leis an gcéanna; chun Costas áirithe faoi na hAchtanna um Chiontaí in aghaidh an Stáit, 1939 agus 1940 (Uimh. 13 de 1939 agus Uimh. 2 de 1940), agus faoi na hAchtanna um Réamhchúram in aghaidh Aer-Ruathar, 1939 agus 1946 (Uimh. 21 de 1939 agus Uimh. 28 de 1946); chun Costas i ndáil le Boinn a thabhairt amach, etc.; agus chun Deontais-i-gCabhair do Chumann Croise Deirge na hÉireann (Uimh. 32 de 1938).
Mr. K. Boland: I was dealing with the question of civil defence and I had expressed my appreciation of the manner in which Deputies had approached that problem. If we can accept the general sense of urgency with regard to this matter and the general appreciation of the importance of civil defence evidenced in the speeches of Deputies as an indication of the results of the recent efforts of my Department to arouse interest in the subject, we can take it that those efforts have been very successful. I hope that the same interest has been aroused amongst local representatives generally and that it will be translated down to the people throughout the country because it is one of the greatest difficulties to get the ordinary people to appreciate the importance of civil defence.
Deputy Vivion de Valera dealt with many of the organisational aspects of civil defence and I can assure him that all the points he raised have already been incorporated in the basic studies of this problem in the civil defence section of the Department of Defence. The question of getting the required technical assistance for civil defence is being worked out in my Department, and it will be possible to secure much of this through the help of technical  officers who are already in the public service, both central and local, but where it appears to be necessary steps will be taken to try to secure the assistance of experts outside the public service. I would appreciate the assistance of Deputies generally in bringing home the importance of this subject to the people generally.
I think I should refer to the criticism by Deputy O.J. Flanagan of the size of the Estimate for the Department of Defence. I cannot agree with him that it is a huge amount, or a huge proportion of our overall expenditure. In fact, I should say that most countries of our size, or smaller, are spending a greater amount on defence than we are. Deputy O.J. Flanagan suggested that the Army was of little or no value to the taxpayer, and seemed to throw doubts as to whether there is justification for our having a defence force here or not. As far as the Government are concerned, we believe that if we do not show our determination to defend the country to the best of our ability—if we do not make reasonable provision for that and if instead we leave what amounts to a military vacuum here—others obviously will come in and do that for us. No country that values its independence would take that attitude.
I am aware that there are people who would like to see the British Army back here and I think it is time for people like Deputy O.J. Flanagan who talk like that, to say definitely if that is what they desire to have here or not. It is also time for his Party to set out their position with regard to that, to set it out definitely, and state whether or not they back him in that viewpoint.
I did promise Deputy O'Donnell on the last occasion that I would deal with a point he raised with regard to the reorganising of the Officers Training Corps of the Universities. The position about that is that it is not proposed to reorganise the Officers Training Corps. There does not appear to be any need for it now. Our requirements as regards officers are adequately met by the intake of cadets, and the reorganisation of that Corps would not fit in with the new organisation.  There is, of course, a unit of An Forsa Cosanta Aitiúil, Cathláin an Phiarsaigh, which caters for University students, and that would appear to be sufficient in that respect at the moment. Therefore, I am afraid, I cannot hold out any hope of the reorganisation of the O.T.C. I think I have dealt with most of the points raised, but if there are any other points that require consideration, I shall consider them during the year.
Vote put and agreed to.
Aire Cosanta (Caoimhín Ó Beoláin): Tairgim:—
“Go ndeonfar suim nach mó ná £1,118,550 chun slánaithe na suime is gá chun íoctha an mhuirir a thiocfaidh chun bheith iníoctha i rith na bliana dar críoch an 31ú lá de Mhárta, 1960, chun Pinsean Créachta agus Michumais, Pinsean Breise agus Pinsean Fear Pósta, Liúntas agus Aiscí (Uimh. 26 de 1923, Uimh. 12 de 1927, Uimh. 24 de 1932, Uimh. 15 de 1937, Uimh. 2 de 1941, Uimh. 14 de 1943, Uimh. 3 de 1946, agus Uimh. 19 agus 28 de 1949, Uimh. 23 de 1953 agus Uimh. 19 de 1957); Pinsean, Líúntas agus Aisci Seirbhíse Míleata (Uimh. 48 de 1924, Uimh. 26 de 1932, Uimh. 43 de 1934, Uimh. 33 de 1938, Uimh. 5 de 1944, Uimh. 11 agus 34 de 1945, Uimh. 7 agus 29 de 1949, Uimh. 5 de 1953 agus Uimh. 12 de 1957); Pinsean, Liúntas agus Aisci (Uimh. 37 de 1936; Uimh. 9 de 1948; Uimh. 30 de 1950; Uimh. 27 de 1952, Uimh. 4 de 1953 agus Uimh. 17 de 1957); Iocaiochtaí i leith Cúitimh do Chomhaltai den Fhórsa Cosanta Aitiúil (Uimh. 19 de 1946, agus Uimh. 15 de 1949); agus chun Ranníoc agus Costas iolartha ina dtaobh sin, etc.
Milliún, sé chéad, seachtó is seacht míle, cúig chéad is caoga punt méid iomlán an Mheastacháin seo; sé sin, £22,600 de bhreis ar an méid a vótáladh le haghaidh na bliana air-geadais 1958-59. Tá méaduithe de £72,384 ar Fho-Mhirchinn áirithe,  agus i bhFo-Mhírchinn eile tá laghduithe a dhéanann £49,784. Ag seo na nithe is cúis leis an méaduithe is mó—Fo-Mhírcheann D—Liúntais agus Aiscí do Chleithiúnaithe, etc.— £3,500; Fo-Mhírcheann H—Scéimeanna Óglaigh na hÉireann (Pinsin)— £45,000 agus Fo-Mhírcheann O— Liúntais Speisialta—£22,600. Seo iad na laghduithe is mó—Fo-Mhírcheann C—Pinsin agus Aiscí Créachta is Míchumais—£10,500 agus Fo-Mhírcheann G—Pinsin Sheirbhíse Míleata—£31,000. Fairis sin, ní gá i mbliana soláthar a dhéanamh don Réiteoir agus don Choiste Comhairlitheach, rud a chosnaigh £7,834 anuraidh.
Maidir leis an soláthar laghdaithe i gcomhair pinsean créachta agus míchumais agus pinsean seirbhíse míleatha, is comhartha é, dá mhéid ár n-aiféala ina thaobh, go bhfuil na daoine lena mbaineann siad-san ag imeacht uainn ó bhliain go chéile.
Is é is mó is cúis leis an soláthar méadaithe i leith liúntais agus aiscí do chleithiúnaithe ná dámhachtana lena bhfuil coinne agus a bheidh le déanamh má achtaítear reachtaíocht atá ar intinn agam a thabhairt isteach go luath.
Ós rud é gurb iad na hoifigigh, na hoifigigh neamh-choimisiúnta agus na fir sa bhreis a bheidh á scor agus á n-urscaoileadh ar pinsean faoi ndear é, ní féidir an soláthar méadaithe i gcomhair íocaíochtaí faoi Scéimeanna Óglaigh na hÉireann (Pinsin) a sheachaint. Is ionann cás don soláthar méadaithe le haghaidh liúntas speisialta mar is ag dul i líonmhaireacht do na daoine atá ag fáil na liúntas sin.
This Estimate, at £1,677,550, stands £22,600 higher than the amount voted for the financial year 1958/59. Increases in a number of the Subheads amount to £72,384, while in others there are decreases which account for £49,784. The principal increases are in Subhead D—Allowances and Gratuities to Dependants, etc.—£3,500; Subhead H—Defence Forces (Pensions) Schemes—£45,000 and Subhead O— Special Allowances—£22,600. The main decreases are in Subhead C— Wound and Disability Pensions and Gratuities—£10,500 and Subhead G— Military Service Pensions—£31,000. In addition, provision for the Referee and Advisory Committee, which last year amounted to £7,834, does not recur this year.
The decrease in the provisions for wound and disability pensions and military service pensions is a manifestation, however much we may regret it, of the inevitable action of time. This was not so apparent in previous years in the case of military service pensions, because a number of new pensions was being awarded all the time, and this counterbalanced to some extent the downward trend as a result of deaths. The Referee and Advisory Committee completed, on the 30th September last, the work which was commenced in 1950 pursuant to the Military Service Pensions (Amendment) Act, 1949. I should like to take this opportunity of expressing my deep regret that the Referee, Judge Sheehy, died within a short time after his task had ended.
The increased provision in respect of allowances and gratuities for dependants arises mainly from anticipated awards which will fall to be made if legislation which I propose to introduce soon is enacted. As Deputies are already aware, this legislation will, inter alia, provide for an extension of the date of application for allowances under Part II of the Army Pensions Act, 1953, and it will also contain provision for certain other types of benefit.
Resulting as it does from further retirements and discharges on pension of officers, non-commissioned officers and men, the increase in the provision for payments under the Defence Forces (Pensions) Schemes is unavoidable. There is at present awaiting the approval of this House an amending Scheme—recently approved by the Seanad—which has been made to adjust retired pay, pensions and gratuities in relation to the pay increases which were granted as from April, 1958. The adjustment is to be retrospective so as to  include persons who have retired or have been discharged since the beginning of April, 1958, and who were in receipt of the increased rates of pay before retirement or discharge.
The increase for special allowances is likewise the result of the increasing numbers in receipt of such allowances. On the 30th April last, 5,833 special allowances were being paid as compared with 5,544 a year previously. That increase was a nett one; actually 795 allowances were awarded during the twelve months while 506 ceased because of death or other causes. The proposed Amending Bill which I have mentioned already will include a provision to remove the closing date of application for medals, the award of which would render the recipients eligible to apply for special allowances. While it may seem surprising that people should still at this stage be applying for the 1917-1921 Medal, more than 500 applications have been received since the closing date at present laid down—the 18th July, 1958. It can only be assumed that these persons deferred application until they regarded themselves as likely to qualify, on age or other grounds, for special allowances.
In response to requests made to me, I have considered the question of easing further the means test for special allowances. While it has not been possible for me to go as far as some would like, both because of other pressing demands on public funds and because, having regard to the nature and purpose of special allowances, the means test must have some significance, I have nevertheless been able to effect further easements as regards the assessment of the value of free lodging and the earnings of children, and also with regard to free lodging and maintenance reserved under deeds of transfer where the provision of these amenities constitutes a hardship. As well, I propose in the Amending Bill to remove the distinction, for the purposes of the appropriate annual sum, between persons married before the 1st October, 1942, and those married on or after that date. The distinction in question operates to the disadvantage of the latter class.
 The Estimate does not, of course, contain specific financial provision in respect of the proposed increases in pensions recently announced in the Budget. To such extent as may prove necessary, these will be covered by a supplementary estimate later in the financial year.
I think that that is all I need say in introducing the Estimate. If I can give any further information which will be of assistance, I shall be glad to do so when replying to the debate.
General MacEoin: This is a vote which we must pass because failure to do so would cause considerable hardship and annoyance to many people. I note the Minister says the great controller, Time, is having its effect upon the payments which are falling due each year. That is inevitable but it is to be regretted that so many are passing away. However, the Minister must expect a fairly large number of us to pass away in the immediate future if one bases the figure on the amount of money by which he has reduced the Estimate for military service pensions, disability and other pensions. I am glad he has announced an amendment to the Act to extend the time by which people can become qualified to receive medals. This has been a very difficult matter.
As far back as 1956, in answer to a Parliamentary Question, I said that the Government had given approval to an amendment of the Act to enable that to take place. There are many people ever since who have been debarred. The fact that 500 have applied since the closing date shows that there are still a large number who claim to be entitled to pensions. That is due solely to the reason that when persons applied for a certificate of service, they thought, and they were never fully disabused of the thought, the application also included the application for the medal.
I found that, in law, the Department did not take that view. I have contended all the time that the medal was a lesser application than the certificate  of service and, therefore, on the old principle that the major always includes the lesser, the medal should automatically be awarded on the application for a certificate. I think the easiest way out of it would be for the Minister to declare, in whatever legislation he is bringing in, that an application for a service certificate would be sufficient and would be regarded as an application for the medal. I think it would rectify the matter and eliminate hardships.
There will be people, then, who will receive the medals later but who, if they had had them before that, would be entitled to receive their special allowances. I have very little to say with regard to the Minister's proposals. They are inevitable. But when he says that 506 special allowances ceased because of death or other causes, I should like him to give us some indication of what the other causes were and are.
I am aware that there were many causes that led to the disqualification of people who had medals and special allowances. I should like the Minister to give us an indication of how that matter is now proceeding. I want him, further, to say why the people who are called on to certify the service of applicants are often people who have no possible chance of knowing whether or not they were members. If they are unable to say positively that the person was a member, then it is taken almost as a disqualification.
I know of several instances in which a brigade officer is regarded as a certifying officer but he resides miles away from the applicant and could not possibly say whether or not he was an active member in the period 1st April, 1921, to 11th July, 1921. I suggest to the Minister and to his Department, because of the number of deaths and other causes, that, where company officers are prepared to make a sworn affidavit or a declaration that the applicant was a member of a company within the qualifying dates, it should be accepted. Furthermore, if one or two officers or section commanders were prepared to give that certificate, I do not see why the Minister or the Department should not accept that  certification. Failure to do so has created very great hardship.
I regret to say the position has created a situation in which there are allegations of partisanship. No matter what political views a person may hold, that is no reason why he should not get what he is justly entitled to, in law. It has been brought to my notice that if a person has certain views, there is a danger that he will not get certification if the officers hold a different view. Such a thing should not happen.
I urge on the Minister that where the officers are not immediately available, the certification of a company captain, a first or second lieutenant or, alternatively, certification by a person who himself has a fairly substantial military service pension, should be sufficient evidence to warrant the issue of the medal. It is very disconcerting and a very great hardship to people who rendered service to find themselves with a medal and a special allowance but, because some anonymous scribe sits down and writes a letter, that special allowance is withdrawn or suspended and a considerable time elapses before a decision is come to and, when a decision has been reached, the applicant has no indication of who complained or what evidence was given against him.
Like the Social Welfare claims, where that happens, where a special allowance or a medal is withdrawn or, to use the official phrase, not duly awarded, the evidence on which that decision is based should be sent to the applicant who will then know what he has to meet. Unfortunately, he is left in the dark. He is not told that the officers failed to certify him. He is not told the names of the officers who were asked to certify him. He is told in a very vague way that the matter is under investigation.
I had a scheme in mind under which the whole question of military service pensions and the award of medals would be reviewed and put on a firm basis. I suggest that, even  at this late stage, the Minister should take that up. Time is passing rapidly and the Great Reaper, the Almighty, is calling on more and more. In another ten to 15 years, this Estimate will be very small and I feel that generous treatment should be meted out to those people who are in need.
I am glad to learn that the Minister has been able to get the Department of Finance to concur in the proposal to amend the means test because there were some extraordinary assessments. Unlike the old age pension assessments, these assessments varied from area to area. I think there should be uniformity. Then there would be no difficulty in establishing the fact that justice was done to all, that there was no partiality, that the Act was administered in a very clear and impartial manner, that everybody was dealt with in a similar way and no hardship imposed, but, on the contrary, where there was to be a privilege and a benefit that that would be ensured.
There are still a very large number of members of the Old I.R.A. who had pre-Truce service and who did not take part on either side in the Civil War, and there are some people who had pre-Truce service and also service in the Civil War, who are still dissatisfied. They are dissatisfied for the simple reason that they got it into their heads that there was political action in every phase of the matter and that there was partisanship, that you had to belong to some Party and then whatever Government were in office, you were all right. Of course, that was not so, but because the applicants never knew what they had to prove, what witnesses or what evidence were necessary, they claimed that there was this disparity in the matter of awards and certificates. They got the impression that the applicant who was able to make a good case, even if it were not 100 per cent. accurate, but was substancially true, was well away, but that another person who said: “Well, I did everything I was ordered to do”, or something like that, and was a bit hesitant about going into his service,  got the order of the boot and was eliminated.
I saw that happen. I saw the Referee and the Board of Assessors dealing with a case in which a person came in and was sworn and was then asked when he joined the Volunteers. Then he was asked what service he rendered in the year 1917—1918 and he replied: “Everybody knows what I did,” and the Referee wrote “everything” for that year. He put the same question for the next year and for each year up to the end of the Truce. I saw the Referee putting down the word “everything” for each of those years and when it was all added up it meant—nothing. I asked if I might intervene and I said to the applicant: “Did you not take part in the attack on such a barracks?” The applicant replied: “Of course I did” and then the referee remarked that it was a wonder that the applicant had not told us of that fact. Were it not for the fact that I was in a position to examine the witness myself and to give him a hand it would have meant that when all the “everythings” were added up, they would have totted up to nothing.
On the other hand, if the applicant knew what he had to establish and what constituted service, he could bring in a legal officer, or a solicitor to assist him. It is an extraordinary situation that if the applicant had a motor-car accident in which a car hit a calf worth, at that time, £2 or £3, or perhaps less, and if he were going to court about it, he would have employed a solicitor to prove what happened, but here was a case where a military service pension was at issue for the rest of a man's life and he had no knowledge of how to set about proving his case. That may all be too late but it was something which, when I was Minister, I decided would be rectified as far as possible. I should like the Minister to examine that matter and when he is amending the Act, as he says he proposes to amend it in certain respects, that he will see how far he can get these matters rectified.
I know, as his predecessor, that the Government were favourable that when the Referee would wind up, there  would be a new set of circumstances established. I want to join with the Minister in expressing regret at the death of the last Referee. He was a very kind and courteous man but he was restricted in the discharge of his duties by the terms of the legislation which he had to operate. He wrote some very fine memoranda upon what he thought were the flaws in the present Act. It is a pity the Minister and the Government have decided to wind up the Act. Of course, this is the second time they have done so, but I am not going into that because I feel the Minister is favourably disposed towards those who have claims which have yet to be met and I do not want to jeopardise them by saying anything which might be likely to prevent them achieving success in their efforts.
Mr. Sherwin: Last year, I referred to certain members of the Old I.R.A. who, in my opinion, did not receive justice. Now that there is a saving as a result of deaths and, as has been stated already, we will continue to have that saving as time goes on, the Minister might consider certain classes not previously considered. I wish to refer to those who took part in the Civil War. I am not going into the question of who was right or who was wrong, or any other aspect, but I want to deal with persons who served during the Tan War but who, because they could not prove some armed activity, were denied a pension.
The impression given by some people is that only a few thousand men fought and one would imagine that the other people “funked” it. They were just as anxious to fight as the others but in guerilla warfare you cannot go out and ask to fight. Only a small number can fight and the rest are reserves who are just as anxious to fight as the others. In fact, a large number would be a danger. During the attack on the Custom House a large number took part and many were captured. Throughout the Tan war there were a chosen few, usually the same few. But all the time the reserves were standing to. They were anxious to go out but were not given the opportunity.  I hold that they served just as well. They had given up their time. If captured they would likely have been murdered and certainly would have been imprisoned.
No credit was given to those who could prove they served, especially during the critical period. I understand that those who could prove armed activity during the Tan War got service also for the Civil War. That is strange. Why deny the men who served during the Tan War, but did not get the opportunity of carrying out a job, and who also took part in the Civil War? Why is it right in one case and wrong in another? In the Civil War, unfortunately, we had brother fighting brother, but both sides acted in good faith. Those on one side at least had their liberty, their wages or their rank in the Army—all the privileges of victory—while those on the other side lost their jobs and their health. Many of them never regained what they lost and had to go to England or America. Many of them had to start from the bottom again. But, no matter what they lost, they got no pension. If the Minister thought they had no right to a pension because they took part in the Civil War on the anti-Treaty side, at least he could have considered some form of compensation for loss or imprisonment. But to give certain classes pensions for the Civil War just because they had the privilege of taking part in the Tan War and to deny consideration of those who took part in the Civil War seems a very strange contradiction to me.
I want to point out to the Minister again that there are a considerable number of people who served faithfully throughout the Tan War but who may not have thrown a bomb or fired a shot because they did not get an opportunity. They suffered very much and should get some consideration, at least in the matter of compensation for monetary loss or imprisonment. I mentioned this matter last year and I mention it again now. I do so on behalf of all those with whom I was associated. I took part in the Civil  War on the anti-Treaty side and I know how those men suffered.
There is another matter I mentioned last year. A Disability Act was passed in 1932. There was another Act in 1938 which provided for the case in which a man's health was aggravated as a result of service. Many people did not avail of this Act because there was a time limit for making applications. In the original 1932 Act there was no time limit, or at least the Minister for Defence had power to reopen a case at any time when new evidence was produced. But there was no such provision in the 1938 Act. There were a number of people in America and England not aware of the Act and when eventually it occurred to them they could come in under the Act, they found that unless they applied within a certain period they could not be considered. Therefore there are certain people entitled to a disability pension because of aggravation, but because no power is given to the Minister to reopen their cases they are still in need. I know several such cases.
I know some people got medals who were not entitled to them. I was a member of the Fianna. I remember only too well that before things got hot there were 70 or 80 in the company always, but when things got very hot there were only 20. For at least eight or nine months before the Truce there were never more than 20. I know that a number of those who were active before things got hot came back afterwards and got medals. I assume that has happened in many cases—I shall not say a big number of cases. When years pass it is simple for a fellow to say “Remember me?” The point is: can you remember him being active during the critical period? Very few men can remember after years in what particular months a man was active or not. I know it is difficult, but at least the Minister should make sure that whenever there is a claim for a special allowance the whole question will be re-examined. I should not like to think of some fellow who “funked” it when things got hot coming back later getting a medal and, perhaps, a special pension.
 During the year several questions were asked about the Casement Brigade. I feel that some of those men are entitled to some recognition. The question is this: did any of them suffer for their action? It appears that as a result of Casement's activities certain people agreed, to form a brigade in Germany. I understand that many of them suffered. They threw no bombs or took part in no action of that kind, but nevertheless the propaganda value was there. They did as much as many of those who have medals. But, as I say, the question is: did they suffer as a result of joining this brigade? Surely the Minister could easily find out from the British pensions people if these men lost their pensions or gratuities? If any of them did suffer as a result of their actions, then they should get some credit in the form of a medal at least. Any man who made any sacrifice is at least entitled to a medal.
On the question of medals, I enquired from the Department of Defence if there are any replacements. I have a medal but I broke the hasp a couple of years ago and could get no replacement. Surely there should be some replacement? I understand you can buy ribbons in a few places but not a hasp. Surely a person should at least be able to purchase a hasp? I have a broken hasp and when I go out I have to get a safety pin——
Mr. K. Boland: The Deputy can get a replacement.
Mr. Sherwin: I accept that if the Minister says so. I asked and I was told that they could not be replaced. I asked three years ago.
General MacEoin: There is 5/- to pay.
Mr. K. Boland: You have to pay 5/-.
Mr. Sherwin: We do not mind that so long as they are obtainable. I would ask the Minister again to consider the cases of those who did not receive any compensation for their service in the light of the fact that now the account is small and will continue to reduce  and perhaps he can afford to consider the question.
Mr. O'Sullivan: There is a minor matter to which I should like to draw the Minister's attention. It was decided in the Budget this year to award an increase in old age pensions—a delayed action increase—which will become operative later this year. In the assessment of means for a special allowance, the recipient's old age pension is not taken into account but that of his spouse is. On a previous occasion when increases were granted in old age pensions, in a number of instances it had the effect of reducing the husband's personal allowance by a much greater amount than the increase in the old age pension granted to his wife as a cushion against the impact of the cost of living. This is an administrative matter that can be corrected. As the increase is intended to help people to meet the cost of living, no Minister would wish that existing regulations would operate to reduce the total income of the household. I should like the Minister to examine this matter before the increase in old age pensions comes into operation with a view to guarding against the injustice that resulted on former occasions in similar circumstances.
Mr. T. Lynch: I think this is a sordid business, a business of bartering service to Dark Rosaleen for money. I think it is a sordid business because, when I first entered Dáil Éireann, I was approached by members of the Irish Volunteers, men who could say that everybody knew their record. I had not very much to do with what is called “the movement” but I had seen these men arrested several times; I had known what their services were. They were on the run. They were recaptured. They went to various prisons. They were on hunger strike. One of them went what we call anti-Free State or Irregular during the Civil War. They came to me together and asked me did I know who were the people in my constituency who had military service pensions. I said that I had no idea. They asked me to find out for them.
I wrote to the Department of  Defence and was told that such information was not made readily available. I used my Parliamentary privilege and put down a question, which was answered in a tabular form. A member of the House said that it was a shame to ask such questions. I was rather startled at that. “Why should such a question be asked?” he said. I said that it could not be considered a shameful thing to have one's name on such a list, that the list should be a roll of honour. When I showed the list to the people who had asked me to get the information, and who will give me permission any day I like to use their names, whose names are household words, they were appalled at many of the names that were on the list.
The two people who approached me are not in receipt of pensions. They are not disappointed men; they never applied for pensions. If they did apply, they are the type of people who would be awarded the maximum pension.
I do not know what the law is in relation to these pensions but I do know that medals were given for service, or alleged military service, or alleged service to the State and in many cases the medals had to be returned, which shows that the machinery by which the medals were awarded was liable to error. It would be of service to the State and a service to those who gave great service to the State if all pensions were reviewed because the information that I have and that I can stand over is that there were many men who got military service pensions who, in the opinion of people who had great service, who are not disappointed men, who did not apply for pensions, should never have applied for them.
Deputy Sherwin suggested that a man should have suffered before he would get a pension. I do not think that is a necessary requirement. Pensions have been awarded for service. I do not think it is fair to say, and it is constantly being said, that people who served the country were all thrown on the dust heap. It was said in the House this evening that the members of the Casement  Brigade were not properly treated. I know some of the members of the Casement Brigade. When they arrived back in Ireland they were provided with very good jobs under the State and I do not think it is fair to say that the State abandoned all these people. I have known hundreds of people who gave military service to the State and the State gave them the recognition that they deserved.
We should get away from the constant carping at the Department of Defence, alleging that it abandoned these men, that it gave them nothing. The majority of those who served the State well have been well treated by the State and have been well treated by all Governments. There are people who may not have been able to present their cases for a military service pension in the proper way. There are people who are jealous because a neighbour got a pension and who consider that their services were better but whose services were not better.
There are the people to whom we should give the greatest credit, those who joined the Volunteers in the early days, who served in the Black and Tan War and in the Civil War, on the side of their choice. I am not making any issue about that. When everything was over they went back to their counters, their ploughs, their jobs. Some of them applied for medals and got them. Others did not, because they take pride in the fact that to-day they can still call themselves Irish Volunteers.
General MacEoin: Before the Minister concludes, may I ask, in relation to Part II of the Act of 1953, how many cases are still outstanding, how many are to be investigated by him and how many are with the Minister for Finance, still in the pigeon hole?
Mr. K. Boland: I have not the numbers, but there are very few. There were a number of points raised by Deputy MacEoin. Adverting to the part of my speech where I mentioned that it was proposed to remove the time limit on applications for medals which, if granted, would qualify people for special allowances provided that they  satisfied the other conditions, Deputy MacEoin mentioned that Government approval was given in 1956 to the extending of the date. That date was, in fact, extended up to 18th July, 1958, and the 500 applications which he mentioned were since that date. If you like, it is an admission of defeat that we are now proposing to remove the date altogether. A great deal of publicity was given at the time of the Army Pensions Act, 1957, to the fact that this was the last date for applying for these medals, but in spite of all the publicity given—I am sure all Deputies spread the news as well as they could in their areas—we still had these 500 applications since 18th July, 1958. In view of that, we have come to the ultimate decision to remove the time limit.
Deputy MacEoin also asked for some indication as to what the other causes were, apart from death, for the reduction in the numbers of special allowances. The main cause is on the grounds of improved means. There were very few cases where the entitlement to a medal was questioned in the case of a person who is actually in receipt of a special allowance. There were a number some time ago, but in late years there are very few cases of that type occurring and very few cases where the special allowance has been withdrawn because the entitlement to the medal was in question and it was found not to be duly awarded.
With regard to the question of verification of service for these medals, it is to company officers we go, in the first instance. It has been the experience that going to company officers alone in a number of cases is not sufficient. We sometimes get contradictory evidence and it is obvious in a number of cases we have to go further. We do not go to brigade officers. It is to battalion officers we go. That is simply because it has been found necessary in order to establish the fact that a person is entitled to a medal. You have to go somewhere.
General MacEoin: If he says he  does not know, then the unfortunate person is done.
Mr. K. Boland: You are back trying to make up your mind. It is obviously a very difficult thing——
General MacEoin: I agree.
Mr. K. Boland: ——when you have contradictory evidence. If there are cases of local animosities, the battalion officer is likely to be unaffected by them. There is the possibility that we may get an opinion that we can accept from him but it is a difficult thing all right. I agree that the company officer should be the person who would know.
General MacEoin: Swear them. Put them on oath.
Mr. K. Boland: In any case, it is a difficult thing to do. The only thing you can do is to approach all the officers who, it is felt, might be in a position to verify. Of course, there is also the question of the company rolls. Most of the cases turned down were cases of people who were not on the company roll. I think it would be agreed that these rolls were in most cases very carefully prepared. The mere fact of a person not being on the company roll is in itself sufficient to cause doubt.
General MacEoin: It is some evidence. It is not complete.
Mr. K. Boland: It is not conclusive evidence, I agree, and is not used as conclusive evidence, but it could be the deciding factor in the case of contradictory evidence. With regard to the question which Deputy MacEoin raised of applicants for military service pensions who, in his opinion, were unable to present their cases properly, both on the Board of Assessors and on the Referee's Advisory Committee, there were always two high-ranking officers of the old I.R.A. who were put there because they were people who knew the circumstances which obtained during that period and who, it was assumed—and, I think, rightly assumed—would help people to make their cases properly.
I think that was how the system operated. These old I.R.A. officers  knew the type of activity that was involved and knew the information the applicant should give and gave him every possible help. Of course, they saw to it that people got fair treatment. In addition, any applicant was entitled to be legally represented there. They were invited to bring any witnesses they could. I do not see what more could be done. It may be that there were some people who did not present their cases properly but the whole question was reopened a number of times. They certainly got sufficient opportunity. It is hard to see, even if they were again reopened, that they would make any better fist of their cases. They got every opportunity and if they did not succeed before, there is no reason to think they would present their cases any better now.
The question raised by Deputy Sherwin with regard to awarding pensions for civil war service only would, of course, be an entirely new principle and it has never been considered that that should be done. It has always been part of the qualification that there should be pre-Truce service also. He also suggested that when a medal holder applies for a special allowance, the award of the medal should be re-examined. That is always done. When there is an application for a special allowance, it has to be established that the medal was duly awarded. That investigation is what Deputy MacEoin was complaining about. It has to be done because it has been discovered, as Deputy Sherwin says, that some medals were awarded originally before there was a special allowance attaching to them which should not have been awarded because the persons concerned had not got the requisite service.
The question, raised by Deputy O'Sullivan, as to whether the recent increases announced for old age pensions would be taken into account in connection with the means of the spouse of a special allowance holder has not been decided yet.
There was another point raised, I think, by Deputy MacEoin in regard to cases where the entitlement to a medal is questioned. It was suggested  that in those cases, I think, the special allowance is suspended while the entitlement is being investigated. That is not the position. That is not done at present. Even if we are reinvestigating entitlement to a medal, the special allowance continues to be paid until such time as it has been definitely established—to our satisfaction, anyway—that the medal is not duly awarded. I do not know whether that was always the case but it certainly is now. I think at one time payment was stopped, but that is not the position at present.
In regard to the other question Deputy Sherwin raised concerning these aggravation cases, I am afraid I am not familiar with these, but I shall have the matter looked into and find out if, in fact, those cases cannot be reopened.
Mr. Sherwin: The disability cases?
Mr. K. Boland: Yes.
Vote put and agreed to.
Progress reported; Committee to sit again.
Aire Cosanta (Caoimhghin Ó Beóláin): Tairgim:
Go ndaingneofar Scéim Óglaigh na hÉireann (Pinsin) (Leasú), 1959, a d'ullmhaigh an tAire Cosanta, le toiliú an Aire Airgeadais, faoi Alt 2, 3 agus 5 d'Acht na bhFórsaí Cosanta (Pinsin), 1932, agus Alt 4 d'Acht na bhFórsaí Cosanta (Pinsin) (Leasú), 1938, agus a leagadh faoi bhráid an Tí an 21 ú lá d'Aibreán, 1959.
That the Defence Forces (Pensions) (Amendment) Scheme, 1959, prepared by the Minister for Defence, with the consent of the Minister for Finance, under Sections 2, 3 and 5 of the Defence Forces (Pensions) Act, 1932, and Section 4 of the Defence Forces (Pensions) (Amendment) Act, 1938, and laid before the House on the 21st day of April, 1959, be confirmed.
Rinneadh an Scéim seo de bhun na nActanna Fórsaí Cosanta (Pinsin),  1932 go 1957. Ní thiocfaidh sé i bhfeidham go dtí go ndaingneofar í le rún ó gach Teach den Oireachtas. Daingníodh amhlaidh cheana í ag an Seanad.
De na 18 Airteagail atá sa Scéim, is mínithe na ceithre cinn thosaigh. Baineann ceithre cinn eile—uimhreacha 7, 9, 13 agus 15—le cúrsaí léiriúcháin; nii iontu sin dáirire ach léirithe lenar glacadh nó a ceapadh riamh, a chur síos go foirmiúil. Baineann céithre cinn eile fós—uimhreacha 5, 6, 12 agus 14—le méaduithe ar an bpá scoir, na pinsin agus na haiscí de chomhaltaí áirithe de na Buan-Óglaigh, de dhroim mhéaduithe ar phá an Airm a tháinig i ngníomh ar an Iú Aibreán, 1958.
Tagann Airteagal 8 d'athscrúdú na Scéime Gearr-Sheirbhíse le haghaidh oifigigh den Aer-Chór agus, faoina réim sin, tabharfaidh na daoine a cheapfar 18 mí seirbhíse mar dhaltaí agus 5½ bliana seirbhíse mar oifigigh. I gcás daoine a ceapadh tar éis an 31ú Nollaig, 1958, ar an ábhar sin, cuireann Airteagal 8 deireadh leis an teideal chun aisce a bhí ann roimhe sin ar 3½ bliana seirbhíse a chríochnú.
Cúlghairmeann Airteagal 10 Airteagal 18 den Phríomh-Scéim lena bhforáiltear nach mór d'iar oifigigh a bheidh ag fáil pá scoir agus ar mian leo cónaí lasmuigh den Stát cead i scríbhinn a fháil ón Aire Cosanta chun sin a dhéanamh. Forálann Airteagal 11 go n-íocfar pinsean le baintreach oifigigh a céadcheapadh le haghaidh dualgas speisialta le Fórsa na nÓglach, a scoir dá dheoin féin agus nios lú ná fiche bliain seirbhíse aige agus a fuair bás le linn dó pá scoir a fháil. Mar atá an Scéim faoi láthair, níl an bhaintreach i dteideal pinsin. Toisc a gcúrsaí ar leith, rinneadh leasuithe ó am go ham nár bhain ach le hoifigigh ina leithéid chéanna de chás agus lena gcleithiúnaithe. Níl i gceist ach baintreach amháin.
Baineann Airteagail 16 agus 18 le hoifigeach a scoireanna dá dheoin féin agus níos lú ná dhá bhliain déag seirbhíse aige agus a athcheaptar ina oifigeach dá éis sin. Faoi láthair, ar an oifigeach sin a athcheapadh, ní  bheadh a sheirbhís ina seirbhís inphinsin. Tá sin curtha i gceart le hAirteagal 16 agus forálann Airteagal 18, má fuair an t-oifigeach aisce i leith a chéad thréimhse sheirbhíse, go gcuirfear an aisce sin san áireamh agus méid deireanach a shochar scoir á ríomh.
Tugann Airteagal 17 cumhacht chun leanaí arna n-uchtáil faoin Acht Uchtála, 1952, a áireamh i leith sochair faoi na Scéimeanna amhail is dá mba leanaí a rugadh de phósadh dleathach do na tuismitheoirí uchtála iad, ar an gcoinníoll gur uchtáladh iad sula raibh deireadh le seirbhís an oifigigh nó an tsaighdiúra uchtála.
This Scheme is made pursuant to the Defence Forces (Pensions) Acts, 1932 to 1957. It will not come into force until it has been confirmed by a resolution of each House of the Oireachtas. It has already been so confirmed by An Seanad.
Of the eighteen Articles which make up the Scheme, the first four are definitory. Another four (those numbered 7, 9, 13 and 15) relate only to questions of interpretation; these merely express in a formal way interpretations which have always been accepted or intended.
Still another four Articles (those numbered 5, 6, 12 and 14) relate to increases in the retired pay, pensions and gratuities of certain members of the Permanent Defence Force. Increases in Army pay came into operation on the 1st April, 1958, and the Articles I have mentioned provide for proportionate increases in the retired pay, pensions and gratuities of those members of the Permanent Defence Force who, before retirement or discharge, were in receipt of the increased rates of pay.
Article 8 arises from a revision of the Short Service Scheme for officers of the Air Corps. Up to the 31st December, 1958, the Short Service Scheme provided that those appointed under its provisions would serve for six months as cadets and 3½ years as officers and that selected officers would be permitted to extend to 5½ years. Gratuities were payable to officers on completion of these periods of service. Under the revised Short Service  Scheme, the persons appointed will serve for 18 months as cadets and 5½ years as officers. Article 8 removes, therefore, the entitlement to a gratuity, on completion of 3½ years' service, in the cases of persons appointed after the 31st December, 1958.
Article 10 revokes Article 18 of the Principal Scheme which provides that ex-officers in receipt of retired pay who desire to live outside the State must obtain the written permission of the Minister for Defence to do so. The Article in question is being revoked because it is not considered necessary that any restriction should be placed on the movements of retired officers, except those with commitments to the Reserve Defence Force, whose position is provided for in Defence Force Regulations.
Article 20 of the Principal Scheme as amended provides for the payment of pensions to the widows and children of deceased officers but it does not cover the case of the widow of an officer with twelve or more, but less than twenty years' service who died, following voluntary retirement, while in receipt of retired pay. Article 11 of this Scheme provides that a pension be paid to the widow of such an officer who was originally appointed for special duties with the Volunteer Force. Amendments limited to officers in this category and their dependants have been made from time to time because of their exceptional circumstances. Only one widow is involved.
Articles 16 and 18 relate to the case of an officer who retires voluntarily with less than twelve years' service and who is later reappointed to be an officer. Such a case would be that of an officer who retired to follow a religious vocation but who, not finding himself suited to the religious life, was permitted to return to the Army. At present, such an officer's service on his reappointment would not be pensionable. Article 16 adjusts this position, and Article 18 provides that if the officer received a gratuity in respect of his first period of service, that gratuity will be taken into consideration in the calculation of his final retirement benefits.
Article 17 of the scheme enables  children adopted under the Adoption Act, 1952, to be reckoned for benefit under the schemes as if they were children born in lawful wedlock to the adopting parents, provided that they were adopted before termination of the service of the adopting officer or soldier.
General MacEoin: I regard this as an improvement and I have had no complaints, so I presume there is nothing to do but adopt it. I am sure the Minister will not amend it now whatever I say.
Mr. K. Boland: I do not think there is any need.
General MacEoin: I have no further comment to make.
Question put and agreed to.
The Dáil, according to order, went into Committee on Finance and resumed consideration of Estimates for Public Services for the year ending 31st March, 1960.
Minister for Health (Mr. MacEntee): I move:—
That a sum not exceeding £6,132,050 be granted to complete the sum necessary to defray the charge which will come in course of payment during the year ending 31st March, 1960, for the salaries and expenses of the Office of Minister for Health (including Oifig an Árd-Chlaraitheóra) and certain services administered by that Office including grants to local authorities and miscellaneous grants.
I feel it will be to the convenience of the House if I begin by quoting some of the more important vital statistics in respect of the preceding calendar year. At this stage, the figures are provisional but any subsequent adjustment which may have  to be made will not affect the general picture.
The number of births registered in 1958 was 59,510 as compared with 61,242 in the preceding year. The birth rate, while lower in 1958 than in 1957, continues to be higher than in adjoining countries.
The number of marriages in 1958 was 15,111, compared with 14,657 in 1957, an increase of over three per cent.
The general death rate in 1958 showed a slight increase over the previous year—12.0 against 11.9 per 1,000 population, due mainly to an increase in the number of deaths from diseases of the heart.
Deaths from the infectious diseases continued to decrease. In the case of tuberculosis they fell from 696 in 1957 to 584 in 1958, thus reversing the slight upward trend which appeared for the first time since 1943, in 1957. Deaths from influenza fell from 687 to 311. Deaths in children under 2 years old from diarrhoea and enteritis and in children of all ages from whooping cough, diphtheria, measles and scarlet fever fell from 150 to 121. Deaths from poliomyelitis numbered 9 against 13 the previous year.
Another satisfactory feature was the decline in maternal deaths to 61, which, though still too high and comparing unfavourably with the figure in some other countries, was a considerable improvement on the figure of 81 for 1957.
Finally, mortality from cancer fell to 4,683 as compared with 4,819 in 1957.
The major development in the health services in 1958/59 was the enactment and bringing into operation of the Health and Mental Treatment (Amendment) Act, 1958. The implementation of this Act was necessarily made coincident with the raising of the income limit for compulsory insurance under the Social Welfare code from £600 to £800 for non-manual workers. It extended the benefits of the Health Act, 1953, to the additional group of persons thus brought into insurance, to the dependants of that group, and to noninsured  persons and their dependants whose family incomes, broadly speaking, did not exceed £800. These groups were absorbed into the scope of the services in the last quarter of the financial year without any major upset to those services or any diminution in the standard of those already provided for the group previously eligible.
During the year I received the report of the committee set up by my predecessor to consider the fluoridation of water supplies. The task entrusted to the committee was to investigate whether by this means the incidence of dental caries—in nontechnical language, teeth decay— particularly in young persons could be reduced substantially. The report has been published and copies are in the Library. I am sure Deputies will join with me in paying public tribute to the members of the committee for the careful and efficient manner in which they dealt with the problem. Their recommendations, all of which were made unanimously, have been accepted by the Government and legislation to give effect to them is in course of preparation.
Another body which deserves public thanks is the National Organisation for Rehabilitation. It is the body which again was set up by my predecessor to consider the question of rehabilitation and whose interim report has been before me for some time. Unfortunately the issues with which it deals are not as clear-cut or as readily capable of solution as the issues with which the Fluoridation Committee had to deal. As Deputies can readily appreciate, rehabilitation is not only an extremely complex subject but is also one of immense scope. At one extreme we have the self-rehabilitating individual who, if he should have contracted a cold, is glad to cure himself with a jorum of punch and, maybe, an aspirin before going to bed; at the other extreme, however, we have the seriously disabled person who must have complete re-training to enable him to follow a new occupation, where this happens to be feasible; or, where this is not feasible, as occasionally happens, to help to make him less  dependent on others in merely living. Since rehabilitation covers the entire field of doing everything reasonable to repair the ravages of physical or mental defect or disease, it will be readily understood how vast and difficult the problem is. The interim report on the subject is still being examined and, while that examination is proceeding, I do not think it would be appropriate to publish it. Apart from anything which may or may not have been dealt with in it, I should stress that through the medium of the hospital services and through a variety of voluntary agencies, many of which receive subventions from public funds, a great deal is already being done in this field.
During the year, my Department had to deal with some complaints about the manner in which the health services have been operating. The majority of the complaints which I receive on this score relate to entitlement to services under Section 14 of the Health Act, 1953. Some complain that too few, others that too many, are accepted as entitled to these, that is, broadly, to the full range of free medical and hospital treatments. Others complain that, although entitled to dental or ophthalmic services, people have experienced difficulty or delay in obtaining those services. Still others allege they have been charged too much by health authorities for the hospital services provided for them; so that some who regarded themselves as entitled to financial help towards the cost of services availed of in voluntary hospitals, found they had to meet bills altogether beyond their expectations. I propose to deal separately with each of these types of complaint. In passing, I should say that, happily, there were few complaints regarding the standard of the services provided.
In regard to Section 14—that is, in regard to the medical card—complaints, Deputies will have seen from replies I have given to Parliamentary Questions from time to time that the number of persons covered by medical cards, relative to the entire population, varies very widely from area to area. In some  areas, more than 40 per cent. of the population is covered by medical cards; in others, the percentage is less than 20. Strangely, in the areas in which the percentage covered by cards is highest, the number of complaints that medical cards have been refused is as great as, indeed, if not greater than, the number in the areas in which the percentage is lowest. While I must stress that, as Minister for Health, I have no appellate functions whatsoever in regard to such complaints, I do, whenever the circumstances seem to warrant it, pass on representations to the appropriate manager for his further consideration, and in that respect I am bound to say that, in general, managers have seldom failed to convince me of the correctness of their decisions.
The second type of complaint to which I have referred is the complaint of difficulty and delay in providing dental and ophthalmic services for eligible persons. Here the hard inescapable fact is that money cannot be found at present to provide a comprehensive and readily-available dental service for all who may need it. For that reason, it is settled policy to concentrate so far as possible on the children and to provide only a limited or in some cases an emergency service for other eligible groups. It is inevitable, therefore, that many persons in need of dental services cannot get them immediately, but must wait until their turn comes. The situation in regard to ophthalmic services does not, in general, give rise to the same volume of complaints. In some areas, however, there are long waiting lists, and in these I am hopeful that measures will be put into effect to improve the position.
The next type of complaint is that eligible persons who receive treatment in local authority hospitals are charged the maximum amount which the law allows—I am not dealing here, I should say, with maternity cases where treatment in a public ward is free or with infectious diseases including tuberculosis, where it is also free—but the law is quite specific on the question of charges. A person who is covered by a  medical card is automatically entitled to free treatment. If he is an eligible person, but does not hold a medical card, the maximum charge is 10/- a day. But that limit of charge is subject to an important proviso which is often overlooked: to wit, that the person concerned does not obtain private or semi-private accommodation. Apart, however, from this condition, 10/- per day is the maximum permissible charge. Moreover the 10/- per day is not an invariable charge; it must be adjusted to the patient's financial circumstances. This was clearly contemplated by the Act; so that the practice which until recently was common, of automatically furnishing a patient with a bill computed at the rate of 10/- per day is, in my view, indefensible.
It has been contended that a charge computed at the maximum permissible rate is in the nature of a provisional assessment, which can be reduced when the patient, or a councillor or a Deputy on his behalf, makes representations. Not only do I not accept that contention, but I feel that the practice of overcharging in the first instance is very objectionable; for it may lead a patient to believe that he has received through improper influence, something which he would have received as of right. The patient, on admission to hospital, makes a declaration as to his circumstances, and, in my view, he is entitled in law to have his account made out on the basis of that declaration.
Of course, the patient's declaration should be checked, and in most cases can be checked, I think, even during his period in hospital. If it is found to be incorrect or misleading, he can be reassessed. If there are good grounds to suspect that he deliberately made a false declaration in order to get something to which he is not entitled, he should be prosecuted. During the year I caused a letter to be addressed to each county and city manager, drawing attention to this matter; and I feel that in those areas where the offending practice was current, it has now been ended. If it should happen, I should be glad to hear evidence to the contrary  and I shall deal with the position accordingly.
Probably the largest number of complaints received during the year related to eligible patients who, either themselves or through their family doctor, had made their own arrangements to enter hospitals of their own choice. In most of these cases, the arrangements were made without recourse to the local authority. In consequence, the patients were faced with bills considerably greater than they had expected from the hospital, or from the hospital doctors, or, in many instances, from both.
To elucidate how this can occur, I shall take the case of an eligible patient who enters a hospital of his own choice and accepts treatment in a public ward—it is important to note in this connection that I am dealing only with treatment in a public ward. In this case, the local authority pays the hospital for the patient's treatment at a reduced rate, which is equivalent to the rate it would pay for him if it had sent him to hospital, less 10/- a day. The patient himself is then personally liable to the hospital for a charge of 10/- a day.
In order that there may not be any confusion between this charge and the other charge, I want to make it clear that in this instance the patient has entered the hospital of his own choice and the charge is not “a sum not exceeding 10/- a day” but a flat 10/- a day. The amount paid by the health authority, plus the patient's 10/- a day, covers all charges and the hospital cannot charge anything extra for special services, X-rays, drugs, etc. It is not permissible either for the doctors who attend on a patient under this arrangement to charge any fee for their services in the hospital, since there is an element for remuneration for the doctors in the amount paid by the health authority to the hospital. I want to emphasise that in those circumstances in general no charge beyond the permitted 10/- per day is made. The complaints I have received in relation to cases of this kind have, in the main, arisen from misunderstandings, and all of them have been or will be put right.
So much for the patient who accepts  treatment in a public ward. Where an eligible patient accepts treatment in a ward which is designated or described as private or semi-private—and in some hospitals wards which are described as semi-private may be quite large wards indeed—the patient is liable to the hospital authority for whatever charges it chooses to make, over and above the subvention which in the case of a general hospital is 8/- per day which is paid to it by the health authority. Furthermore, the patient is liable also for the fees charged by the doctors who treat him in hospital. This, as everyone knows, may be a costly business for the patient. But once he has accepted private or semi-private treatment, he has no escape from the liability which he has thereby incurred; and the Minister for Health cannot do anything to help him. To adapt perhaps a little crudely an old saw, he has selected his bed and must pay for it.
Mr. Dillon: That is very comforting to the people who get the bill.
Mr. MacEntee: Now, let Deputy Dillon keep off health.
Mr. Dillon: They are getting £2,100 a year to help people.
Mr. MacEntee: Let him deal with agriculture—he is an adept at mixing that up. Let him allow me to make my speech without interruption. Health authorities have been furnished with draft leaflets explaining all this; detailing the health services which are available and the conditions which apply to them. They have been requested to make these freely available to the public in printed form. I believe that this request has been generally complied with but there are one or two health authorities who have been dilatory in responding to it, and, in their cases, I propose to oblige them to do so without further unreasonable delay.
I would stress again that most of the complaints I receive are from persons who accepted treatment in private or semi-private accommodation without appreciating the implications. Unfortunately, there is nothing I can  do about such cases at present—except to utter a warning that no person should accept accommodation in a private or semi-private ward in a hospital, or in a nursing home, or in any institution which is not a recognised institution for the purposes of the Health Acts, unless he or she is in a position to meet the financial commitments which accommodation of this kind entails. I should perhaps say also that in view of the volume of the complaints which I have received about this matter, I feel that there may be some grounds for fearing that the provisions of the Health Acts which deal with institutional services and provide for an exercise of choice by the patient are being abused, and I propose to take such measures as are open to me to deal with the matter. Most doctors should know by now what financial obligations are accepted by a patient who asks for or who is provided with accommodation in a private or semi-private ward. I am sure that, in general, they will readily give their patients advance information as to what may be involved.
I would now like to say something about three particular diseases which are of great concern to any Minister for Health. These are poliomyelitis, tuberculosis and cancer and I propose now to review them in that order.
Poliomyelitis is a terrifying disease and its effects on the unfortunate victim may be extremely serious. Notwithstanding this, however, it is important that it should be placed in its proper perspective. As I have said, the number of deaths from it in 1958 was 9, in the previous year it was 13. The number of cases was 264 in 1958 as against 148 in the previous year. I do not give these figures in any mood of complacency or with any wish to minimise the seriousness of the problem. But I give them objectively against a background of much higher mortality from more prevalent diseases, so that I may bring home to Deputies that “polio” is not the only, or the most important, health problem with which a Minister for Health has to deal.
The arrangements introduced some years ago for dealing with the more  serious types of the disease continue to operate smoothly; and I feel justified in saying that the cases encountered during the period which I am reviewing received, as previously, the best possible treatment. In 1958, the original scheme of free vaccination was extended to a wider group of the population, so that vaccination was made available, free of all charge, to expectant mothers and to children over six months and under ten years who were covered by medical cards. Furthermore, in the case of those not covered by such cards, a flexible approach was adopted, whereby if it were reasonably certain that it would impose any hardship upon a parent to pay for the vaccination of his children, they were vaccinated free.
In addition, in July last, I introduced a scheme to enable expectant mothers and children within the age limits mentioned, who were in what is termed the “middle income group” to avail themselves of the services at a charge per complete vaccination of 10/- per child, where there were more than two participating children in the same family. Where only one or two children in the family availed themselves of the service the fee was 15/- each. I am sorry to say that the public response, even to the free scheme, was disappointing. Not more so, however, than it had been in Great Britain before the death of a young and well-known footballer from the disease evoked a mass-reaction in the adult population. About 45% of the children eligible to participate in our free scheme came forward for vaccination.
In the case of the contributory scheme, which, as I have said, did not come into operation until July, the corresponding figure was 8%; but to this, of course, must be added the very considerable numbers of children who were vaccinated privately. This year the public scheme has been extended. The age limit for children is now 18 years and, where a charge falls to be made, it will be reduced to 7/6d. each, where there are more than two participating children in a family. Where there are not more than two the charge will be 10/6d. each.
 I have already mentioned the decline in deaths from tuberculosis. In 1958, at 584, the number was the lowest on record. Though that figure, which is equivalent to a death rate of 20.2 per 100,000 of the population, represents a considerable advance, we must not be satisfied with it. Notwithstanding the very large sum already spent on the eradication of the disease and the progress which has been made, we have still a very long way to go.
Against our figure of 20.2 for 1958, the 1957 death rate in Northern Ireland was 12.5, in Scotland was 14, in England and Wales was 10.6, in Denmark was 4.9 and in the Netherlands was 4.7. By and large the average conditions of life in this country, our housing, our food and our environment render our people less liable to primary infection than the people of any of the countries which I have mentioned. This is good enough so long as the conditions, in particular the environment, do not change. When it does, our people are much more liable to catch the disease, because, not having been infected in the early stages of their lives, they have not built up a natural immunity against it. This fact is of particular significance in the case of country-reared young people who leave Ireland to work in industrial centres abroad.
Formerly tuberculosis was regarded as a disease which took its heaviest toll of the young, and which marked young women rather than young men for its prey. In recent years, however, marked changes have taken place in the age and sex patterns of its incidence, and some of these call for special comment. The first of them is that the mortality rate has decreased at a faster rate amongst women than amongst men; so that considerably more men than women die from respiratory tuberculosis. Next, the incidence of the disease is particularly marked among middle-aged and older men and, in fact, more men die from respiratory tuberculosis in the group between 55 and 64 years of age than in any other age group. Then among women, the greatest number of deaths due to that disease occurs in the group  aged 35 to 44 years. Nobody, therefore, whatever their sex and even if over 30 years of age, should feel that he or she is no longer at the risk of contracting and harbouring this disease. We must conclude, indeed, that notwithstanding the progress which has been made towards eradicating it, there is still a large reservoir of infection in the community, and because of it, still a considerable risk of contracting T.B.
The moral, of course, is that all adults, regardless of age, or sex, should use the diagnostic and preventive facilities which are available for countering the disease. These facilities are not only extensive but they are free. We have a first-class mass-radiography service. It covers the entire country, and its units visit every locality regularly. The service, let me repeat, is free. It is most regrettable therefore that the public response should be so poor that we have still a high proportion of infective cases propagating the disease among their fellow-citizens.
Thanks, however, to the fall in the incidence of the disease we have ample accommodation nowadays for all tubercular cases requiring hospital treatment. In fact, most of the chest hospitals and sanatoria have beds to spare. The smaller tuberculosis hospitals, while they have served a useful purpose in the past, cannot provide as good a service as the larger institutions, and therefore, with decreased bed occupancy in the smaller units, those hospitals become uneconomic to maintain. Accordingly we are striving where possible to adapt them for other and more pressing purposes. In consequence there is nowadays a progressive concentration of hospital treatment in the larger sanatoria, where the fullest range of diagnosis and treatment by highly specialised staffs is available.
The difficulty hitherto experienced in getting adolescents to avail themselves of the B.C.G. vaccination service continues. The National Committee in charge of that service have found, in the course of surveys over a prolonged  period, that more than one-half of all those aged 15 to 30 years in the rural areas are tuberculin negative. This is a highly significant fact, for it means that the younger elements—and I have already referred to this earlier—in our rural population have not acquired a natural resistance to tuberculosis and are, therefore, especially liable to contract the disease when eventually they come in contact with it. It is highly desirable, therefore, that this important section of the community—as well, of course, as our even younger people who are also at risk—should seek and obtain the valuable protection which B.C.G. vaccination can give them. B.C.G. vaccination is more than desirable, it is essential for those in this age-group who may wish to go abroad. For abroad, the conditions of life are likely to be such that the odds are that those who have never contracted the disease at home are likely to fall a victim to it in their new surroundings.
Cancer is one of the great killers of our day. In this country more people die from it than from any other single cause except heart disease. In 1958 it was the cause of no fewer than 4,683 deaths, as compared with 3,329 in 1930. Within these figures, the number who died from what is usually described as cancer of the lung rose from 99 in 1930 to 575 in 1958. This is a truly disturbing increase; for lung cancer now kills practically as many of our people as all forms of tuberculosis combined.
Research into the problem of lung cancer has been undertaken extensively in recent years in different countries, and numerous surveys have been made of selected groups of people. The results of these have been published and should be noted. They agree in showing that the condition is more prevalent in smokers than in non-smokers, and that mortality rises as the amount of smoking increases. I have already publicised impressive evidence pointing to an apparent association between smoking—particularly cigarette smoking—and the established increase in the incidence of mortality from lung cancer. Within the next few weeks I hope to have placed in the hands of every school child above the age of 13  or so, in national schools, in secondary schools and in day vocational schools, a leaflet pointing out how wise it is to refrain from smoking. A second leaflet will be circulated to adults.
In conducting propaganda of this sort a high degree of circumspection is called for. Nothing is gained by overemphasis. On the contrary overemphasis is likely to evoke not merely passive opposition, but positive defiance of the good adviser. Most of all, we are not a regimented people. We are still free. And, therefore, no Minister for Health can stop a boy or girl from starting the habit, or compel an “addict” to give up smoking. I hope that it will always remain thus.
All that a Minister can do, therefore, is draw attention to the established facts. But parents and teachers and others responsible for the care of children I am sure can do much more. I appeal particularly to them to impress upon those in their charge how foolish and imprudent it is to smoke. But even this will not suffice to end the disease. Cancer is produced by many agents, apart from smoking. Iron given in a certain way is the latest scapegoat. All we can say is that with the new techniques the ratio of cures to cases is steadily rising and that early diagnosis and early treatment are the most reliable guarantees against the ultimate victory of the disease.
The schemes of voluntary health insurance provided by the Voluntary Health Insurance Board are making satisfactory progress. In the 18 months which have elapsed since the Board commenced business approximately 60,000 persons have been brought into insurance, and the number is increasing daily. Within the period which I have mentioned the Board has settled over 2,500 claims from their members, representing some £82,000 in all. The success of the Board must be very gratifying to my predecessor, who introduced and piloted the legislation on which the scheme is based.
Some months ago the Board, following a review of their financial position and an analysis of their claims experience, found themselves justified in proposing to improve the benefits  in their schemes, without increasing subscriptions. The proposed improvements took the form of extensions to the existing benefits and were designed to increase the degree of protection afforded by the schemes. I consented to the Board's proposals, and the improvements have recently been introduced. I understand from the Board that as their experience grows and membership of the schemes increases they hope to be in a position to propose further extensions of benefits.
To avoid any misunderstanding, I wish to emphasise that membership of the scheme is open to everybody, regardless of his class or income, at an extremely reasonable cost. I feel that everyone who is entitled to services provided under Section 15 of the 1953 Act, or whose circumstances bring him into the margin where his entitlement to the benefits of that Section is doubtful, as well, of course, as all those who, being better-circumstanced, are not entitled to those benefits, will be gain greatly in peace of mind by becoming members. The cost of few drinks or a few cigarettes per week will be sufficient to give them adequate cover against the unavoidable expense associated with illness.
On this occasion last year I indicated that it was my intention to put in train measures which would build up an adequate reserve in the Hospitals' Trust Fund so as to give a reasonable assurance that commitments imposed upon the Fund would be met. I am glad to be able to say that the measures are beginning to show results. Shortly before the end of the 1958-59 financial year the bulk of the proceeds of the recent Grand National Sweepstake, viz., £1 million, was paid over to the Hospitals' Trust Fund, and this will, of course, reduce the current year's receipts pro tanto. But for this exceptional payment the balance in the fund would have been only £1.1 million at 31st March last. Against this there were inescapable commitments, amounting to about £1.8 millions in respect of capital works in progress and works completed but not fully paid for, as well as our obligations in respect of hospital deficits and other normal charges on the fund.
 When we think of the Hospitals' Trust Fund as the main source of finance for the building of hospitals, it is important to remember that, even as the intake to the fund has been increasing, so have the revenue deficits of the voluntary hospitals which are met from it. If, therefore, any falling-off in receipts from the Sweepstakes were to occur the consequences would be extremely serious. Furthermore, as matters stand now, it seems unlikely that the amount available for capital building works henceforward will ever greatly exceed £1 million per annum. Nothing like this amount, I wish to emphasise, will be available this year. On the other hand, there still remains a large number of hospital building projects which, though approved years ago, have not yet been put in hands.
In the two years that I have been Minister for Health I have, time and again, referred to the extremely straitened condition of the fund and the uncertainty of its only significant source of income. Notwithstanding this, I am constantly pressed for grants in respect of new projects. In respect of all such proposals, I want to make the position quite clear. Grants-in-aid of any one of them cannot be sanctioned except at the expense of many other hospital authorities to whom undertakings were given many years ago for projects, many of which are of great importance and of great urgency.
It is my firm purpose not to approve of any new project, or sanction grants for it, until I feel assured that our existing and long-overdue commitments in respect of these much-needed institutions can be honoured. Therefore, until our present approved programme appears to be well on the way to completion, it will be futile for anyone to look for a grant from the Hospitals' Trust Fund for a new project; it will be vain for anyone to try to influence me to depart from that position; and it will be worse than that to look for grants in respect of projects or commitments entered upon without my prior sanction. Let there be no doubt about it: I shall refuse to be coerced by any fait accompli; and  those who think otherwise are likely to find themselves shouldering not merely the capital cost of their new venture but every other expense arising out of it as well.
I am forced to speak bluntly in this matter because in some quarters there is a disposition to think that hospital authorities can spend first and then turn to the Minister for Health for recoupment. I trust that my saying will be hearkened to. If it is, we can make progress with our hospital and institutional programme and deal fairly with everyone, including those special classes of sufferers whose great need even for the basic hospital accommodation, we have so far not been able to meet with any degree of adequacy.
One other aspect of this matter which I wish to stress is the need for extreme economy in the design, construction and furnishing of new institutions. The days of lavish spending on hospital construction are over and, in my view, are not likely to recur. It is no secret that many experts from other countries, who have inspected our hospitals, have commented rather unfavourably on the disregard for considerations of economy manifested in their lay-out and in their building, and upon the unduly heavy burden of overhead and running costs which this fact must impose on the national economy.
Personally I do not believe that the art of healing is made more effective by unnecessary spending. Our recent experience with sanatoria indicates that in this age of rapid therapeutic discovery, it is unwise to design hospitals as monumental buildings; since new drugs and new techniques may rapidly empty some of them of patients, leaving them to be converted at substantial cost to other uses—uses, indeed to which they may not be very readily adaptable.
For several reasons, I am convinced that in future we must carefully consider whether many hospital requirements cannot be adequately met by using standardised plans, capable of being readily adjusted to suit particular  sites, and, in the execution of these plans, using to the greatest extent possible pre-fabricated or partially pre-fabricated components. The two principal reasons which compel me to this view are the need to cut down the capital cost of hospital shells, and the need to make good as rapidly as possible present deficiencies in accommodation for certain special classes of patients, notably those suffering from mental illness, handicapped children and children and others afflicted with defects of the mind.
Even with the conditions which I have laid down, it is certain that many of our long-standing commitments cannot be honoured for a long time. Within the next few years, it will not be possible to finance more than one or two projects of any magnitude. It will be necessary, therefore, to determine which of the many before me will be proceeded with soon, and which should be deferred, perhaps for many years. The place in the queue in which projects find themselves will be determined, other things being equal, by the cost per bed. Therefore, hospital authorities who wish to secure the early realisation of their plans, should insist that their advisers confine themselves to inexpensive, though appropriate forms of construction and decorative treatment. In our future hospitals, we do not need magnificence; what we do need is utility with economy. And it is on this basis that building priorities will be determined.
In October, 1951, a White Paper was published, in which was set out the Government's intention to reconstruct and develop existing county homes as hospitals for the chronic sick and as homes for old people. The policy as outlined involved the transfer to special institutions of all other classes, for example, unmarried mothers, children, mental defectives, blind persons, etc. who were then, as now, accommodated in county homes. And it also envisaged that voluntary agencies would be assisted by local health authorities to establish or improve institutions catering for persons who would otherwise be accommodated in county homes.
 The cost of adapting the buildings for these purposes was to be met from loans raised by local authorities, mainly by borrowing from the Local Loans Fund. Repayment was to be made over a period of forty years and the Exchequer was to recoup the local health authorities in respect of the annual loan charges payable by them to the extent of 50 per cent., subject to the proviso that the amount on which recoupment would be made would not exceed the equivalent of £500 per bed in the new or improved accommodation.
Works costing about £250,000 have been carried out under this scheme. They include, in Dublin, improvements to St. Kevin's Hospital and the conversion of Cork Street Fever Hospital for the accommodation of old people, improvements to the City Home and Hospital, Limerick, and the provision of a home for unmarried mothers at Dunboyne Castle, Co. Meath. Owing to the balance-of-payments crisis of 1956, it became necessary in that year to defer consideration of further schemes until such time as they could be undertaken without endangering the economy.
Now that our financial and economic position has improved, and that the danger of a collapse has been surmounted, I feel that the reform of the county homes should not continue to be deferred. I have given instructions, therefore, to the Department to set the scheme moving again and to put the essential preliminary alteration and reconstruction works in train. I know that Deputies will agree that it is high time that this should be done, so that the old concept of the county home should disappear once and for all. Reconstructed and adapted as is proposed, the existing structures should provide a measure of the essential facilities, now so deficient, for the care and treatment of the chronic sick and the aged; the other people now accommodated in these institutions will be transferred elsewhere and afforded proper care in decent surroundings.
The net amount of the Estimate which is before the House is £8,212,050, an increase of £59,150 on the Estimates provision last year. If we ignore the Exchequer subvention of  £318,300, representing the receipts from the Local Taxation Account, and add the cost of services provided by other Departments without repayment, the amount to be met by the taxpayer is £8.57 millions. The amount to be met from the rates is estimated at £8.32 millions, so that the taxpayer and ratepayer will contribute in the current financial year a sum of nearly £16.9 millions for health services. To this we should add the subvention which another public fund, the Hospitals' Trust Fund, gives to meet the deficits on the voluntary hospitals. We then find that the public expenditure on health services from public funds in the current financial year is estimated at the rather staggering figure of about £17¾ millions.
Naturally we must ask ourselves what value does the citizen get from this large expenditure? First, a completely free comprehensive health service, covering medical, surgical, maternity and infant, psychiatric and hospital and specialist care, is available to those who by their own industry or other lawful means cannot provide these for themselves or their dependants. Not more than 30 per cent. of the population come within the category of those who are entitled to have the whole range of medical services made available to them at the public expense. Next; for the middle income group, representing about 55 per cent. of the population, there is a completely free maternity and infant service and, at low cost, a complete hospital and specialist service.
Lastly, everyone, no matter what his or her circumstances may be, can have treatment free of expense for any infectious disease, including tuberculosis, diphtheria, scarlet fever, enteritis and poliomyelitis—to mention a few. In addition, allowances are payable to the disabled; and there is for all an excellent public health service. Under this comprehensive scheme, much illness is prevented and, when illness occurs, curative services of a very high order are within the reach of all.
A few specific examples of what has been achieved will show how effective  the preventive and curative services have been. Tuberculosis is a case in point, for here mortality and morbidity are being reduced steadily, so that in 11 years the number of deaths from this disease has fallen from 3,103 to 584.
Mr. Dillon: Hear, hear!
Mr. MacEntee: The incidence and, in particular, the mortality rates in respect of some other infectious diseases have also greatly diminished. Scarlet fever is an outstanding example. In 1947, there were 1,660 cases and 6 deaths, or 1 death per 277 cases; last year, 1,145 cases were notified, but there was not a single death. In the case of measles, although its incidence is still very high, the number of deaths declined from 106 in 1947 to 6 last year.
Though a much higher standard still is capable of attainment, there has been a marked improvement in the maternal mortality rate. Whereas, in 1947, the death rate in child-birth was 2.15 per thousand births, last year it had fallen to 1.03 per thousand births. There has been a similar decline in the mortality rate in infants under one year. In 1947, it was 68 per thousand births; but by 1958, it had been reduced to 35 per thousand births.
The undeniable benefits which, as a community and as individuals, the people in general have derived from the health services are manifested, not only by the facts which I have given in relation to particular diseases but in the ever-lengthening expectation of life to which in the normal course everyone may now look forward.
My endeavour will be not only to maintain, but to improve and, within the limits imposed by our available resources, to expand the services through which longer and healthier lives have become the general lot of our people. In furtherance of this purpose, the Department for which I am responsible will take full advantage of current progress in medicine and surgery and their ancillaries. The officers of the Department are charged to ensure that all health services are administered as efficiently and  economically as possible. It is their particular duty to see that within the scope of the Health Acts the individual is fairly treated and is promptly afforded all the services to which he is legally entitled. I do not think that anyone deserves more.
A substantial proportion of the complaints which I receive are from individuals who want more, and with them I have no sympathy. I think rather of the £17¾ millions which the health services cost and of the decent people who are taxed to provide this money, and who do not seek to impose themselves without due cause as a burden upon their fellows. Unfortunately a few of the complaints which I receive are found on investigation to be justified. Where this happens, those responsible are dealt with firmly, but, as my aim is, fairly. Sometimes what I or my officers have to do in fulfilment of our responsibility to see that the Acts are justly administered may not meet with the unqualified approval of those affected, but I think I can say that with the general body of those— the executive officers of the several health authorities, doctors, nurses and hospital administrators—who are actively engaged in the services, our relations are harmonious and co-operative. I hope they will continue to be so; for I appreciate how greatly the future of the health services depends on the maintenance of such a relationship.
Before I sit down, I should like to make a passing reference to and to issue a word of warning in connection with the advertisements which appear in Irish national newspapers from time to time offering employment to girls either as probationer nurses or as domestics in health institutions in Britain. While the conditions in the majority of these institutions are satisfactory, it has been brought to my notice that in some cases the terms of employment include a condition that service may be terminated by a week's notice on either side.
When this clause is invoked by the employers, it frequently happens that girls who have been in employment for only a very short period and who have not had time to establish contacts  in their new environment find themselves in a very difficult position at the end of the period of notice, as they will not have had sufficient time to make alternative arrangements either to take up new employment or for accommodation locally while seeking such employment. I think it would be well that all girls seeking employment in reply to such advertisements should ensure that the terms of employment include a condition to the effect that they will receive adequate notice, if their employer should wish to terminate their engagement.
Mr. Dillon: I move:—
That the Estimate be referred back for reconsideration.
If we accept the figure of £17¾ million as the annual charge for our health services, I wonder would the Minister agree with me that the time has come when the whole structure of our health services requires revision, with a view to determining whether an annual expenditure of £6 per head of the population, as they are at present costing, is giving the people real value for their money. I am bound to say this: From the point of view of someone familiar with rural conditions—I want to emphasise there is a distinction between urban and rural conditions and I do not profess to be an informed authority on conditions in the cities of Cork, Dublin or the like —in respect of those of our neighbours who in the past we expected would receive medical or surgical treatment free and expeditiously, we now experience the fact that such persons not infrequently find themselves unable to have access to the services, whereas others who do not seem to be so urgently in need get the benefit of such services as are available.
Let me give a case in point. I knew a labouring man in rural Ireland who was recommended by the dispensary doctor to see an oculist, on the ground that his recurrent and disabling headache derived from some ocular defect. He attended on six separate occasions at the dispensary on the day appointed for the attendance of the county  oculist. On each occasion, he was told that there were already a sufficient number of patients in the waiting room to occupy the oculist that day and that he could not be seen. Ultimately, he had to go with the help of his friends some distance to an oculist in a neighbouring town and have prescribed there the spectacles which he required on a prescription which had then to be sent to a manufacturing optician and the spectacles paid for. Yet, he was a labouring man for whom one would imagine a health service costing £17¾ million per annum could provide a pair of spectacles. I am quite satisfied that that man could have gone on going up to the dispensary almost indefinitely and would never have got the treatment he required because there would always have been more people in front of him than the oculist was prepared to deal with.
Facts of that kind require investigation and it it a useful thing that Deputies should intervene in this debate who do not hold themselves out as experts on public health administration because what is vitally urgent is that the Minister responsible in this House should hear the tale told from the point of view of the poor rather than from the point of view of the administrator. What is really important in our health service is not the beauty of the machine that is supposed to operate it but the effectiveness of the service in relieving the sufferings of the poor because the well-to-do, in the last analysis, if they are not satisfied with the service they get from the public provision that is made can have recourse to alternative service but the really poor cannot. I give that one case as an illustration of a situation for which I do not propose, with the limited information at my disposal, to prescribe a remedy but which, I suggest, illustrates the case that exists for a general inquiry into the way existing health services are working.
I now give another illustration of the kind of thing which I think is causing considerable public malaise. Some old lady writes to me that she wants artificial teeth, an old person drawing a widow's pension, and she  finds that a neighbour living a mile down the road has access to that service and has got artificial teeth but, because she lives a mile down the road, in the jurisdiction of another local authority, she cannot get them and is simply told that the resources will not permit of her difficulty being met, that all the money available is required for the treatment of children and adolescents. There may be a good reason for that but certainly in rural Ireland it gravely exacerbates the sense of privation of the person experiencing it if he or she sees a neighbour receiving readily a benefit that is withheld from him or her when that benefit is of a character that materially affects his or her daily life. There is no doubt that elderly people have their lives radically changed by the provision of artificial teeth where they are required and the lack of them can involve very real suffering of a kind peculiarly difficult to bear because it is constant, relatively trivial, but cumulatively extremely distressing.
Again, I am not prepared to pretend that I am in a position to prescribe the remedy but I do say that this is another facet of the existing situation which to me suggests that the time has come to review our whole health services to see if we could not get better value for the money we are spending than we get at the present time. The burden of my complaint must be that, whereas in the past I never knew the poor in rural Ireland to go without whatever treatment they required, to-day I experience constantly the situation in which the really poor cannot get the treatment and, in many cases, those much better-off are preferred before them. In so far as that is true, I think the machine has broken down and I very much doubt whether appropriate remedies can be found unless and until an adequate inquiry is made into the whole problem and suitable reforms envisaged and enacted.
The Minister has referred to the sanatoria and their monumental character and the fact that many of them now appear to be superfluous and half-empty. That seems to be  causing him great distress of mind. To me, it is a glory. That is what we set out to do. Ten years ago you could not get into a sanatorium in this country for six months after you were diagnosed as suffering from tuberculosis. There is not a single Deputy or a single responsible person resident in rural Ireland who does not remember the purgatory of going around from Billy to Jack craving a bed for a case of open tuberculosis and frequently having to wait anything from four to eight months to get the patient in, then learning that one had secured the bed too late for not only was the patient fated to die but in the interval of waiting had infected one, two or more members of the family to which he belonged. To-day, the Minister is in the happy position of saying that no one need wait 24 hours and he points with satisfaction to the reduction in the death rate from 3,103 per annum to 584.
Let us face this fact. That admirable record of empty sanatoria, of a death rate from tuberculosis reduced from 3,103 to 584, and of a bed available for anybody in Ireland who is suffering from the disease, is in part due to new therapeutic procedures but is almost entirely due to the fact that we made the beds available into which the infective cases could be promptly removed and that the spread of the disease in the families has been arrested and the curative procedures brought to bear upon the disease at the earliest possible moment. If we have empty sanatoria now, let us glory in that fact because I remember when this programme was inaugurated. I remember when we started to build the sanatoria. I remember we then hoped that within 25 years the sanatoria then being built would be empty.
That was our objective. We set out to build them in the hope that in 25 years half of them would be empty. We knew, when we were building them, that that would be the criterion of our success or failure. Is it not something we ought to thank God for that we did not have to wait 25 years to achieve our objective? So effective were the dynamic proposals inaugurated  in 1948 that within ten years, we were in the happy position that the Minister for Health in 1959 is wringing his hands and weeping tears that his sanatoria are empty.
Thanks be to God, they are empty. That is what they were built for and every far-sighted administration in the world has had the same experience. The tragedy has been where this problem was tackled with a niggardly, fainthearted approach and in these cases the sanatoria are not empty. They are still full, and where ample provision was not made right from the beginning, you have a long weary story of sanatoria overflowing with patients and little or no progress being made in the conquest of this fell disease, but because in this country we had the vision and true sense of proportion that to save lives that could be saved was immediately worth the outlay of money, we are in the happy condition that the death rate has fallen from 3,103 to 584 and that our problem to-day in regard to tuberculosis is that we have too many empty beds.
That should be the least of our troubles. With a little sensible planning, it ought to be possible to transform some of these monumental structures to which the Minister refers to other purposes, but so long as they are there, we shall see them not as monuments to the dead but as triumphant monuments to the fact that last year 2,600 young people in this country did not die who would have died in one year, if we had not embarked upon the programme which, with our eyes wide open, we inaugurated in 1948. Before I depart from that, I should like to say that one of the proudest boasts of the Coalition Government was that they inaugurated that great scheme.
Mr. MacEntee: They did nothing of the sort. The sites——
Mr. Dillon: It conferred upon our people the benefits which the Minister for Health has recorded to-day. I should like to recall that it was the Coalition Government, representative of every element in this House, except the Fianna Fáil Party, that inaugurated that scheme and I should  like to glory in the fact that, though many despair of ever teaching Fianna Fáil anything, the Coalition Government not only inaugurated the solution of this grave problem but they taught Fianna Fáil the lesson that it could be solved. Remember that for 16 weary years before that, they had believed it could not be solved and had accumulated the money in a growing heap upon which they comfortably sat deploring that this problem was virtually insoluble.
Let us all join together in mutual rejoicing that with a little courageous leadership from a Coalition Government, Fianna Fáil joined in the excellent work inaugurated ten short years ago, as a result of which we can jointly rejoice that last year 2,600 young people who would have died did not die and that the empty sanatoria are monuments to their survival. I think the money was well spent, if it saved one of those children for one family whose parents would otherwise have mourned. How well we may rejoice that in one year 2,600 families in our community were spared the purchase of mourning because we did what we did and we started what we started ten short years ago. The Minister spoke on the maternal death rate declining since 1947 from 2.15 to 1.03. That is a very satisfactory record, too. A reduction of 50 per cent. in the maternal death rate is something of which we may be proud. Further progress no doubt will be made but could the Minister tell me what the trend has been, say, in the past three years? I saw recently a statement at a symposium held in this city that, while there had been a gratifying decline over the decade of years, in the past two or three years, the trend had turned in the opposite direction and that the maternal death rate had shown a tendency to increase.
If my memory serves me right, the speaker, who professed to have some expert knowledge, suggested that the wide expansion of domestic accouchement for women had resulted in some percentage of cases which might have been more properly dealt with in a maternity hospital, where special facilities  are available, being dealt with at home, with a consequent deterioration in the maternal death rate. I do not know whether that is true or not. I know there is argument on both sides, some saying it is better for the mother that the child should be born in a fully equipped hospital and others arguing powerfully that in cases where normal birth is anticipated, the domestic surroundings are preferable.
This, naturally, is a question upon which I can form no opinion, but if the statement to which I now refer is to be taken at its face value, it would appear that some inquiry should be made into the general question because the costs of domestic maternal treatment, excluding gynaecology and dealing exclusively with midwifery, are pretty steep. I know a dispensary doctor in rural Ireland whose dispensary salary is in the order, I think, of £1,200, including salary as dispensary doctor and other small emoluments which he may receive, who receives annually cheques amounting to £900 for the domiciliary midwifery practice under the Health Act. That is a formidable figure and that is one dispensary doctor. I do not want to suggest to the House that that figure is an average figure: I am not in a position to say that. I am saying that is the figure which I know is paid to one doctor. I imagine the average figure, taking one dispensary area with another, would have very little significance, bearing in mind the different sizes of dispensary areas and that some have substantial towns in them and some have not. The one to which I am referring has a substantial town; but I know of other cases where doctors receive £600 or £700 a year for their domiciliary midwifery practice under the Health Act.
If that is helping to reduce the maternity death rate, the money is well spent, but if it happens that it is not in fact contributing to greater safety for the children and the mothers, then this also, I think, would call for calm and objective review with a view to determining whether the patients, who are the people who matter in this context, are getting value for the money spent.
 Nobody should lose heart in Dáil Éireann: that is the beauty of a democratic Parliament. There is a question which I think is immensely important and which I have been labouring in this House for years and on which I am greatly encouraged today. I have been thumping the drum here for 20 years about the treatment of juvenile delinquents. I read in the evening paper—I need hardly expect that we would be told in the Dáil— that the things I have been trying to get done for 20 years are to be done. I suppose in the course of the next 12 months some Minister in the Government will consider it worth his while to come and tell the Dáil about it. That encourages one to keep struggling for things which sometimes one feels one is making no impression about.
I want to talk about county homes. I was filled with dismay to hear the Minister announce today that he proposes to refurbish all these old revolting establishments throughout the country and saddle us with county homes for ever more because if we spend money on these disgusting old barracks, we shall be persuading ourselves, like the emperor of old, that we are beautifully dressed and unfortunately there will be no innocent infant to say: “That old gentleman has no old clothes at all.” I suggest no matter what frills or furbelows you put on county homes, it is an act of barbarism to take an old, solitary person from the town or village in which he was born and reared and transport him 30 miles away from his neighbours and put him in the county home.
I think of some of my old neighhours, old men who spent their lives working hard and who struggled desperately to keep their little room and gradually their neighbours helped them with food and clothes to enable them to stay where they could stroll out in the course of the day and have a chat with friends and neighbours, smoke their pipes at the corner of the street and hear the news. Ultimately, they become crippled in a way that there is danger they would fall in the fire, or they were unable to dress themselves or could not keep their room even moderately clean with the help of  neighbours. Then comes the fell day on which they cannot get out of bed and there is nobody to look after them. Finally, the ambulance comes to take them to the county home. Then you make the grim discovery when you go to visit them, that their health has improved and you feel, perhaps, that one of the greatest tragedies that can overtake them is that they will not be allowed to die.
Taken from the home where they become destitute because of ill-health rather than from want of resources, they are brought to the county home 30 miles away; their health returns, their colour improves; where they were dirty, they are now clean. But they have lost something infinitely precious—the desire to live. That which was burning and intense and powerful, that which made them revolt against the thought of being carried into an ambulance to be drawn away, that which gave meaning to life has gone from them and there is given to them a whole lot of amenities which they do not want because the one thing they cherish is no longer available— the sight of their neighbours and the sound of their voices.
Would some other Deputy from rural Ireland get up and tell us what he knows of the old person who is taken from the environment in which he has grown old and put in a county home 20 or 30 miles away? I put it to the Minister in the earnest hope that he will believe me when I tell him that I am not trying to make difficulties for him in this regard, but I think it is a complete illusion to spend public money on county homes particularly as his plans envisage the removal from them of the chronically sick and the mentally afflicted to appropriate institutions. It will be a disaster for rural Ireland if the county home is perpetuated for the aged and the infirm. You are giving them everything but the thing they really want. You are giving them everything but the thing that will make them really happy, that which makes life significant to them.
I think there is a remedy, an alternative, which I do not believe would cost as much. I believe it would achieve an  amount of human happiness which would be very hard to measure. I suggest that we should have in every parish a modest parochial home. Mark you, under the old system in Britain when it was a Catholic country, and when there was charity of that kind abundantly available, that was the system adopted. In every small rural community, there tended to grow up almshouses supported by benevolent endowments of rich people who left sums of money to maintain them. You would find rows of cottages which were approximately adequate to house the poor of the parish who could not provide for themselves. In such charities, there were commonly to be found some apartments designed for the accommodation of the helpless poor and their helplessness was relieved by the ministrations of an almoner assisted by the active aged occupants of the other units in the charity.
That was, and is, the ideal system and if the Minister really means to adopt an imaginative approach to this problem, I put this to him: will he not differentiate between conditions in cities and conditions in rural Ireland? It does not make very much difference to the aged person who requires institutional accommodation in Dublin whether that accommodation is in Drumcondra or Rathfarnham because his friends and relatives can take a bus and go out to see him. He will never be very far away from those with whom he is familiar.
To take someone, however, from Ballaghaderreen and put him in Roscommon is tantamount to putting him down in Tralee because to get from Ballaghaderreen to Roscommon is a day's journey, there and back, and the cost is quite out of the competence of the kind of people whom he would like to see. In any case, he sees them in a way that is entirely and radically different from the way in which he wants to see them. It is no comfort to him to have people coming in commiserating with him for the misfortune that has come upon him, bidding him “Good-bye” and “Maybe I will never see you again, John”, and the visitor then goes home and leaves John 30  miles away from his old home.
Compare that with the condition of the old person who is living in a decent apartment on the outskirts of the town in which he was born, based and reared; he can stroll in in the evening of the market day, ramble around the town, hear the talk and gossip and chat. If a neighbour passes by on the road outside where he is spending his declining years, it is possible for him to ask that neighbour in to have a cup of tea. He is not a pauper. He has a decent room into which he can bring a friend. He is a man with an apartment into which a neighbour can ramble, and he himself need not be the rambler in search of company all the time.
Compare that with the narrow bed in the county home, the enamel cup, the enamel plate—the derelict, the abandoned—and all that means to the country person 20 or 30 miles from home. If Deputies representing rural Ireland will join their voices to mine in this matter, I believe we can get something done. If a couple of million is spent refurbishing the workhouses our neighbours will be in them long after we are all dead and buried. If half that sum were spent now in devising ways and means of getting accommodation suitable for aged people, so as to avoid the necessity of removing them from their home environment, we could pull the workhouses down and forget that they had ever been built.
There are very few things in this world of which I am certain, except the existence of God and the revealed truths of religion. The longer I live the fewer things appear to me to have a degree of certainty approximating to them. This is one of them: to take country people from the environment in which they have been born, bred and reared and put them in an institution far away is no panacea for anyone. I think it is true that in every community the bulk of the old and afflicted can, with the assistance of our existing social services and the help of their neighbours, carry on on a reasonable basis of comfort and security. In any case, they can carry on in a mode of life infinitely preferable to them as against any institutional treatment.
There will admittedly continually recur the problem of the old person  who grows helpless and who has no family or immediate relative with whom to live. That old person cannot be left alone lest he, or she, may come to harm. But I want to make a strong appeal now to the Minister that old people in rural Ireland should not be accommodated in county homes or workhouses. We should tear these institutions down as unsuitable for human habitation, with their stone corridors and grim exteriors; we should provide that a person born and reared in Castleblayney will stay in Castleblayney until the end of his days, and that a person born and reared in Clones will not be compelled to finish his days in Castleblayney, which, for the ordinary amenities of his daily life, will be as remote for him as if he had been transferred to Waterford or Cork.
Does any Deputy, except myself, receive a stream of protests from his constituents that they cannot get blue cards while neighbours in far better circumstances have them readily made available to them? Maybe I am peculiar, but I do not think I am. Remember, if Deputies will not get up and tell the Minister what their experience is there is no means of the Minister's knowing. I am prepared to meet any constituent's unreasonable complaint with remonstrances, if I think it is unreasonable, but I do not like being in the position of having to answer a constituent and tell him that I cannot do anything when I feel he has got a real grievance. Is there any possibility of establishing some system whereby, if a county manager says a person is not entitled to a blue card and the person sincerely believes he is, that claimant can have some right of access to an independent referee?
Mr. Moher: He has an appeal, has he not?
Mr. Dillon: No.
Mr. MacEntee: He has no appeal.
Mr. P.J. Burke: It is at the discretion of the county manager.
Mr. Dillon: It is at the discretion  of the county manager. The claimant has no appeal. I do not want to make any onslaught on county managers. They are the conscientious servants of the local authorities employing them. They have a dual function. First, they have to protect the ratepayers and, secondly, they have to see that the people get the services to which, under law, they are entitled. Now, every sensible man will tell you that if you want to buy a house you should not employ the vendor's solicitor. There must be two separate solicitors. It seems to me there is some fundamentally mistaken element in this business when a man, whose duty it is to protect the ratepayers, has imposed upon him simultaneously the function of final arbiter of the rights of somebody who wishes to become a charge on the ratepayers. I do not think there is any living creature who can with universal satisfaction discharge that dual function. It may work out in practice.
Doubtless, as a result of a broad general direction, the county manager can sort out the cases with a high degree of equity, but surely we ought to be able to think up some device by which those individuals who are denied the blue card would have access to a referee. I should like any Deputy—this would help the Dáil in its deliberations—who feels anybody has been refused a blue card and who believes that that person was entitled to such a card, to get up here and say so. I think people who are entitled to these blue cards are being refused them. There is a pretty powerful vested interest operating in rural Ireland to secure that a great many marginal cases will be turned down. I would not make the case I have made if I did not believe it to be true. I am in the dilemma that I am not in a position to say to my constituents when they write to me and complain: “You have a remedy.” If a person complains that he is not getting an old age pension to which he is entitled, I can send his case to the Minister and he will send it on to the appeals officer.
The average reasonable constituent in Monaghan, in my experience, accepts it as a fair do, that he should  have access to a referee, but he does not feel he is getting a fair do if, as in this case, an officer of the local authority, one of whose particular duties is to protect the ratepayer, is the final deciding officer as to a person's eligibility and has apparently no obligation on him—though indeed the courteous officers of the local authorities in Monaghan have always helped me, as I am sure they have helped Deputy Mooney when he was in a similar difficulty—to explain so far as he can the circumstances which induced him to reach his decision. I do not think there is any statutory obligation to give me or anyone else this information.
The county manager could say, if he chose to do so: “I have decided that A.B. is not entitled to a card and that is that.” I remember 20 years ago a practice grew up in the Custom House that if a person was refused an old age pension, they would not tell you on what grounds it was refused. They would say it was excess means, but if you asked what the excess means were, the reply was: “We cannot tell you that.” The number of grievances that created in rural Ireland had to be experienced to be believed. They would say: “He has so many acres of land and four cows, three heifers, and a horse and so forth and we estimate they yield a certain income.” Whether it is that he knows he is being found out or not I do not know, but sometimes—I admit rarely—there was an indignant rebuttal of that: “I have no bullocks, no cows, no horse”, and cases have been known where the investigating officer's examination proved to be mistaken. It is much easier to change his findings, if you know what they are.
I do not think the public administration position has been rendered impossible by the provision of information but it has certainly proved to be a great relief to the people who were labouring under a grievance in the past because for some reason, unknown and unknowable, a pension was being withheld from them to which they felt they were entitled. I ask the Minister favourably to consider either of two plans. One is to establish an appeals officer——
Mr. MacEntee: That would require legislation.
Mr. Dillon: I do not think it does. Why does the Minister say it requires legislation? Is it because he is afraid to deal with the problem? That is only a silly device. There are plenty alternatives which do not require legislation.
Mr. MacEntee: I was merely indicating that it is not in order to advocate legislation.
Mr. Dillon: Do not be silly. If the Minister is too incompetent or too lazy to face this problem, I shall suggest other methods to him, if that is not suitable to this discussion. Would the Minister then give directions that the county manager, who is at present the administrative officer, should provide the claimant with a detailed statement of the reasons for which he has refused to give him a blue card? If it then transpires that the allegations on which the manager founds his refusal are incorrect, doubtless a means would be found, within the law, to constrain the county manager to do what is necessary.
I implore the Minister if it is humanly possible for him to shed the facetious folly in which he habitually luxuriates when addressing this House. I am trying, on a reasonable basis, to bring to his attention defects which exist in the existing health services, and which I believe a great many of his colleagues who are sitting behind him would agree with me are defects, if they had the spunk to get up and say so. I am trying to suggest that in respect of some of them at least, some ameliorative measures should be taken —and we might not have to operate them for very long in order to remove the very deep sense of grievance which at present exists—on the very sound ground that I am perfectly certain you will not remove that sense of grievance until you give the people who entertain it a reasonable method of having the grievances under which they believe themselves to be labouring, tested by some impartial authority or referee, other than the county manager, who at present manifestly has a dual and  conflicting function as the protector of the ratepayer and of the potential beneficiary of the health service, with special reference to the blue card.
I want to refer to another matter in the hope that the Minister for Health, despite his conservative observations about the resources of the Hospitals' Trust Fund, will be able to deal with it. I refer to the mental hospitals. I want to say with calm deliberation that the time has passed when discretion imposes upon us the obligation to maintain silence about the conditions in our mental hospitals. They are a public scandal and we all know it. It is really a dreadful tragedy that mentally afflicted people are left in the conditions in which they at present are, in the vast majority of the mental institutions in this country.
The mental hospitals are overcrowded; they are scandalously equipped; many of them are grossly unsuitable survivals from the last century; the amenities provided for the patients are a horror; and, in the experience of the vast majority of Deputies here at present, one of the most distressing obligations which can devolve upon any of us is to go to the general ward of a mental hospital to visit the chronically mentally sick. That is something of which this House should be ashamed.
I do not believe in going into too great detail in the description of an evil of that kind but, if there is no other way of getting a move on, I think I shall not be the only Deputy who will undertake that disagreeable assignment. I believe that if I coldly and deliberately described the conditions obtaining in certain of our mental hospitals, which are common knowledge to many Deputies, it would create a scandal so great as to move any Government from whichever side of the House it came. I think something could be done about that now and one of the first things that requires to be done is to build auxiliary hospitals sufficient to reduce the actual population of the mental hospitals to something approximately  commensurate with their proper capacity.
The fundamentally approximate evil is overcrowding. There is also the very grave problem that many of the premises are too old and are not properly designed for mental hospitals but, even in the relatively well-designed and relatively modern mental hospitals— those no more than 50 years old—overcrowding is a perfect horror and, if my information is correct, renders the efforts of conscientious R.M.O.s utterly ineffective in trying to treat the patients, to treat them therapeutically and to provide them with tolerable amenities.
We have got to face the fact that one of the ghastly features of this situation is that the mentally afflicted are too often forgotten. There is a natural tendency, once they have been safely deposited in an institution charged to care for them, that nobody wants to talk about them. The great danger is that that vast conspiracy of silence will permit conditions to obtain which none of us would attempt to justify if they were fully ventilated, but I think that we should impose an unreasonable and an undue burden of added trouble on the backs of those who have friends and relatives in these institutions were we dispassionately to describe the conditions obtaining in many of them. Nor do I think it would be responsible on my part to raise this matter in so urgent a form if I were not prepared to make some proposal to the Minister for its immediate alleviation.
The first suggestion I make to the Minister is that out of the population of any mental hospital there could be drawn a considerable number of patients who could be accommodated in relatively simple accommodation. I refer to the cases of old people for whom there is little prospect of improvement, bedridden people and categories of patients of that kind not requiring the constant and vigilant supervision that ambulatory patients in mental hospitals must have. Therefore, if you could provide annexes in separate buildings to accommodate these categories of persons, the staff required to manage them would be for less than is required when these  patients form part of the ordinary population of a mental hospital where the ratio between staff and patients must be kept at a certain level owing to the disturbed condition of some of the patients.
The second proposal I have to make to the Minister is this. I do not know if his attention has been drawn to certain experimental work proceeding in the South of England. The medical officer of one of the big mental institutions in the South of England was faced with this very problem of having a mental hospital which he believed was adequate for the area it was designed to serve, but the resources of the institution were being grossly overtaxed by the necessity for accommodating a large category of patients whom hitherto it was thought impossible to treat or, indeed, to accommodate except on an institutional basis. That resulted in intolerable overcrowding. He got the permission of the local authority for which he worked to experiment with a scheme under which certain categories of patients, reasonably old people and people suffering from mild forms of senile dementia, were allowed to go home where their families had accommodation to receive them, on the understanding that the mental hospital would maintain a constant service, analogous to the Jubilee Nursing Service operating in this country, to visit them regularly, to provide help where it was necessary in the nursing and care of the patients in the homes of their immediate relatives.
That seemed so simple and so obvious a thing that one could not imagine it could have any very dramatic result, and yet I do not know if the Minister's attention has been drawn to recent reports on the experiment. It has resulted in that area, in two short years, in the entire problem of overcrowding in the existing mental institutions being overcome, and where before this R.M.S. was labouring under a chronic and apparently insoluble problem of gross overcrowding, he is now in a position to say he has vacant beds for cases which may require institutional treatment. He has had no difficulty over the last  two years in any of the cases where he has allowed the patients to go home, supported by this system of domestic care, which has imposed a charge on the local authority but which is substantially less than would have fallen on the local authority if these persons had been maintained in institutional care.
I suggest to the Minister that at least an experiment of that kind might be attempted. Doubtless it would be met with varying degrees of success but it would be some contribution to the solution of the existing deplorable situation that at present obtains. I think we should here resolve that if there is not something pretty effective done during the course of the next year, the time will then be ripe to give this House a factual description of the conditions obtaining in some of the mental hospitals in this country. If any Deputy faithfully discharges that duty, I think we will have every reason to hang our heads in shame.
The last thing I want to refer to is the care of the retarded child. I gathered from the Minister's opening statement that he had something general in mind. He went into very considerable, extensive detail and for that I commend him, but I think he ought to be in a position to give more information about the retarded and afflicted child. I acknowledge that he has referred to the problem in his opening statement and I am quite prepared to accept that he recognises its gravity and extent. The only thing I complain of is that I get little or no reassurance from the statement he has made. I do not think the problem is materially greater than one of accommodation. I do not believe it can be satisfactorily dealt with except through the medium of persons with a religious vocation. So far as I know if we were prepared to provide the accommodation the personnel would not present the greatest difficulty. Orders of religious could be found who would undertake this immensely onerous task.
I need not labour this question because I feel it is as much present to the  mind of other Deputies as it is to my mind, but it is no harm to say that when you go to an institution like Merrion and see what is being done and can be done for blind children, when you see what a revolution is made in their lives by being brought under the care of persons dedicated to that task and who have trained themselves to this work, it is a revelation. It is not only a revelation of the benefits that are conferred upon the children; to me the great revelation is the immense dedication required if the task is to be successfully done. So difficult and formidable is the work, that nothing short of a religious vocation will meet the exigencies of the demands that this kind of disability makes upon these who accept the responsibility for care of children so afflicted.
Great as is the affliction of the child blind from birth and complex as are the problems of its care and education, there is the great reward of making it in some degree equal to the burden of meeting life and living usefully. That is the great reward for effort spent. But there is in the case of the mentally-retarded child the terrible additional burden upon those charged with its care that there stretches out before them the virtual certainty that all they can do produces no visible result and simply means that they are being cared for in conditions which make life as comfortable and tolerable as it can be made for them.
I do not think we ought to wait to provide the accommodation necessary to deal with the number of such afflicted children we have in our community. I know of no greater trial for a family than to have such a child and to feel that it cannot do for the child all that might be done especially where the effort to do the best a mother can do means that other children in the home must be, in some degree, neglected. The daily struggle of an ordinary mother of a family trying to determine what is fair and equitable between the claims of the afflicted child and those of the other children is a burden which is very hard to conceive unless one has had experience of it.
 I know the Minister to be of a conservative mind but I do not think the economic foundations of this State would be shaken if we ascertained the dimensions of this problem and took the decision forthwith to provide the accommodation. We were told ten years ago by many wise people that to provide the sanatoria necessary to save the lives of those who did not die would shake the economic foundations of this State. We told them to take a running jump at themselves and that, if the foundations shook, in God's good time they would stop shaking, but if the children died the balance in the Bank of Ireland would not bring them back, that so far as we were concerned we would much sooner see the foundations shake than prop them up with the coffins of our people.
I believe we were right. There are approximately 20,000 people, boys and girls, alive today who would have been dead if we had not put the Hospitals' Trust Fund in debt. There would be 20,000 families mourning a dead child, who have instead attended its wedding, if we had not put the Hospitals' Trust Fund in debt. Who says we were wrong? Not even the most poisoned tongue amongst them. The Minister goes as far as he dares to suggest we were wrong by complaining of the load of debt he has been trying to get rid of. I glory in every penny of that debt. It was much better spent on equipping them for their weddings than buying coffins to bury them.
The problem on which I speak with a much more liberal attitude is that of the afflicted child. We must face the fact that in the vast majority of cases, though not all, institutional treatment has little prospect of cure, but if we cannot cure the children we can do a great deal to improve the circumstances of the family called upon to bear the cross of the afflicted child. I would suggest to the Minister that this is a matter in respect of which he might take a risk. If he can find the dedicated personnel to man these institutions he should provide the accommodation for all these children and trust confidently in the capacity of our people to meet whatever charge will come in course of payment to provide whatever that afflicted microscopic  element in our society require for their relief.
I have said all I wish to say on this Estimate except to renew my appeal to the Minister to take steps to establish some kind of body which would review the whole of this £17¾ million annual outlay so that we may better satisfy ourselves that those for whom it is primarily intended, the poor, are getting value for the money we provide.
Mr. Kyne: Although I admit there are still many improvements our present health service could do with and which are very desirable, I am still confident that many of the criticisms of the health service arise from a misunderstanding either of the benefits to which some are entitled under the Acts or to the amount of benefit actually conferred by the service itself. Standing Orders in relation to debates on Estimates prevent me from indicating where I think the service should be changed and the changes I would suggest. Because of this, my remarks will have to deal with, as I see them, the defects in the service over the past number of years which I have come across as a member of a local authority.
My main criticism of the health service is the non-uniformity of administration in the various boards administering the Act, and in fact, even among officials administering the Act in the one board of health or board of public assistance. I appreciate that there must be a good deal of give and take, or elasticity, in deciding in cases, but nevertheless I think Deputy Dillon was quite right in saying that there are glaring cases of inconsistency or non-uniformity between the various groups who come under benefit, varying as between one county and another. I do not speak of the groups—the middle income group and the lower income group— but the fact is that people who would be classified in the lower income group in one county would in an adjoining county not have at all the same classification.
One of the failures of the Act, to which I drew attention last year  when dealing with this Estimate and to which I feel I must draw attention again this year, is that, where a middle-income group patient is admitted to hospital, as the Minister in his opening speech today mentioned, under present regulations he or she can be charged anything up to a maximum of 10/- per day. That is quite correct: possibly in many areas that is the way it is administered. I suggest the Minister has his head in the clouds if he believes anything other than that the maximum is now the minimum charged to all people. It is tried on at first. When the middle-income group patient leaves the hospital, he is charged the maximum charge of 10/- per day. Not until a local representative such as a Deputy or a member of the county council or a member of the board of health makes representations, and repeated representations, is any reduction at all made. The Minister deplored that fact. I quite agree with him.
I do not feel that a public representative, be he a Deputy or a member of a council, has a right to be able to secure a reduction for a patient. Either the patient was wrongly charged at first and it was only on the representations of the public representatives that the injustice was seen, or else there was a deliberate attempt to secure more from the patient than the law entitled the local authority to secure. I am quite well aware of what I am saying and of its veracity. I have on occasion asked for information as to the names or the numbers of people who secured the reduced charge at the original time of the issue of the charges. I have never yet received any answer other than to the effect that the bills are sent out from the board of assistance and that I am not entitled to know what charges were made as that is specifically precluded by the Act, unless the person comes to me myself.
I do not suggest that 10/- per day for the care and maintenance of an adult in hospital is an extremely high charge. It is quite a moderate charge if we take into account the fact that an adult receives three good meals a day in a normal hospital, plus skilled nursing  and skilled medical care in respect of the illness. For all of that, 10/- per day is very reasonable. I have no sympathy for the person who can meet that expense but who grumbles about it. In the case of prolonged illness, lasting sometimes over a period of months, in certain circumstances, there is grave difficulty because the family, faced with a bill of £10, £15 or £20 at the end of such a long period of illness of one of the members, may not be able to face the bill. It may be an injustice to demand the full sum of 10/- per day in such cases.
I suggest the Minister should draw the attention of county managers to the fact that this injustice is happening throughout the country. Notwithstanding all the talk to the effect that the county manager is the final arbiter in all things connected with the Health Acts, I am quite well aware that in most cases the county manager does not deal with the matter at all, other than to sign his name. It would be absolutely impossible for any county manager to deal personally with every detail of the various Acts he is required to administer and to give individual attention to all these matters. In most cases, the matter is dealt with on the recommendation of a relieving officer —if not of the ordinary relieving officer certainly of the superintendent of the area. Whatever he says is usually accepted. He usually makes out the maximum charge, safe in the knowledge that if he erred on the side of charging too much, it is always easy to refund but that if he erred the other way it is difficult to collect, once the person has gone away from the jurisdiction of the hospital and has received the benefit. Nevertheless, injustices are occurring. I suggest the matter requires special attention and a special direction from the Minister.
There is one aid to the Health Act which appears to receive very little sympathy or consideration from the officials administering the Act and that is the Health Consultative Committees set up under the Act. These committees, as the Minister is aware, are formed from groups of council members, or lay people who are attached to some voluntary organisations concerned  with health, and doctors' representatives, or the doctors themselves representing their associations. That is an invaluable group of people to advise on health matters coming under the jurisdiction of a county manager. However, I have found that any advice or any attempt to advise on how the Act should be administered seems to fall on deaf ears.
I am a member of a Health Consultative Committee which has repeatedly endeavoured to improve the administration of the Act in the area under its control. I have never known of one recommendation we made which received even an indication that it was considered, apart altogether from receiving any comment on it. We recommended, say, that clerical assistance should be given to doctors attending our hospitals so as to enable them to devote more time to practising their medical skill rather than wasting it doing clerical duties. That recommendation fell on deaf ears. We recommended the control, distribution and stocking of various drugs and medicines at dispensaries. We recommended that some system should be evolved to decide on a middle income group pattern of identification so as to eliminate waste of time when middle income group people attended a specialist. We recommended that something should be done about those matters but we found that at no time did we receive an acknowledgment of our recommendations or a comment from the administrators of the Act. At meetings of the committee following the recommendations, when the minutes had been read, we asked was there any correspondence or any comments from either the county manager or his medical advisers. In no case have I heard of any comment being made in connection with our advice. Certainly, I am quite sure there was no action taken on the advice tendered.
The question of whether or not a middle income group person should hold a medical card is one about which many of the medical people, especially specialists in the various categories, are very anxious. It is not for me to put forward the doctor's point of view. Normally I am more  interested in the patients, but when a reasonable case is put to you it is only natural that you should be interested in it. Some doctors—heart specialists, ophthalmic specialists, or some other type of specialist—state that when they have their clinic a patient may come along without any reference from his private doctor. When questioned as to whether he has a medical card he replies that he has not. He is then told that he cannot be treated in the clinic unless he decides to opt to be a private patient.
The doctor often has to send the patient back to his own doctor and he is then referred to the clinic through his own doctor. Very often there is a delay which does not improve the condition of the patient. The specialists feel that if there was some indication as to the category to which the person belonged, whether he was from the middle income group or above the middle income group—which could be shown by the production of a card— they might be able to advise immediately on the case and treat it or indicate to the person that because he was outside the scale entitled to treatment he would be well advised to get treatment as a private patient.
I do not know whether this is advocating legislation, and if it is I know I am not entitled to make the suggestion, but I think that a regulation could be made, or an instruction given to county managers, that people in the middle income group should be issued with some form of identification to show to what category they belonged. I think it is the final step necessary under the Act and that eventually it will have to come. I am quite well aware that it deals with another problem which the Minister has been deploring in his opening speech.
That problem was the question of private or semi-private beds. The Minister emphasised the fact that if a patient goes into a hospital to avail of the facilities under the Health Act he must go into a public ward. I wonder if the Minister is aware of what happens in an ordinary home if, say, a man suddenly becomes ill with an appendix. If he is taken ill with appendicitis,  he is rushed into an hospital on the advice of a doctor. Does the Minister suggest for a moment that the wife, daughters, or sons of a man taken seriously ill in the middle of the night and who is rushed to hospital, are interested in what type of ward he is put in? All that the relatives and the man are interested in if he is conscious enough, is having his life saved by immediate treatment. If the patient wakes up in the morning and finds that in order to have his life saved, and to get that immediate treatment, the hospital authority had placed him in a semi-private or private ward, is it right or reasonable that he should be deprived of the rights of the Act, because of something of which he had no knowledge and over which he had no control?
I have known occasions when patients have been taken into hospitals for treatment without their express desire on the advice of doctors attending them. They were told: “So-and-so is the only doctor who can save your life in such-and-such an hospital.” Foolishly they go into that hospital to find later that they receive a bill for anything from £50 to £100, which they are unable to pay without causing great distress to their family. I suggest to the Minister that there should be an obligation placed on the hospitals, and not on the people, to see to it that each patient is made aware of the conditions under which he is taken into a particular ward. If the hospital authorities failed to inform either the patient himself or, in cases where he was unable to appreciate it because of his illness, some responsible person on his behalf, that if he availed of the treatment given in that ward he would be called upon to pay all his hospital expenses and doctor's fees, the patient would not be deprived of the benefits under the Act.
Deputy Dillon stressed the need for the supply of dentures to adult working-class people who are entitled to secure artificial teeth under the health services. The Minister admitted that the difficulty was lack of money. I am aware that as far as the Department is concerned the replacement of dentures for adults is practically nonexistent. Take the case of a working  man's wife who is the holder of a medical card. She attends the doctor and he advises her, in the interests of her health, to have her teeth removed. Is it reasonable that she must go about without teeth for the next three or four years, to the detriment of her health and her appearance, because of the fact that she is in the lower income group ?
It is frequently suggested here that money is not necessary in these matters. But it is all-important to a working man or his wife who is unable to provide, through their own lawful efforts, for the replacement of teeth. Such replacement should be provided through the State health services, but by an instruction of the Minister's Department, that is being refused. It is claimed that the cost is prohibitive, but I know that in many cases the actual charge for dentures made between the contractor and the board is practically repaid in full by the charge made by the board to the person receiving the dentures.
Whether or not the money is recovered, the Minister should realise that, where local authorities are willing to provide the money, there is need for the sanctioning of the employment of temporary dentists to overcome the time-lag caused by the accumulation of applications for necessary replacements due to the fact that the scheme came in such a short time ago. That would help to reduce the waiting period from three or four years as at present, so that in future people would have to wait at most a year for replacements. I appeal to the Minister particularly in regard to my own board of assistance area, to give the necessary permission. Year after year, we have asked for sanction for the employment of a temporary dentist to enable us to reduce the large number who have to wait for up to four years.
During the past two or three months, I had occasion, as a trade union official representing a union that has organised a number of hospital attendants throughout my constituency, to ask the Minister if he would be gracious enough to consent  to a proposal put forward by the board by which these attendants are employed that in future the attendants should be asked to work only a 48-hour week. I indicated to the Minister that a 48-hour week was a normal period of employment for all types of people, except hospital attendants, and that even nurses have secured that concession within the past eight or nine years. Unfortunately, the Minister has always seen fit to reply that that would disrupt the services and that he could not—again, I presume, for economy reasons—agree to the proposal.
The Minister must be aware that those of us who have responsibility for advising people employed in that capacity are being placed in the position of having to make up our mind whether to serve the interests of our members by advising them in one direction or whether we must take into account the interests of the patients in our hospitals who, in general, are our fellow workers. On the whole, trade union officials have been discreet, and even courageous, in refusing to advocate or encourage the use of the industrial strike weapon to secure the fair compensation to which they are well aware their members are entitled. I suggest to the Minister that their forbearance over past years and their anxiety not to do anything detrimental to the interests of the sick, the poor, the old and the insane should be seriously considered and that he should grant to those who serve humanity the same concessions as they would get if they worked in industry and were entitled to use the necessary weapons to secure what they felt were reasonable remuneration and conditions of employment.
Even in regard to other matters, hospital attendants appear to be out of favour. Female clerical employees in the Minister's Department under 21 years of age receive a reduced cost of living bonus; but as the Minister replied to me last week, should a case be made to the Department, he is prepared to concede an increase in that bonus to the amount paid to similar employees over 21. When asked if he would grant a similar concession to female hospital attendants, the Minister  could only reply that that was another question involving a much greater issue. It seems strange to those of us interested in the payment and conditions of those who do the menial but nevertheless essential duties in a hospital in the interests of the sick and the old, that such a different outlook should prevail in regard to what is good and just for them and what is good and just for the clerical or upper class. I recommend to the Minister consideration of that aspect of the position.
In connection with the Minister's report on infectious diseases, I must draw his attention to a matter I have repeatedly laboured on the Estimate for Health year after year, namely, the spread of infectious disease by the sale of secondhand clothing. In any country town on a fair day, the hawkers display secondhand clothing, which is laid out almost in the mire, on a loose shake of straw, and is tried on by practically half the visitors to the fair. Evening papers circulated in Dublin have advertisements offering to purchase secondhand clothing without reference to where it comes from or from whom it is secured.
On numerous occasions, I have put down Parliamentary Questions on this subject to the Ministers for Health in the various Governments and the invariable reply has been that each local authority has sufficient powers to control the sale of secondhand clothing without the intervention of the Minister. I suggest that the sale of secondhand clothing is not controlled, that there is no guarantee that such clothing is free from infection, that there is no guarantee that secondhand clothing offered at fairs has not come direct from a source infected with polio, tuberculosis or any other infectious disease. Until such time as the Minister sees fit to compel local authorities to exercise the powers he claims they have, there is a danger of the spread of polio or tuberculosis by this means.
There is one small matter on which I seek, rather than desire to impart, information to the Minister. It is the question of the inspection of boarded-out children and the precautions taken  to see that proper treatment is given to such children who are boarded-out from county homes. A short time ago in a court case, the claim was made that certain things happened because of the child life of the person concerned. It was indicated that the child was boarded out and was required to go into employment at the age of ten years and continued in employment up to the time he came to his misfortune. That is quite a while ago but I am not aware of what is the system of inspection at the present time of children boarded out from county homes, who are usually sent to farming people or to cottiers in rural areas. The relieving officer has a responsibility for the payment of the money for their keep and I presume a lady health inspector or nurse from the Department of Health pays periodic visits. Does the Minister feel quite happy that adequate protection is given to these children to ensure that their treatment is fair and just? One hears stories of illtreatment of children of 14 to 16 years of age by brutal employers or careless foster parents. It is desirable that the Minister should instruct the various boards to have a more strict check on such children.
Deputy Dillon spoke of mentally handicapped children and indicated what he felt was desirable in their case. I want to mention only one aspect of the matter. In Dublin and Waterford, there is a voluntary committee that takes upon itself the responsibility of running a clinic where mentally handicapped children can be taken on one or two days a week. Good ladies give voluntary service on two or perhaps three days a week to take charge of the children in order to afford the mothers an opportunity of carrying out their normal domestic work, which is difficult for them if they have the care of mentally handicapped children, of relaxing and enjoying some measure of contentment. There is no medical treatment provided and no teaching of any sort is given. The organisation is simply to relieve wearied mothers for even a few hours on a few days each week of the burden of the continuous care of  a mentally handicapped child. The organisation is maintained solely by voluntary subscriptions and voluntary effort. I would suggest that the Minister should indicate to local authorities that such organisations are worthy of contribution from the funds of the authorities and, if legislation is necessary to make that possible, that he should institute such legislation. I apologise, a Leas-Cheann Comhairle, for advocating legislation on the Estimate, but I am not quite sure whether legislation is necessary or not.
Finally, I would draw the Minister's attention to one aspect of his administration, at the top, which is causing disquiet in my area and other areas. On occasions, it is alleged that certain actions of officials, doctors, nurses, or somebody connected with health administration, require investigation. A report is made to the board and the matter is brought up at the next meeting. We are informed by the county manager usually that he has reported to the Minister's Department and that the Minister has indicated he is sending an officer down specially to investigate the case. A period of three months, six months, nine months and more often 12 months and two years elapses and no report ever comes back to the board. Notwithstanding Dáil questions and repeated questions at board level, we are still left unsatisfied as to the truth or otherwise of the allegations or charges made. If true, very often when a delayed decision comes down, you find that the person concerned has left the employment of the board or possibly left the country so that no action can be taken.
I suggest to the Minister that it is his duty to co-operate with the board in holding, if he has to hold, his inquiry and come to a decision as quickly as possible informing the people who have the responsibility of carrying out the health decisions in the county and making the local representatives and, through them, the public fully aware of the action taken in each case.
It would, I believe, have a salutary effect on any people likely to transgress. Thank God, there are very few in our health services who have ever given us any occasion to have to resort  to investigation or inquiry but it is the few who give the name to the rest of the people. It is desirable—it is in everybody's interest—that not only should justice be done but that justice should appear to be done by the facts being made fully known.
That is as much as I desire to say on the Estimate, primarily because of the fact that on such an Estimate as this I cannot indicate where I would suggest changes should be made without transgressing Standing Orders. As a member of the Labour Party, I have a deep interest in the health services of this country. I do not wish to be associated with the group who say nothing has been done in this. country. The country is gradually improving but I am a firm believer that until such time as our health services are based on a contributory scheme, we shall have complaints and I look forward to the day when a Minister of some Government will recognise that fact.
Mr. P.J. Burke: It was very pleasant to hear the heartening statement of the Minister for Health in regard to the fall in the death rate from tuberculosis over the past few years. It is a very encouraging sign and we all welcome it. Even it if our sanatoria are vacant, it is a good job to see that we have at least reached the stage where the number of deaths from T.B. which were up 4,000 or 5,000 a few years ago were down last year to 500. That was due, above all, to the early treatment of T.B.
Deputy Dillon naturally claims all the laurels. He said that everything was done during the period of the inter-Party Government. I should just like to correct the Deputy and assure him that before we were defeated in 1948, big advances had been made in regard to the building of sanatoria. A Bill was introduced and all provision made for the building of these sanatoria. The war was in progress and it held us up considerably owing to the difficulty of procuring materials and other things. We could not get on with the job as fast as we wanted to.
I believe that the T.B. allowance was a great national investment which yielded great dividends. While people  may talk about our health services in that respect as being very expensive, nevertheless, since the T.B. allowance was introduced, it has helped the patient undergoing treatment. If he were a married man, for instance, he knew that his wife and family got an allowance as reasonable as the State and the local authorities could afford. That was the greatest contribution towards the cure of the patient concerned. If the patient were left there, knowing that his wife and family were in want, the unfortunate man would be in a very bad way. In a number of cases as a result of mental worry, the man might have died.
I look upon the T.B. allowance as a great national investment and I was delighted to be associated with the passing of the Bill through the Dáil. I look upon it as one of the best Acts we passed. As a result of that Act, together with the move we made to try to build more sanatoria in the country and provide early treatment for our people, we have succeeded over the past ten or 12 years in saving the lives of 20,000 of our people, taking it on the average, or, perhaps, more.
Furthermore, we have arrested the disease now. When a person is ill and knows he has T.B. he is taken away immediately and not left at home to spread it amongst his relatives. I welcome the wonderful advances that have been made over the past two years as far as the treatment of T.B. patients is concerned. Thank God, we have reached the stage to-day when we can at least say that we have gone a good distance towards eradicating the disease.
On the other hand, I was very perturbed to hear the Minister's statement on lung cancer. This is one of the diseases which is taking away a number of our people. While much research has been carried out in other countries —I must admit that quite a number of advances have been made in regard to our own people, too—there is still a long way to go to grapple with this disease which is taking away so many of our people, not alone old people but very young people. One hears of cases day after day of young men and women and even in certain cases,  children, being taken away with lung cancer.
Another dread disease in the cancer family is leukaemia, cancer of the blood, which is one of the most serious problems with which we now have to deal. Even countries with greater resources for research than we have do not seem to have made great headway against this disease yet. Fifteen years ago when I came to this House we had the problem of T.B. and of not being able to do anything worthwhile about it but I hope I shall be alive to thank God again in this House at some future time when we shall have succeeded in saving the people from death from cancer. Many cancer institutions in Dublin have a long history behind them and have done much good. For the past 15 years I have been associated with one of them, Hume Street Hospital, one of the pioneer hospitals for the treatment of this disease. It has done a great deal and humanity owes much to the doctors who started this institution.
I appeal to the Minister to give whatever money he can afford to research laboratories and to doctors with special experience in dealing with cancer because no money should be spared in fighting cancer. I feel the resources of the State will be able to cope with any research work carried out here and I believe it will amply repay the amount expended just as expenditure on T.B. has been repaid one hundredfold by saving the lives of 20,000 people in recent years.
I compliment the Minister on the appeal he is making in regard to smoking. He has pointed out that a large number of smokers, especially cigarette smokers, have died from lung cancer and that more smokers have died from it than non-smokers. He is starting a campaign to advise children of 13 or 14 not to smoke cigarettes. He is going as far as possible and I welcome that step. I trust he will continue the work he has promised to do in the schools.
Another problem to which I have referred in previous years is the provision of proper accommodation for the aged. I must pay tribute to the  religious orders who are doing such valuable work for our aged people. I welcome the advance which the Minister made recently in deciding to use Crooksling as a home for old people and also Cork Street. This is a good investment and we must try to make our old people as happy as possible.
I agree with the Minister's statement on county homes. Efforts have been made to modernise county homes, but the very idea of the county home, the atmosphere of the county home in Ireland, must be eliminated. Much has been done in that direction but much is still required. Anything that tends to eliminate completely the old stamp of the county home will be welcomed by all sides of the House. None of us knows how he shall end; we are here to do our job as best we can and anything that the Minister can do to provide accommodation for the old people will be generally welcomed.
Deputy Dillon spoke about the possibility of homes in towns. These matters are easily advocated but the big factor to be considered is that all these small homes are uneconomic. They are very expensive. I must pay Dublin Corporation the compliment of saying that they have been very helpful in housing aged people but I feel that local authorities generally should take up the matter with a view to having suitable rooms or houses provided for old people. By doing so they would contribute a great deal to the happiness of the aged.
Frequently, there is the problem of the old man living in the same house as a young family with, perhaps, his wife and a married son or daughter. The house is overcrowded and conditions often not as good as they might be. If the local authority could deal with such overcrowding and have houses specially built for old people it would be a good advance and might lead to a solution of the problem. Every other day we have experience of trying to get an old man or woman into some home. In my constituency people do not want to go to St. Kevin's; they want to get into homes of religious orders in the city and county. We have not sufficient accommodation  for all the applicants. That is our problem. Thank God we have reached the day when the old county home is being completely reconstructed. I should like to see the day when the taint of the old county home will disappear. Old people have much hardship to contend with in their lives and anything that can brighten their declining days will be welcomed generally.
We have another problem in the large numbers suffering from rheumatism. They do not qualify for T.B. allowances; some do not even come under the national health services and yet a number of them are severely crippled. Frequently it is hard to get home assistance for them. I believe they fall into a special category. Some future Minister for Health and the local authorities will have to deal with that problem. I understand there are over 300,000 people suffering from rheumatism of one kind or another. Some are completely disabled; some are partially disabled. None of them comes within any of the recognised categories for the purpose of allowance. If they are destitute, they get home assistance. If they are living with relatives, the means test applies and they get no home assistance. There is a problem there in urgent need of solution. I know our health services are very expensive. I know it is hard to look after everyone, but this is a problem I should like to see dealt with as early as possible.
The blue cards are a headache for public men. John Jones gets a blue card while Peter Murphy, two doors away, is refused. I have tried to get a proper interpretation of entitlement to blue cards from the responsible authority, but I have failed in my endeavour. The county manager has discretionary power. I should not like to see that power taken from him because discretion must be used in certain cases and, if it were taken away, it would be just too bad. Certainly the position would not be improved.
I have been dealing with a particular case in my own constituency. Two brothers are looking after an invalid brother of 25 years of age. They are working. The invalid has to have  someone to look after him. Both these young men are about to get married. I have tried to get the invalid one of the allowances but I have failed. I have tried to get him a blue card. I have failed in that also. As far as I know, there is no responsibility placed upon anyone under the Act except upon parents. There should be some definite ruling. I do not believe the Minister envisaged making brothers and sisters, or any other relatives, except parents, responsible in cases such as I have cited. I believe this young man is entitled to a blue card under the Act. Equally, I believe he is entitled to some allowance. I admit there are borderline cases. Unfortunately it is the borderline cases we are asked to deal with.
With regard to health administration generally in the city and county of Dublin, we have an official who is doing an excellent job in my estimation.
An Leas-Cheann Comhairle: The Deputy should not mention officials because subsequent speakers may take the line that officials should be criticised.
Mr. P.J. Burke: I merely mention it in passing.
An Leas-Cheann Comhairle: It is not usual to discuss officials.
Mr. P.J. Burke: The task is so big in the city and county of Dublin that one man could not possibly cope with it. He has, therefore, to take the advice of the relieving officer and the home assistance officer. He has to go from one meeting to another. His work is very exacting. In administering the Act he has to try to do the best he can to meet the wishes of the people and, at the same time, be as fair as possible to all concerned, In my opinion the job is too much for one man.
I am very concerned about the need for institutional treatment for mentally retarded children. Accommodation is very limited. I disapprove wholeheartedly of putting mentally retarded children into the ordinary mental hospitals.  Admittedly, the staffs in these institutions do the best they can for the children. But that is no solution to the problem. Large numbers are still awaiting proper treatment. That does not apply to mentally retarded children only. It applies also to the blind and the deformed. These children are a burden on their families. I know the Minister has been actively working on this problem for some time, but unfortunately he cannot wave a magic wand and find a happy solution overnight.
I welcome the steps taken to alleviate the position in relation to overcrowding in our mental hospitals. The Minister has taken over some of the sanatoria no longer required for the purposes for which they were erected. Out in Crooksling now, there is a home for the aged. We have still a long way to go, however, and it will take a good deal of money to do all the things we want to do for our people.
Overcrowding in mental hospitals is an acute problem. We have made a big advance since the foundation of our State. The Minister and his predecessors, and the Minister for Local Government have given grants towards the erection of wings, the reconstruction of buildings and so forth. County homes have been improved but there are still many old buildings which are an eyesore. Most of them should be pulled down. Quite definitely it will be necessary to build mental hospitals. We have a problem here. I know it is a matter of money. I know that all the suggestions we make here are matters of concern to all of us, and to the Minister for Health. We have this problem to deal with, so far as our health services are concerned. We have not reached the end of the road yet, even though great advances have been made in the treatment in mental hospitals and in the elimination of overcrowding. Much, however, still remains to be done.
There are a few other points in that connection which I can raise on another occasion. I want to take this opportunity of complimenting the Minister on the advances he has made. I hope he will continue in the good work we all desire to see done and in which he has the support of all of us.
Mr. T.F. O'Higgins: In tabling a motion to refer back this Estimate, it was my desire, and the desire of Deputies on this side of the House, that attention should be directed to the continued criticism of the manner in which our health services are administered. I do not intend to deal fully with the different lines of criticism, as I am sure many Deputies on this side of the House will have their own points of view to express, but it is clear that the continuance and repetition each year of the criticism of our health services must and should indicate that there is need for improvement, within the limits of our resources, particularly in the manner in which existing services are provided and administered.
I shall have something to say about that later, but, before dealing with those matters, I should like to refer to some of the points made by the Minister in his statement today. First of all, it is pleasing to learn from him of the continued success of the voluntary health insurance scheme. Since the inception of this scheme, some 60,000 persons, according to the Minister's figures, have been brought into insurance. I understand that there are now some 250 different insurance groups covered in that scheme. I further understand that those insurance groups include every leading business firm and industrial firm in the country.
It is significant that in so short a space of time so many people should have availed of a scheme which is voluntary, which is entirely unsubsidised by the Exchequer, and which really aims at facilitating different people in helping themselves. A tribute is due to those who are responsible for the success of the scheme, to the members of the Board and the Board's officers, who have in such a short space of time demonstrated clearly that there is room in this country for a self-supporting provident scheme of this kind. I hope I shall be permitted to remind Deputies that, when this scheme was introduced and when legislation promoting the scheme was introduced some years ago, it was suggested that a scheme of this kind could not succeed, that it would merely result  in facilitating doctors in securing their fees and that, in fact, no particular benefit would be provided in the way of health services.
It is clear that those views have now been proven to be wrong. The scheme has established itself. It was certainly gratifying to see that in the past few weeks the Health Insurance Board were able to announce an extension of the benefits made available to policy holders. I trust the Board will continue with that policy of turning back into benefits whatever profit—“profit” is not the correct word or whatever reward they get from the business they engage in.
May I mention to the Minister on that, that when legislation was being prepared for this House, difficulty was envisaged in relation to our finance legislation and the impact of income tax on a board of this kind. It was not possible at that time to deal with the problem but I trust the Minister will keep it in mind. I am sure he does. Obviously, it would be quite wrong if the temporary surplus made available from such health insurance business, which should go back into increasing the benefits, since the board is not a profit-making body, should become taxable. I trust that the Minister—I am sure it is present to his mind—will ensure that any possible difficulty in that regard will be overcome.
I hope the Health Insurance Board, as a continuance of its work, will realise that the limited objectives set out in the earlier schemes should not be regarded as the ultimate aim of health insurance. I should like to believe that, with continued success in its operations, the board will aim at meeting certain continuing high costs of illness which arise outside hospitals or through out-patient treatment. Until now, the different schemes have been largely concerned with what was the immediate problem, of course—the problem arising from the high cost of in-patient treatment in hospital, and the attendant expenses.
In relation to that problem, the board have achieved a considerable measure of success, but there still remains the problem of many illnesses which cause considerable expense outside  hospitals, in respect of which inpatient treatment in hospital is not required and where a patient, over a long period of time, must have recourse to the out-patient departments in different hospitals. I should like to see the Board providing some form of assistance in relation to a problem such as that.
Having said that about the Health Insurance Board, I should like to turn to another matter which was mentioned by the Minister in his speech today, that is, the question of rehabilitation. In effect, the Minister said today that the interim report of the body set up to consider the problem of rehabilitation was still being examined in his Department. I can appreciate very well that the problem of rehabilitation is no easy one. In fact, it always astonishes me that the framers of the Health Act of 1953 should have taken such an optimistic point of view in relation to many of our health problems. It is extraordinary that now, six years later, the Minister for Health should still be faced with the problem of how to implement certain sections of an Act which were light-heartedly commended to this House in 1952.
There are sections in that Act, such as the one dealing with rehabilitation and the different sections dealing with dental treatment, dental benefit, aural and ophthalmic benefit, which have not been put into operation and which, I believe, will not be put into operation for quite a number of years. When I had responsibility in the matter of rehabilitation, I asked a number of people to consider the best means of dealing with the fact that we have living amongst us large numbers of disabled persons who are a burden to themselves and to their families and who might be able, through training and education in one way or another, to earn something for themselves.
I cannot help expressing disappointment that the interim report sent by that body to the Minister in 1957 has not yet been published and there has been no evidence given by the Minister of any contemplated action to deal with the the problem of rehabilitation. I have a feeling that this matter is  being long-fingered because, of course, it is a difficult problem, but, after all, it is in the Health Act of 1953 and there does not appear to be any good reason why, six years after that Act was passed, we should be told by the Minister that the problem of rehabilitation is still engaging the attention of his Department. The report has been there for two years and at least publication of it would be of assistance to Deputies, and to others, to enable them to assess the size of the problem and see what requires to be done.
I know that here, in this country, not having had the experience of warwounded living amongst us, not having experienced the patriotic fervour that generally arises to rehabilitate a person who becomes disabled because of a wound in war, we are inclined to regard the problem of physically handicapped and mentally retarded persons as something that can be shrugged off to another day. In my view, that is a wrong approach. These thousands of handicapped people, where it is possible to do so, should be assisted into the position in which they are able to earn at least portion of their daily bread. I did hope that by now we would have seen established in some suitable centre, some suitable venue, a national centre for rehabilitation and that at such a centre, training, particularly for the physically handicapped, could be given and those, who through industrial accidents of one kind or another may have lost an arm or a limb, could be trained to adapt themselves to some trade or occupation in which they could earn.
I know that one of the suggested problems in that respect was possible opposition from the trade union movement, but I am glad to be able to say that in my day when that suggestion was made to the trade union movement, there was every evidence of complete co-operation in seeing that the problem of rehabilitation was met and tackled, and I have no doubt that goodwill would still be available and that no able-bodied man would make it difficult for a disabled person to take his place amongst the wage earners. In any event, I do express  regret that the Minister is still unable to report progress on this important matter.
I note also from the Minister's speech this afternoon that the question of dental services continues to be a problem. Again, I envy the abandon with which the appropriate sections were inserted in the Health Act of 1953. Perhaps the Minister may remember that the full dental services for the middle income group, the full aural and ophthalmic services, were to come into operation on 1st January, 1955. That is some four years ago and I wonder whether the Minister is any “forrader” in seeing these services are provided.
It is worth recalling that a Minister for Health, in the year 1954, made a regulation providing that these services would come into operation four years ago. He made it without seeing that it was possible to do it and without making any arrangements so far for their actual operation. We see now today that a successor of his has got to say to this House what I was criticised for saying some four years ago, that it was not possible, within our resources and with the facilities available to us, to provide an adequate and proper dental service both for children and persons in the lower income group and in the middle income group. I stated my view to be at that time that it was much better to try to do one thing well than to try to do a number of things and do them badly.
I gave priority at the time to the building up of the school dental service and I know that that view is still adhered to and that the improvement of the school dental service is still given priority, at the instance of the Minister, by the different health authorities. We should realise, however, that we are as far away as ever from the promises contained in the appropriate sections of the Health Act of 1953. We shall not see in the foreseeable future any comprehensive dental service and once we have realised that we can then approach this matter in a more realistic fashion.
The Minister also referred in his statement today to some of the complaints he has heard in relation to the  operation of different parts of the health services. He referred to a circumstance which I am sure occurs quite frequently where a person entitled to the hospital services under the Health Act decides to choose his or her own accommodation either in relation to a hospital or in a hospital itself. The Minister instanced as an example a person who, being entitled to service, goes into one of the Dublin general hospitals, but elects to go into a semi-private ward. It is quite true, as the Minister says, that such a person is putting himself in the position of having to meet the difference between the hospital bill and the contribution made by the health authority. But on this subject I should like to ask the Minister whether he is aware of the fact that by reason of the operation of the hospital and specialist services under the Health Act, a considerable unforeseen and uncovenanted benefit has been conferred on insurance companies in the State? Is the Minister aware that in the last three years —because the service came fully into operation only in 1956—motor insurance companies have been the chief beneficiaries under these services operated under the Health Act?
It comes about in this way. A motorist is negligent in the driving of his car. He knocks down a person who comes within one of the categories entitled to service under the Health Act. That person insured is removed in an ambulance to one of the teaching hospitals in Dublin. There he is detained, his injuries treated, often over a protracted period. He must have the best of medical and specialist attention, as he does have, and when it is all over there might be a hospital bill which, if the hospital were preparing this bill, might come to £300 or £400.
Up to the operation of the relevant section of the Health Act the cost of that treatment had to be borne by the indemnifiers of the negligent motorist. That does not happen now. It now comes on the rates of this city and the ratepayer has to pay, as has the taxpayer, the cost of treating and curing persons injured by negligent motorists. That is an omission, if you like, in the Act which I do not believe  was contemplated or foreseen when it was being enacted. It is quite wrong that an expense of that kind should be put on to the ratepayer and the taxpayer. The motorist pays his insurance premium now, as he did before, to entitle him to be indemnified in respect of the loss he may cause to any person through negligent driving. It is wrong that the hospital and medical expenses so occasioned should now, under the provisions of the Health Act, have to be paid by the ratepayer and the taxpayer.
The Minister is probably aware of that problem but I would urge upon him that it is now of serious dimensions and should engage his attention. I do not think any wrong would be done to insurance companies. They did not realise that this benefit was coming their way. I do not notice that motor insurance premiums have dropped appreciably since the enactment of the Act and, in any event, it was not intended that the Health Act should operate to benefit them. The Minister has often said, quite rightly, that the impact of the cost of our present services is very considerable both on the ratepayer and the taxpayer. Here is a burden which it was never intended should be borne by the ratepayer and which obviously should be removed from him. I would urge the Minister to examine that problem.
The Minister also mentioned the continued problem of the Hospitals' Trust Fund. As I understand the position, the Minister decided when he came into office that there would be no further building, that all the building projects, irrespective of their stage of planning, would be postponed and that no further buildings would be commenced until such time as he was satisfied there was an adequate reserve in the Hospitals' Trust Fund for building purposes. That was a clear decision taken by the Minister and undoubtedly it represents a definite point of view.
When I left office as Minister for Health I left behind a curtailed building programme, a programme which was the result of considerable pruning, which was of a staggered kind, intended to operate over some four or  five years, and which would derive its finance from the continued income from the Hospitals' Sweep. That building programme I left behind envisaged the building of the new Coombe Hospital, the building of the new St. Vincent's Hospital and the building, at a later stage, of the new St. Laurence's Hospital and of Cork Regional Hospital. However, the two immediate projects were the new Coombe Maternity Hospital and the new St. Vincent's Hospital.
Provision was also made in the programme for dealing with a problem a number of Deputies mentioned today —the problem of the retarded and handicapped child. There was also in that programme provision for urgent buildings for the mentally-handicapped child as it was felt that that was an urgent problem. I cannot remember the details now but the building projects were regarded in the light of what was most urgent to be done and provision was made for getting it done. The present Minister felt that that was an improvident way of doing things. He felt it was not wise to start building unless one was sure one had the money to pay for it. That is a very understandable point of view but it is scarcely an optimistic one.
I cannot help remembering that the foundation work of a hospital in Longford has been done and that the foundation work and contract for the new St. Vincent's Hospital has been completed. I cannot help feeling it is improbable that the Irish Hospitals' Sweepstake will fold up. Every indication is that they will continue to go from strength to strength. Surely their greatest advertisement abroad would be the building of two new voluntary hospitals in this city?
A criticism one hears from time to time is that too little from Trust Funds has been provided for the teaching hospitals and that too much has been provided in the past for the building of smaller local authority institutions of one kind or another. I think it would have been wiser for the Minister to continue with the building programme I had drawn up and which was ready for him when he took office. If he had done so over the past two years, two very important new hospitals in this  city would now be nearing completion. That would have meant quite a lot in relation to the unemployment problem in this city in the past two years and it would have been a tremendous advantage to those who are ultimately responsible for providing the finance for future building activity. I have no doubt but that the Sweepstake authorities would have liked to be able to demonstrate that two big projects of this kind were going on in Dublin in assistance of the voluntary and teaching hospitals. Instead of that, the Minister has stopped all buildings.
Apart from a few minor and urgent expenditures of one kind or another— to prevent a roof from falling in, or something of that kind—the Minister has stopped all building. He has allowed the Trust Fund to accumulate. It was rather extraordinary to see the Trust Fund go into the investment market this year. It is notable that a portion of the last National Loan was bought out of Sweepstake funds. That was not a wise decision and I urge the Minister to depart from it as quickly as possible.
There appears to be some indication in the Minister's statement that he is departing from the very conservative view he adopted two years ago. He has now decided to allow the county home scheme to proceed again. That is good news. It is good that this scheme, which has been suspended for the past two years, may now proceed. I hope it is an indication that further urgent building projects will now get the green light. The present situation is not particularly fair to the hospital authorities. I have consulted none of them and anything I say is purely my own view; I know nothing of their problems or anything of that kind but it would appear to me to be unfair to the authorities in the Coombe Hospital, to the St. Vincent's Hospital authorities, and to St. Laurence's Hospital authorities that they should not know clearly what is in store for them. If they are to build they should at least know when and, if they are not to build, they should at least be told that now. I hope the Minister will be able to indicate that urgent building of this kind will start again in the near future.
 Reference is also made in the Minister's statement to legislation enacted this year for increasing the income limit under the Health Act from £600 to £800, and to a higher figure in certain cases. There is one matter with regard to that I should like to raise. I was disappointed to learn that in relation to that legislation the Minister had not sought any advice or given any notification to those supposed to work this legislation, that is to the medical profession and the various hospital authorities. I do not mean by that that I would expect the Minister to be bound by any advice given to him or to accept any veto from anybody except this House but I do think the manner in which that legislation suddenly appeared here was not conducive to the continuance of happy relations between the Minister and these various bodies.
I hope that if any further changes of that kind are contemplated by the Minister he will make them realising that what we enact here is only part of the story. As we well know, in relation to the Health Act, it is necessary to get the services implemented and that can only be done by the experienced and skilled professions upon whose assistance we can depend. I do not think it would be prudent for me to say anything more about that except that I should like again to emphasise that I am merely expressing my own views in that regard.
During the past year, the chairman of the Cancer Association—now a valued Deputy in this House—resigned his position as chairman and the Minister appointed as chairman a member of his Department. I should like to criticise that action, not in relation to the officer appointed, because nobody could criticise that particular officer—he is an officer who has rendered excellent and first rate service in the Department and for the Association—but I do think it was wrong for the Minister to put into the position of chairman of the Cancer Association a civil servant and a member of his Department.
I always understood the intention to be that bodies such as the Cancer  Association should be, so far as it was possible, freed from civil service control. It was right, in their composition and formation, that the Minister's representatives should be numbered amongst the members of an association such as that, so that the Minister's point of view could be expressed and also that the Minister could be informed of what was going on.
That was understandable but it appears to me to be quite a major departure to appoint a civil servant as chairman of such a body. It would be far better to abolish the Association altogether and to allow the Department itself to take over control of the activities carried out by the Association. I would not recommend that, but I would say that it would be a better way of achieving what must be intended. I criticise that step and I think it was a mistake. As I said, I do not say that in relation to the official concerned because once the Minister decided to appoint a member of his Department it would have been difficult to find a better person for the appointment.
I mentioned that certain criticisms of the administration of our health services have been expressed from time to time. The Minister has referred to some of them. There is the perennial problem of entitlement to the medical card and there is also the continued suggestion that specialist and hospital services are not easy to obtain for those entitled to them. I heard these criticisms when I was Minister. The Minister has heard them and I am certain he will have had a surfeit of them. The fact that criticisms of this kind continue to be made indicates, in my opinion, that these services are not being administered—I am talking about the actual method whereby it is sought to provide them for the people—in the best possible manner.
In relation to the question of medical cards, Deputy Dillon has suggested that some provision should be made for reviewing the decisions of local authorities. I fully agree with that. It was my intention to provide  such a reviewing procedure. I have little doubt that where decisions of this kind in relation to entitlement are made by local officials of high standing eventually they become the humdrum thing. They become automatic and a rule of thumb procedure is eventually adopted. It is inevitable in the end that some cases are not considered entirely on their merits.
I think that if we want to have a uniformity of service for the poorer sections it is essential that there should be some overriding authority supervising the various decisions of different local authorities. It is true, as appears from the figures, that there is an amazingly wide difference between the views entertained by the local officers in one county and those in another county. The Minister has said in relation to the percentage of those on the medical register that it is as high as 40 per cent. in some health authority areas and lower than 20 per cent. elsewhere. We are a small country with a small population. Surely we should not have that difference as to who amongst us are poor and unable to provide for themselves?
In relation to Section 14 services, the time has come to bring about a uniformity in outlook. Whether that will be done by defining terms by legislation or by administration or whether it will be done by providing some supervisory body over health authorities, I do not know; but the time has come to do something about it. I would join with Deputy Dillon in urging on the Minister to take up this problem. I well appreciate that the idea of having in the Minister's Department provision for an appeal from decisions in relation to medical cards would not be a very pleasing prospect for a Department already overworked, but I feel the time has come when something of that kind should be done.
Again on the question of Section 14 services for the poor, I should like to urge upon the Minister a review of our dispensary services. It is just closing one's eyes to the facts to think we can continue a system of medicine which is entirely outmoded. In my view it is quite incongruous that we should say to persons coming within the Section  14 definition when they are ill that they must go to the appointed doctor and no one else while at the same time we say to a wife when she is expecting a baby that she can go to any doctor she chooses. Once we permitted, and rightly permitted, to an expectant mother in the lower income group the right to choose her own medical adviser, the sense behind the dispensary system disappeared.
One can imagine an expectant mother in the lower income group going to see her obstetrician in relation to her condition. As she leaves his house she slips and sprains her ankle. She must then go to the dispensary doctor, and the first thing he will say to her is: “Why did you not come to me in relation to your baby? Why did you select Dr. So-and-So around the corner?” The danger in such circumstances is that the woman will not go to any doctor. I would urge strongly upon the Minister that he should review this whole problem. In this country where we have a scattered population—becoming more scattered regrettably—anyone will realise that in areas where the population is sparse and distances great it would not be possible to provide any medical assistance for poor people unless provision were made to subsidise a doctor to stay there.
I can well understand that, in our conditions, a system similar to the dispensary medical services must be continued in relation to sparsely populated rural areas. But I think the position is quite different in relation to the large centres of population such as this city of Dublin and Cork and possibly Limerick. In the large centres of population I believe the dispensary can be done away with and those entitled to medical services, the poor, given the right to go to any doctor they choose. Again, that was my intention as Minister and it was for that reason that, in so far as it was open to me, I discouraged making permanent the various temporary dispensary posts in this city. I was anxious that they should not be made permanent because I hope to see the day when the dispensary system in this city would be done away with and that in its place there  would be a system whereby each person entitled to free medical services could go to any doctor he or she wished.
It is for that reason regrettable that in the last 12 months the Minister should have created another obstacle in achieving that aim by permitting the health authorities concerned to fill some 12 dispensary posts in this city and area on a permanent basis. That means that the financial cost of abolishing the dispensary system in Dublin—and it will be abolished some day—will be increased. The men appointed to these posts on a permanent basis will have to be compensated on that basis. I would have preferred to have seen a situation whereby gradually it would have been possible to experiment, if you like, in certain areas in this city with another system without being involved in heavy initial outlay. However, the Minister has decided to proceed with that and I think it is regrettable.
I appreciate that it would not be in order to discuss proposals here which might involve legislation and I do not intend to do so. But as I said at the beginning, the motion to refer back this Estimate was tabled to permit a number of Deputies on this side to express criticisms they felt of different aspects of our health services. With some of these criticisms, I agree; with others, I do not. It does appear to me, however, that the continuation of complaints such as the Minister himself has enumerated does indicate that there is room now for a consideration of the manner in which the services are provided under the Act.
I have little doubt that, sooner or later, somebody will have to take a decision to regard the 30 per cent. of our population, whom we all feel should get free medical services, as being entitled as of right to such services and to define them. In relation to the other 70 per cent. future developments will be along insurance lines. I think we are moving slowly in that direction. Whether such services would be provided through the Health Insurance Board or not, I do not know. On a review of our services  now, anyone would feel that there is so much confusion in relation to who precisely are the poor that the time has come for definition and uniformity. If that were done by the Minister, many of these complaints would disappear and it would then be possible to consider in what form progress on sounder lines could be made in future.
Dr. Browne: The point concerning the difficulty of assessment made by Deputy O'Higgins, Deputy Dillon and the Minister for Health in his opening statement, must in time bring home to everybody, no matter what his views are, that no matter how hard we try—and it must be admitted that we have tried very hard in various Bills brought before the House from time to time—it is very difficult to provide a health service which will give a reasonably effective service to all sections of the community. The majority here conscientiously believed that it was possible to legislate for a service which could be administered by the local authorities in such a way as to make certain that the lower income group were given ready access to a good standard of health service and that the middle income group would be assisted in some way, to a certain limited extent, in the provision of a health service. I said at the time, and I should like to say again, and I suppose I shall have to repeat it for a number of years to come, that the net difficulty in all this legislation arises out of the retention of this very difference between the three sections, the lower and higher income groups, and the retention of the means test. That has led to the differences in interpretation in respect of the classes eligible for the different types of service which were considered here and legislated for in this House from time to time.
When listening to Deputies complaining about the differences between the degrees of people eligible for these services—20 per cent. in one county, 30 per cent. in another and 40 per cent. in another—under legislation sent out by us to the managers of local authorities, I feel the same sympathy for the managers as I do for the Minister for  Lands in this House from time to time when he is attacked for not dividing up estates which we give him no power to divide, inasmuch as power is vested in the Land Commission and he has no authority to override that power. Essentially, it is our fault—it originated with us—if he is slow or the process is a slow one. It is a process required by this House.
Equally, in this differentiation by the local authorities between the types they feel are eligible and who, many of us as individual Deputies think are eligible, the error lies, not in their interpretation, because they are fallible and human and liable to make mistakes and there are wide variations and possibilities of interpretation, but in the fact that we have left them with this means test in our health services. As long as the means test is there, we shall continue to get hard cases and we shall continue to get people who feel they are eligible, and who may be eligible, for services which are denied to them and we shall also get persons who, under the law, are getting services which, on more careful scrutiny, they are not entitled to at all.
It is all part of the process of trying to administer a means test in one's health services. So that, if there is any blame attaching to it, attach it where it belongs, to Deputies who pass this type of legislation. If I have contributed to it, I accept my share of responsibility. It all stands with the persisting of a means test in our health services and will continue to persist as long as the means test is retained in the services.
As to the suggestion of Deputy Dillon and Deputy O'Higgins, that there may be some question of a right of appeal to a higher authority, that was attempted, as far as I recollect, in relation to the Infectious Diseases Regulations. There is an appeal to the Minister. It led to a tremendous amount of very difficult work on the part of departmental officers. I do not know whether it led to any greater measure of justice from the point of view of appeals from decisions taken locally. I do not know whether the Minister is really in a better position  to decide such cases because he is away from the cases and the managers have access to the facts in a much more ready way. On the whole, I think the local people are in the best position to judge in these cases.
The only case I can see for a right of appeal to a higher authority, such as the Minister or the Department, is the fact that it is a sobering thought to a local health authority, a manager, who may tend to become weary of these cases or tend to deal with them in too arbitrary a way. It may mean that he will take rather more care in assessing the merits of a particular case, if he knows that the case may be appealed over his head to the Minister and that he may have to state a case, that he may have to justify his case. In that way if you retain the means test in the health services, it might be desirable to have a right of appeal to a higher authority. It would mean a tremendous amount of increased work, I imagine, in the early years, for the Department, but it is possible that a case could be made for it.
The whole case against the means test has been made many times and I do not intend to deal with it again, but it is important that Deputies should understand that that is the origin and the source of the apparent and real discrepancies which exist in the administration of our health services by perfectly conscientious local authorities. There is the difference in interpretation of income level of the family, fluctuating as it does because of unemployment, because of a young person getting married, because of somebody going on pension, because of somebody emigrating. These fluctuations are taking place from time to time continuously and, in that way, re-assessment must continually take place, leading to the creation of colossal, unnecessary and expensive bureaucracy and also leading to evasions, suppressions, attempts to get benefits to which one is not entitled and, generally, to people becoming demoralised and general standards being undermined. I do not think there is anything to be said in favour of the health services as they are. Where we have the no-means type of  service, none of this type of complication exists at all.
Deputy O'Higgins put forward the desirability of giving free choice of doctor. That seems to me to be one of the fundamental prerequisites to a just health service. It seems terribly wrong that the lower income group should have no free choice of doctor. There are very few of us who can afford to change our doctors, whether we are shopkeepers, chemists, engineers or architects. It seems to me that, particularly in the case of medicine, there should be a choice of doctor. Generally speaking, I think everybody will concede that one should have the right to a free choice of doctor and that what we like for ourselves we should endeavour to give to every section of the community.
Dispensary doctors work very hard and give very good service. Being as it is, it asks too much to expect a dispensary doctor to give the same level of service to his dispensary patients as to his private patients. The more unattractive he makes the dispensary services, the more likely is it that he will get more and more private patients. The converse is also true. As everybody knows, individuals will not go to dispensaries. The hours are fixed. The dispensary is usually dilapidated. There are very indifferent waiting facilities and the dispensaries are usually indifferently equipped, not through any fault of the departmental regulations or health authority regulations in this case because the facilities are there. Quite often the doctors do not want to equip their dispensary or make the service particularly attractive to the dispensary patient.
I was interested in the suggestion of Deputy O'Higgins. He wanted to suppress the building of dispensaries. So did I. I did not want to see the dispensary building programme going on. Like him, I appreciate that the dispensary service must inevitably go when we get enlightened. When it does, it will mean that the compensation problem will be tremendously increased by the existence of all these new dispensaries throughout the country. The suggestion I tried to put into operation  was that we should ask the dispensary doctors whether they would accept a grant for the building of an additional room and that we would give them some compensation for domestic help, if they would see the dispensary patients and the ordinary private patients in their own houses. There was no enthusiasm for that suggestion. Certainly, the dispensary system, as we know it now, is most objectionable. I am with Deputy O'Higgins in regard to the building of dispensaries—not that I want to see them evacuated. I want the Minister to change the whole dispensary service so that he can give free choice of doctor.
I am glad to know that he is at least doing something about the figures in relation to lung cancer. The figures are very disturbing in regard to the deaths from lung cancer. The Minister is rather shocked. I am surprised that he was not more shocked than he appeared to be. Everybody accepts that the relationship between lung cancer and smoking, particularly the excessive smoking of cigarettes, has been established.
I can understand the Minister's difficulties to a certain extent. There is the big problem of the tremendous vested interest on the one hand and the question of revenue on the other. The Minister has to try to reconcile both. Up to the present, he has made relatively little contribution to the discharge of his responsibility as a member of the Cabinet to the community. As Minister for Health, he is charged with the care of the health of the community generally. He says he has put on record the statement concerning the association of lung cancer with smoking. As far as I can see, having questioned him repeatedly, we are promised a leaflet for children and another for adults which will set out the problem for them. As Minister for Health, that is the end of his task.
Either the relationship is established and it is a dangerous one and the people ought to be warned, or it is not so. Surely the Minister's warning must be put in a very much more deliberate, persistent and elaborate way than he has suggested. I can appreciate his problem concerning over-alarm or  over-emphasis of the problem, but he must understand that the people are completely ignorant of the serious significance of the relationship between lung cancer and smoking.
In addition, it is not as if he were making a statement or issuing these handbills in a vacuum. He is issuing them in the face of the most costly, extravagant, elaborate and well-thought out advertising campaign carried out in all the national, local and provincial papers and on the hoardings all over the country. This propaganda campaign is carried out by these people who are not afraid to over-emphasise the need to sell cigarettes. Up to now it was grossly misleading and I suggest, dishonest, in view of the implications of the incitement to smoke cigarettes conveyed in the propaganda put out by the tobacco companies.
The Minister must realise that he is fighting this war—that is what it is— in the people's minds, and the Minister must meet the tobacco companies at least on even terms. They have no hesitation, I am sure, in firing as much heavy propaganda as they can lay their hands on. In answer to that the Minister has taken, I think, two years to produce a handbill. In that time he has made a couple of statements which of course have been completely submerged in the Press by the amount of advertising carried on by the companies. It is quite clear that he must embark on a very much more virgorous campaign if he really means to inform the people of the danger of cancer from smoking.
Alternatively there is the possibility of restricting the rights of the tobacco companies to advertise here. The Minister knows as well as I do that he is now engaged in a campaign to alter the people's minds about their lifelong ideas on the voting system in this country and in relation to that neither he nor his colleagues felt that they had satisfied all their propaganda needs in this regard by issuing a single handbill or by making a single statement and hoping that in that way they would alter the people's minds from thinking one way to thinking in a completely different way. The same thing applies to this tobacco smoking  habit which is a drug habit and to which most people are addicted in varying degrees. It cannot be altered by putting a handbill into the hands of children and expecting them to stop smoking or by eventually doing the same thing for adults. He must meet the considerable propaganda of the tobacco companies, in billposting and other forms, on level terms if he is to have a chance of succeeding.
I have asked the Minister on a couple of occasions about the new pharmacy laws that are long overdue. The last answer I got was that the amending Bill was in some way tied up with the Solicitors Bill and the rights of these bodies to strike people off the rolls. That may or may not be so but I would urge the Minister to try if it is possible to introduce legislation——
An Leas-Cheann Comhairle: The Deputy is out of order in suggesting that legislation should be introduced.
Dr. Browne: I merely wish to make the point that changes in regard to the pharmaceutical trade are long overdue and perhaps the Minister would try to get round his problems in relation to the complicating factor raised by the Solicitors Bill. At present pharmacists are tied to legislation going back as far as 1895, perhaps farther.
Deputy O'Higgins was full of praise for the voluntary health insurance scheme. It was his brainchild and I can understand his approbation. My difficulty about this kind of scheme is that it is so limited in its objectives, in its cover, I still believe that it has all the disadvantages—it has shown that it has them—to which I referred when it was first introduced. The principle of health insurance is not new but the voluntary health insurance scheme seems to me to be merely playing at the real problem involved in providing a health service for the people. One can provide a limited cover for a limited section, but I am not interested in that. I think the Minister's responsibility spreads over the whole people and so, consequently, should legislation. If the voluntary health insurance scheme gives a good service, if the idea  gives a good service, then the amenities should be provided for everybody irrespective of whether people can pay insurance premiums or not.
The difficulty of such a scheme is that there is a group that cannot pay insurance premiums. That brings in the means test again. How do you treat people who cannot or will not pay? It involves contradictions. Do those who do not pay get the same standard of treatment as those who can pay? If they do, who will pay any insurance, if they can get away with that? There is a perfectly good insurance scheme available to anyone who requires it. That is the insurance of income tax moneys paid in. Each one is paying as much as he can afford to pay to a central pool and from that pool money is provided to establish a health service which will give exactly the same standard to everyone.
I cannot see why any Deputy cannot accept that principle or how he can find reasons to object to it. It seems to me to meet all the demands put forward for health insurance schemes of one kind or another. If we look at our own health schemes, infectious diseases schemes and so on, we find the raising of money through income tax has been shown to be highly efficient. Successive Minister have pointed to the reduction in the incidence of fevers and to the spectacular reduction in the incidence of T.B. That has been possible through schemes paid for from taxation from rates provided by the payments of individual citizens into this central insurance fund which is the Central Exchequer.
This voluntary health insurance scheme covers some 60,000 people in a population of approximately 2,900,000. I understand that there are something in the region of 500,000 people eligible, leaving aside altogether those who are covered—very inadequately in my view—by the lower income group dispensary services. This is only nibbling at the problem. It is clearly no real solution to the problem. It may satisfy Deputy O'Higgins's ego to know he has devised a scheme which covers some 50,000 or 60,000 people. But there are thousands of people who are not covered at all by this scheme and who will never, in my opinion, be  covered by it. If the scheme were really attractive no one would want to be left out. If the scheme were so attractive as Deputy O'Higgins suggests it is, those taking advantage of it would be up to the 300,000 mark. People are not hanging back through any sense of irresponsibility, lack of interest or lack of concern for themselves or for their children. People want a health service, but they cannot pay for it under this scheme. A small percentage pays for it, and Deputy O'Higgins should remember how small the percentage really is.
As a pilot experimental scheme it may have a certain value from the point of view of collecting useful statistical or actuarial information, but it will never provide any efficient health service. It will never give any information in regard to those who cannot avail of it and who are not covered by any other health services.
The 60,000 in the scheme are very inadequately covered. Cover is restricted. They do not qualify until a certain number of contributions have been paid. They are entitled only to certain limited appliances, to a certain quantity of drugs. They will not be accepted if they have a history of ill-health. They must pay increased premiums after a certain age. There are no dental facilities. There are no maternity facilities. The scheme is positively ludicrous. Surely no one can take seriously the suggestion that this scheme provides an answer to our health problems, even to the problems confronting those who are at present paying for the limited services offered?
There is only one solution. I have said this many times. It is the truth, and truth bears repetition. We shall never solve our health problems until we remove the means test altogether from our health services and adopt the principle already operating in relation to tuberculosis and infectious diseases generally. We shall never solve the problem here until we follow the pattern set by the British, Swedes and the other nations which enjoy such wonderful standards.
On the question of rehabilitation of disabled persons, in the context of our  present society the problem is insoluble. We have a high pool of unemployed able-bodied persons and it is, therefore, quite unrealistic to expect employers to employ to any appreciable extent disabled persons when able-bodied persons are on offer. Except in exceptional circumstances the disabled man will not get preference vis-a-vis the fit man. Our unemployment figure, as everybody knows, goes up to something like 10 per cent. from time to time. In those circumstances the question of rehabilitation of the disabled is largely an academic one. Valiant efforts are made by those who undertake this work and undoubtedly their efforts make some contribution to the rehabilitation of the disabled in our society. It is not their fault that the disabled cannot be absorbed into employment in our society.
The reasons governing the position have nothing to do with the groups in charge of disablement and rehabilitation services generally. Once one gets a state of society in which there is full employment and a consequential shortage of labour the disabled person comes into his own because it is then possible to legislate for the compulsory inclusion of a certain number of disabled persons in the labour potential of both factory and industry. That has been done in Britain. I understand it works reasonably well. Outside of that the only contribution the rehabilitation people can make is by rehabilitating these people for work elsewhere.
The Minister's figures with regard to B.C.G. vaccination are very interesting and very disturbing. I must confess I did not know the position was quite so serious as it is in the 15 to 30 age group. That seems to me to bear out the idea prevalent for so long, particularly in Britain, that we are very liable to tuberculosis here. One of our problems is that the young man or girl from rural Ireland who comes in contact with active tuberculosis is very prone to contract the disease. When these young people emigrate and come in contact with open tuberculosis in Britain they are very liable to develop tuberculosis. That explains why the incidence of the disease is so high. It  also explains the low resistance. Would the Minister try to get the various B.C.G. committees to extend their activities to the 15 to 30 age group? That might give them some sort of protection when they emigrate or migrate into densely populated areas.
The Minister was very stringent in his comments on the quality of the building in our hospitals. This is not new. He has indulged in the same type of cricitisms before. I do not know why he keeps on making it because I think one of the things we should be proudest of is our hospitals. Certain visitors may have criticised quality, standards and costs but it would have been only fair to point out that numbers of visitors have been very loud in their praises of our hospitals and of the way in which the Hospital Sweep Money has been spent over the years—that is, since the money was first made available to the Minister for Health.
The question of the type of finish, the quality and standard of building of our hospitals has been commented on, mostly by people who themselves when they fall ill, go to the best hospital or the best nursing home, if there is a nursing home, or the private wing that is the loveliest, most extravagantly equipped and comfortable, with all amenities. I usually find that the people who comment, including the Minister, are that type of person. They themselves have no intention of making their way into a public bed in a public ward if they fall ill—I do not wish the Minister such ill luck—and they are the type of person who seem to begrudge this very high standard which we have set for the hospitalisation of our sick poor and middle income group people.
Personally, I do not think anything is good enough or certainly that anything is too good for those people and I am proud to have played the small part which I did play in the provision of these buildings. I am very proud of them, as I say. The Minister should remember that putting the rather costly finish to those institutions did not commence in recent years. If one looks at a few hospitals which were built some  years ago, particularly at Cashel, Kilkenny, Castlerea, Roscommon, or Mallow, one sees that all these institutions are very beautiful buildings. They are lovely, beautifully finished, elaborate and very comfortable, and the very remarkable thing about them is that they have withstood the very stringent tests of hospital buildings. They have worn very well.
The Minister knows as well as I do that all Ministers for Health are faced with this problem of deciding on the quality and finish of a hospital institution of any kind. First of all, the demands of the local health authority or the voluntary institutions, the local surgeons or the board of governors generally do not want a makeshift building or an indifferent or poor finish. They want a beautiful building, the more beautiful the better. Most of the local health authorities, most of the doctors, the Orders and the boards of governors have insisted on certain minimum standards, and except in certain instances, generally speaking, the standards are reasonable enough.
No matter who was Minister, the standard has been fairly even throughout the years. There has been very little difference, no matter who was in control of the Department. The standard and the quality have been largely the same, the reason being, and it is one of the factors with which I was concerned, the acceptance of the reality that if you build a temporary type of building, a semi-permanent type of structure, the local authority simply do not maintain it. It is generally accepted that the average health authority has its own difficulties in the matter of raising money for projects of one kind or another and the provision of money for the maintenance of existing buildings is pretty low.
The general feeling is that in the provision of health institutions of any kind they should be made as durable as possible. They will get very little care and attention from the health authority in the years to come and, secondly, the hospital is a public institution which suffers a tremendous amount of hardship with trolleys and individuals and nurses running from one part to the other, and wear and  tear by the patients, so that a hospital must be soundly constructed. While, in theory, one can build a semi-permanent type of temporary structure, it pays in the end to build a really good high quality hospital.
While one of the difficulties is the monetary investment there is a real return, referred to by Deputy Dillon, in the people who are fit and well. The Government spent money pre-war on fever hospitals. They built them and one of the results was that fevers were decimated. They practically disappeared. The process of solving a fever problem in any society involves the expenditure of considerable sums of money on institutions and buildings. If your campaign is to succeed, these extensive buildings must be emptied and left without any patients. Otherwise, your campaign does not succeed. That apparently lavish and extravagant expenditure on fever hospitals had the effect of emptying them and leaving them available for emergency tuberculosis patients at the time. That policy would be a solution of the Minister's problems which arise in trying to rid the country of other infectious diseases, particularly tuberculosis.
People talk about the provision of these expensive hospitals and I suppose it is because they do not appreciate what they are saying when they talk about the building of extravagant hospitals and sanatoria particularly if they do not happen to have tuberculosis. They are the people who will go to the expensive nursing homes and they are always more bitter than anybody else, and they are the type of people who, when we manage to succeed in getting a condition of full employment here and not having people standing at street corners, and when the employment exchanges at Werburgh St. and elsewhere are empty, will probably complain of the lavishness of those buildings and say it is a pity there is nobody to occupy them.
The Minister has extended the poliomyelitis vaccination facilities. The Minister rather querulously complains that poliomyelitis is not the only disease. Nobody suggested it was but it is a disease which killed nine people  in 1958 and 13 in 1957. It is also the disease which to a considerable extent, or at least to a certain extent, disabled over 260 people in 1958 and some 140 people in 1957. Again, with all these things, it is a question of values. It may not be the only disease—it is not and nobody suggested it is—but it is one of the few diseases which it is possible to control to a considerable extent by means of vaccination. It is possible to protect individuals from it by means of vaccination and, because of that, it becomes a rather special disease in one's assessment of the need to apply particularly energetic measures for its elimination.
Once upon a time, smallpox was also very widespread and by means of vaccination, it was completely eliminated. At that time, a complacent Minister for Health might have said that smallpox was not the only disease and, consequently, it could be given only a limited amount of attention, but if it is possible to eliminate, or nearly eliminate, poliomyelitis by means of extensive vaccination, properly carried out, surely the argument for its elimination has the same validity as the argument for the elimination of smallpox. Admittedly, smallpox is a more serious disease in some ways, but, at the same time, the argument seems to apply equally in relation to polio.
The disablement of people is a very sad human problem and, of course, the death of people is a terrible thing, but here we are dealing with the preventing of deaths. Consequently, it is a question that comes into these matters of social values which should have priority in relation to the use of money by the State. I do not think that money can ever be wasted on saving a life, and I do not think that money is ever wasted in preventing a child becoming crippled for life, becoming disabled for life, or even becoming partially disabled.
Consequently, I would urge the Minister to tackle this very much more vigorously and energetically than he has tried up to the present time, to get people to undergo this vaccination against poliomyelitis. Schemes can be devised, sometimes a limited scheme like the Minister's, or the free scheme  like the B.C.G. scheme and the smallpox vaccination scheme, but unless they are brought to the attention of the public persistently, repeatedly, and in a dramatic way, in a taking way, they will not accept the schemes and will not bother with them.
We must always try to realise that people who are healthy and fit and have little contact with the disease do not at all appreciate the implications of a disease such as poliomyelitis and, consequently, cannot be expected to take seriously the possible danger to their children. The Minister, in his responsible position, owes it to the people to inform them persistently, repeatedly, and as energetically as he can, of the dangerous disease poliomyelitis can be, and of the ways in which it is possible to get a certain amount of protection—not complete protection— against it. It is rather like the cancer campaign. The need is there for a positive, more dynamic lead from the Minister to advise, to explain to the people the implications of poliomyelitis and the advantages of the poliomyelitis vaccination scheme. Above all, I think it is his responsibility to make the scheme completely free, without means tests, so that the people can avail of it without any embarrassment or any difficulty all. As he has found, it is rather difficult to get the people, who have available free vaccination, to come along to get vaccinated and have their children vaccinated, but, if he insists on means tests, it will frighten those who would otherwise avail of the scheme. If the Minister would reconsider his attitude on the vaccination scheme and try to introduce a very much more dynamic and vigorous campaign, he probably would get much more satisfactory results than he has got up to the present.
Mr. Moloney: During the course of the debate this afternoon, reference was made to the very unsatisfactory position with regard to the overcrowding of mental hospitals. A suggestion was put forward that not only had the time arrived, but was long since past, for some ameliorative action in that connection. This problem is one that has to be contended with by all local authorities in the  country and, for some reason which the ordinary person finds hard to understand, the rate of progress being made is anything but satisfactory. Annual reports published by mental hospital committees in recent years seem to indicate that there are quite a number of patients in mental hospitals who are not really eligible for permanent mental hospital treatment. It would appear that the patients in this category are mostly persons who are unfortunate enough to have been confined in such hospitals for a number of years and who now find themselves in a position that their families are no longer available to arrange for their discharge, and to take care of them in the future. Some of these patients have no living relatives, and it is sad to say that there are also patients who have relatives in pretty good circumstances who will not apply for their discharge and accommodate them in their homes for the remainder of their lives. In one or two local authorities, the managers, on some occasions within the past few years, endeavoured to have a number of patients in that category discharged and cared for by their friends, but the results were most disappointing.
It appears to me that there is very little hope of reducing the present population in mental hospitals by any scheme of general normal discharge. I think mental hospitals will find themselves in the position that they will have the type of patient I refer to on their hands for as long as these patients live. Various suggestions have been put forward as to the best means of reducing the number of patients in the mental hospitals and so far no practicable scheme has been formulated. Nevertheless the mental hospital authorities, should not lose sight of this very grave problem.
If patients who are fairly well mentally could be boarded out with certain selected people throughout the country, it might ease this very vexed problem. Most people are not inclined to take on a patient who might have spent a considerable number of years in a mental hospital. Nowadays, however, with the scarcity of labour, particularly light labour, it ought to be possible to select a suitable type of  private home in the rural areas, the owner of which would be willing to accept a patient, whose mental and physical condition is reasonably good, with the intention of employing him on a suitable form of work. It is possible that the patient would not be able to do sufficient, work to justify the cost of, his maintenance but if the mental hospital authorities even had to go to the extent of paying a small allowance to any person who would be prepared to take a patient it would be money well spent.
The average cost of those patients in the various mental hospitals differs but assuming that a flat rate of £1 per week could be paid to such selected people as I have referred, with a view to subsidising the maintenance cost of the patient, I believe quite a number of people might be willing to accommodate the type of patient in question. It is unfortunate that an increasing percentage of mental hospital patients comprise people who, generally speaking, become reasonably normal as a result of treatment but for whom it is difficult to find a position in the world because it is on record against them that they were patients in a mental institution.
Many years ago our people were inclined to be rather frightened about giving employment to working-class persons who for a period happened to be patients in mental institutions. However, in recent times that feeling is on the wane and we are beginning to realise that a patient who has had some years of treatment and who, according to medical opinion has recovered, is capable of taking his place in society and of accepting the type of employment he had prior to his admission to a mental institution. This line of approach has not been tried very effectively in the past. I hope the Minister will consider the suggestion and will see fit, having examined all the pros and cons, to offer it as a solution to the mental hospital authorities as one worthy of trial.
Reference has been made in the debate this evening to the general volume of complaints that arise in  regard to the issue of medical cards. I think it was Deputy Dillon who dealt with that matter rather extensively this afternoon. I was present in the House during part of his speech on that aspect and I rather share his views in this connection. Every county manager, who seems to be the competent authority to issue these cards, has a different standard of qualification. Under one health authority a working man with a wage of £6 a week, having one or two dependants, will be entitled to a medical card but in the neighbouring local authority you will probably find that a man with similar circumstances will not qualify at all. There is a great deal of inconsistency in regard to qualification for a medical card.
It is unfortunate that when the Health Acts were being framed the entire jurisdiction in this matter was left to the county manager. With the experience which successive Ministers have had in this connection, it ought to be clear that a change in the arrangement is desirable. In cases of this kind a person who is aggrieved because of failure to get a medical card should have some right of appeal. There is no appeal machinery in operation to deal with such a contingency. The county manager's word in that connection is the last word.
Deputies on all sides of the House have, I am quite sure, dealt with complaints of that nature from time to time. In fact in quite a number of areas, making representations to the county manager for the rescinding of decisions in relation to medical cards constitutes a fairly large part of the work a Deputy has to do. Prior to the passing of the Health Act, a large proportion of the working population was entitled to free treatment through the red ticket system but many of them found themselves completely debarred from that free treatment as a result of the passing of the Health Act.
An Leas-Cheann Comhairle: The Deputy may not criticise legislation or advocate an amendment of legislation on the Estimate.
Mr. Moloney: I am dealing with the  position as I see it with regard to the issue of medical cards. I am indicating that the present situation is not satisfactory and that some other scheme should be evolved.
 Progress reported: Committee to sit again.
The Dáil adjourned at 10.30 p.m. until 10.30 a.m. on Thursday, 21st May, 1959.
Mr. Blowick: asked the Minister for Finance if he will state in respect of each county the number of (a) six days' licensed premises and (b) seven days' licensed premises.
Dr. Ryan: The following are the numbers of premises licensed for the sale of intoxicating liquor for consumption on the premises:—
|County||Number of Premises|
|With six-day licences||With seven-day licences|