Seanad Éireann - Volume 115 - 03 April, 1987

Health (Amendment) Bill, 1987: Second Stage.

Question proposed: “That the Bill be now read a Second Time.”

Minister of State at the Department of Health (Mr. Leyden): I am pleased to have an opportunity for the second time today to come before the Upper House of the Oireachtas and seek its support for the Health (Amendment) Bill, 1987, which provides for the amendment of section 56 of the Health Act, 1970.

This amendment would enable the Minister for Health, with the consent of the Minister for Finance, to impose charges in respect of out-patient services as defined in the 1970 Health Act. The Bill seeks the powers to enable the Minister for Health to make regulations setting out the charges to be made and the categories of people to which they will apply.

These regulations, when made, will be laid before the House. Today, I should like to set out what is proposed in relation to the content of those regulations.

As you see from the Bill, the following exclusions will apply:

1. Medical card holders and their dependants. Approximately 37 per cent of our population are holders of current medical cards and they cover approximately 1.2 million of our population.

2. Children suffering from diseases and disabilities of a permanent or long-term nature;

3. Children who require attendance on an out-patient basis in respect of defects which have been noticed at a health examination provided in accordance with the Health Act.

[2167] Also excluded by the regulation will be:

A. All women in respect of motherhood;

B. Infants up to the age of six weeks as already provided for under the 1970 Act;

C. Persons receiving services for the diagnosis or treatment of certain infectious diseases prescribed under the Health Act, 1947.

Finally, and most important, the chief executive officers of the health boards will have the discretion as provided in the 1970 Health Act, to exempt people where there would be an obvious case of hardship if the charges were imposed.

I would like to turn now to the circumstances in which the charges will be made. A charge of £10 will be made for all out-patient services but only for the first visit arising in respect of a particualr medical condition. That is to say, return visits in respect of that condition will not be liable for the charge. The £10 charge will also be made in respect of attendances at casualty departments of hospitals. I would like particularly to comment on that charge.

In all parts of the country it has been traditional for generations for people to use casualty departments of hospitals to receive treatment which could just as appropriately be provided by there general practitioners. As things stand at the moment, this service is being provided absolutely free of charge. There are two points I should like to make with regard to this situation.

First, I suggest that the use of casualty departments of minor ailments is a misuse of that facility. It is a misuse, because instead of these departments being allowed to gear themselves for the treatment of real emergencies, a very sizeable part of their time is being taken up by the treatment of non-emergencies. Anybody who has visited a casualty department will see ample evidence of this. The second point I would like to make is that, irrespective of a person's [2168] ability to pay for the services, these are provided as I said free of charge.

A visit to a general practitioner at the moment costs in the region of £10, so charging a person £10 for service in a casualty department, given the exemptions I have already mentioned, has to be regarded as reasonable. The House should also note that the £10 charge will be made only in respect of the first visit arising from a particular condition.

The House should be aware that for some time now a number of health boards have been collecting contributions from patients in respect of out-patient services. I have had personal experience of this myself. These contributions are being made in respect of every visit. In my own health board, the Western Health Board, I have had the experience of visiting the out-patients' department of the Roscommon County Hospital where I was charged for 12 visits at the sum of £5 a visit which was quite reasonable. Over the last few days some people have made quite an issue of the charges now proposed. Those people seem to have conveniently forgotten, or perhaps were not aware, that similar type charges are being made in a number of areas at present. Therefore, the proposed arrangements cannot be seen as something totally new and unacceptable. I wish to clarify that there is a £10 charge for a particular ailment. The situation is that if somebody has an accident and breaks an arm the treatment for that breakage would be covered under that £10 charge on an out-patient basis. He or she would not have to pay a further £10 for each visit.

I should also like to make it clear that in applying the new arrangements, a person presenting for out-patient services suffering from more than one condition will be liable for only a single £10 charge. Likewise, a person who at the first visit requires an X-ray or pathology service will also be liable for a single £10 charge only, which includes the X-ray and the pathology service.

These then are the proposed arrangements for making charges for out-patient services. The House must agree that in drawing them up, the Government have [2169] been extremely conscious of the need to ensure that the vulnerable and disadvantaged will be exempt from the charges. I believe this has been comprehensively achieved.

Having explained what is involved in this legislation, I should now like to go on to make some comments on why it is considered necessary to introduce these charges. Everybody is aware that the cost of providing health services in this country has risen dramatically in the last decade or so. For instance, from 1974 overall expenditure on non-capital health services rose to the order of £1.3 billion, or approximately 7.5 per cent of GNP in 1986.

In that period there has been a significant improvment in the standard and quality of care which is highly desirable. However, we have now come to the situation where we must take stock of the reality of the current economic position. Within that, we must assess what should be expected from our health services, the cost of that expectation and how the costs should be funded. This reality has been made perfectly clear over the past few days. It was made clear without any of the fudging which was a hallmark of the previous administration.

As far as the health services are concerned, this reality means that the resources that can be made available to them from the Exchequer, that is through taxation, will be limited. Given that limitation we have to ask ourselves the question: how do we maintain the essential levels and standards of care required?

One option is that we simply cut the services to meet the available resource. Another option is to find alternatives to Exchequer funding to alleviate the consequences of limited resources. This Government consider that such a course of action is perfectly justified in the present circumstances. Therefore, it has been decided, in certain circumstances, to impose a charge for the delivery of certain services. But within that the underlying principle must be that only those who can reasonably afford to make additional contributions should be expected to do so. Conversely, this [2170] means that those who cannot afford to make such contributions should not be expected to do so, and will not be expected to do so by this Government.

That is the basis of the Bill before the House for the imposition of out-patient charges. The same basis will apply in relation to the imposition of charges for in-patient hospital services which have already been indicated. Even in respect of those people who will be required to pay both out-patient and in-patient services, arrangements are being made with the Voluntary Health Insurance Board so that they can insure themselves against charges at minimal cost. Negotiations are at present taking place between the VHI Board and my Department regarding the bringing forward of a very attractive scheme which I believe will be supported by the people in the categories which will be affected by the proposed out-patient and in-patient charges and will impose no hardship whatsoever on them.

Since the intention to introduce out-patient charges and in-patient charges was announced, there have been a number of quite misleading comments made on the proposals. It has been alleged that the charges are aimed at the most needy in our society. It has been alleged that they are going to cause considerable hardship. I must say that I find these comments, particularly when they are widely reported, especially disturbing. These comments are being believed by many people who are very worried as to how the proposed measures will affect them should they fall ill. I have already detailed the categories of people who will be excluded from charges. I will repeat that only those who could be expected to pay without hardship will have to pay. I am personally very concerned to get this message over and allay people's fears.

I will also continue to point out that the measures which we are proposing are infinitely preferable to the kinds of charges which the previous administration threatened to impose. In particular, a charge on prescriptions for general medical services patients was proposed, at the rate of £1 per perscription, which would [2171] have imposed tremendous hardship on the least well-off members of our society, the present medical card holders, 37 per cent of the population or approximately 1.2 million people who benefit from the conditions applicable to holders of medical cards. We are exempting them from what we regard as a very heavy charge in respect of that service. This would be a charge on those people who, by definition as medical card holders, cannot provide services for themselves or their families without incurring hardship. It would be incomprehensible that, when they are in most need, they should be faced with that kind of savage charge.

There is no doubt but there are difficult times ahead as far as the health services are concerned. The level of resource which we would all like to have is just not available. I am sure there will be many demands for increased funding, just as there will be similar demands from other sectors. But, in making these demands, people must ask themselves where the additional funding is going to come from. Are people prepared to face a considerable further increase in taxation across the board? I would not think so. Therefore, it is necessary that all our people consider carefully what they expect from a health service; to what extent they are prepared to pay for that service; and especially how they would wish to have the service used. The Bill before the House today is just one measure being proposed to protect the fabric of our services. I believe it is a reasonable measure.

This Government have taken a very courageous stand since the introduction of the budget. The Government had no alternative but to introduce such a budget bearing in mind the very difficult position with which we were faced when we assumed office some weeks ago. We are prepared to take hard decisions for the sake of our people. We are prepared to grasp the nettle, to take unpopular decisions, because, if they are not taken by us then they will have to be taken by others on behalf of our people. We are not prepared to accept such a scenario. [2172] Fianna Fáil, in Government will take the right hard decisions.

I commend the Bill to the House.

Mr. Durcan: I should like to welcome the Minister of State to the House. I also wish him a courageous and constructive period in office. However, I hope his ministry will be short one because if what we have experienced is anything to judge by, then it would be preferable for the Irish people that his term of office be brief. I do not mean any personal disrespect to the Minister of State personally. Hard decisions must be taken and I am glad the Minister has been converted to that belief. However, it is only right that our people be shown courage, honesty and clarity in the taking of those decisions.

I resent the remark by the Minister in the course of his introductory remarks when he stated:

This reality has been made perfectly clear over the last few days. It was made clear without any of the fudging which was a hallmark of the previous administration.

Certainly the outgoing Minister, Deputy Desmond, brought our people to a sense of understanding of the problems and how the health service should relate to them. My worry is that I cannot have faith in this administration in tackling the health services because of their inability to understand those problems over the past four years, their failure to see the need to clip back certain areas of the health services and even more so their approach in the recent general election campaign. In so far as the health services are concerned, that election was notable for fudging, and was marked by something far from honesty or clarity. The people were not presented with the true facts by the then principal Opposition party.

I very much resent the fact that the Minister of State has come into this House and accused the previous Government of fudging on these essential issues. The one thing we did not do was fudge which was what the Minister's party did. [2173] Indeed that same lack of clarity, I would contend, was one of the reasons we had a change of Government. Having said that, I welcome the Minister because, in Opposition, as a member of a health board, he showed considerable concern for the need to ensure that the health services were administered in a realistic fashion. I hope he will ensure that that attitude will prevail.

The Fine Gael Party cannot disagree with the underlying principle of this Bill, that health boards should be empowered to charge for certain out-patient services and in Government we made suggestions along those lines. In farming the budgetary proposals in the early part of this year we made certain suggestions along those lines. Of course those suggestions were pilloried by the people now holding office, having trotted into power on the basis of the unreal fears they created among the electorate during those tense few weeks. Nevertheless, I am glad to note that the Minister has been converted to the type of realism we outlined in those same weeks. Even though we may have lost power we were honest and presented the facts as they were to the electorate. I am glad we have achieved that conversion on the part of the people now holding office.

The financing of the health services was a matter we faced realistically and honestly having again presented the position fairly to the electorate. However, in so far as the provisions of this Bill are concerned. I have certain reservations. The fact that I have reservations does not mean that I should vote against the Bill.

I will outline my reservations. The Bill, in effect revokes subsections (2), (3), (4) and (5) of section 56 of the Health Act, 1970. The Bill doe not in any way affect the definition of out-patient services. On the face of it, it does not affect the exemption currently existing for medical card holders and for children who suffer from certain diseases prescribed by the Minister. My basic worry is that whereas the Minister says that regulations will be made to deal with certain circumstances, this Bill has the effect of revoking the vital provisions in subsections (2), (3), (4) [2174] and (5) of section 56 of the 1970 Act. Presumably, therefore, it revokes the regulations which we made under these provisions and if we enact this Bill, we will merely have an enabling section without regulations. If that is the case, I would be extremely unhappy. There will be no regulation to govern children who may suffer from permanent or long term disabilities referred to in section 1(3) of this Bill.

Without being personal, I find it difficult to accept any undertaking from the Minister's party in relation to the health services by virtue of the undertakings which were given in the recent past and which were broken. I am in extreme difficulty as far as this Bill is concerned because there will not be regulation to govern the cases to which I have referred. Will the Minister consider amending this Bill for the purpose of providing that the regulations which currently exist will remain in force following the passage of this Bill, unless otherwise revoked? It is important that the Minister should consider amending the Bill tonight. If he does so, I will support such an amendment. This is, after all, the place where we try to improve legislation.

This Bill is urgent, but I am sure the Dáil can be recalled to deal with an amendment from this House. Will the Minister address himself to that because a lacuna will exist unless the matter is remedied. I agree with the principle underlying this Bill but it contains a technical defect which must be remedied if the weaker sections are to be protected.

Mr. Fallon: Today, we had two sets of draft regulations— on the health services and on the Social Welfare Bill. We have now this Health (Amendment) Bill. It is all part and parcel of the budget provisions which have been passed. A common denominator for all of these items is that the economy is on its knees and drastic action is necessary. The Departments of Social Welfare and Health are very high spending Departments and we must look at those areas with a view to reducing expenditure. At the same time, we must make every effort [2175] to maintain the services and the level of care required. We could cut the services but a more humane way is to find new finance to fund them, hence this Bill and the charges it brings.

It is no harm to spell out, as the Minister did, the very many people who are excluded, for instance, medical card holders and their dependants. As the Minister said, they represent 40 per cent of the population. Also excluded are children suffering from diseases or disabilities of a permanent or a long term nature and children who require attendance on an out-patient basis in respect of defects which have been noticed at a health examination provided in accordance with the Health Acts. There are other exclusions too. It is very important that hardship cases which may arise later can be exempted by the CEO. The Minister made the point that, within the underlying principle, only those who can reasonably afford to make a contribution should be expected to pay. There is a definite hope that if hardship presents itself such a case can be dealt with humanely.

In regard to the paying of charges in other areas such as for water, sewerage services and to the local authorities, we tend to be slow to pay but in the end we pay. I assume that about 65 per cent of people required to pay these charges will pay them, but I see problems in relation to administration. It is not just a straightforward situation. One could argue that this is a new layer of bureaucracy and I wonder how much of the money raised will go on administration.

As the Minister said, it is not a new charge. There were charges under the health boards before this Bill was introduced. The press have highlighted somewhat inaccurately the whole approach to these charges. There are difficult times ahead for the health services. Everyone accepts that. The health and social welfare services are in many ways a barometer for the economy. In the fifties, a time of depression, there was little if any, expansion in the areas of health and social [2176] welfare, but in the sixties and the seventies when we had great economic growth, the health and social welfare services expanded. In the eighties we are again in difficult times. The Government and the Minister are concerned that we are spending too much on health. That is regrettable. The Minister and the Government are forced to introduce this Bill. While none of us likes the idea, we are forced to the conclusion that we must support this Bill.

Mr. O'Mahony: The Government have no mandate for what they are proposing in this Bill. Not only have they no mandate but on two occasions the electorate decided against hospital charges for out-patient or in-patient services. The Minister and the House will remember when Fianna Fáil first introduced charges for out-patient services in 1982 the people promptly and quite definitely put them out of office. During the course of the recent general election campaign the Fine Gael Party also proposed out-patient charges, admittedly at a lower level, and that proposal was rejected by the electorate also. The electorate have spoken twice on this matter and despite this the Government have decided to go ahead with charges. It is regrettable that the Government did not have the honesty, as Senator Durcan stated earlier, to tell the people in advance of the kind of measures they were proposing, such as the one before the House this evening.

The proposal to introduce a £10 charge for out-patient services, when taken with the proposed £10 per day charge for in-patient services, is nothing less than a radical attack on the gains made by our people over many years towards achieving a hospital service which was based on need rather than ability to pay.

A previous Minister in the House this evening, when talking about social welfare, said that the British Government under Mrs. Thatcher had abolished pay-related benefit. Even Mrs. Thatcher has not so far had the temerity to introduce charges for in-patient services in hospital, despite the fact that she has managed to dismantle most of the welfare state. That [2177] is because decent people everywhere recognise that hospital services must be based on need and cannot be based on ability to pay.

It is important to call a spade a spade at this stage. What is being proposed this evening is no less than a tax on being sick; there can be no other definition. That tax on being sick cannot be hidden under any other guise or name. The Government have argued that these charges are necessary to cut down on abuses of out-patient and in-patient services in hospitals but I submit that there is no truth in that suggestion.

I want to digress, very briefly into the area of in-patient treatment even though it is not directly before the House. As any sensible person knows, it is the consultant in the hospital who determines the length of stay of a patient. Therefore, the introduction of a charge on a patient for attending on an in-patient basis in hospital would have no effect one way or the other on the length of stay of that patient, and therefore, no effect on the alleged abuses operating in excessive stays in hospital. In so far as there are excessive stays in hospitals — and I submit that these are becoming less than has been the case in the past — they are determined either by decisions of consultants or by maladministration in the hospital.

With regard to the matter directly before the House this evening, I do not think that anybody with sense would suggest that people would be prepared to stay and queue for half a day in many cases in out-patient departments of hospitals to receive treatment which they do not need. That defies logic. I do not believe that this happens to any marked extent. If people are attending out-patient services in hospitals unnecessarily, it is happening either because they are referred to hospital out-patient departments unnecessarily by GPs, in which case it is not the patient's fault, or because those patients cannot afford to pay GPs for services which they might render to them. In either case the proposal, as a solution to abuse of the out-patient service, will not work. The only [2178] consequence of it will be that many people who at present are forced to out-patient departments by virtue of not being able to pay GPs because they are outside the income limit for a medical card will be deprived of health care. This is what is going to happen in the areas I know in Dublin city.

We need to knock down once and for all the argument that charges diminish abuses in health care expenditure. As I said in relation to another matter before us today, we are all aware that health care expenditure in Ireland has risen rapidly over the last 15 to 20 years as is the case in most countries. Any serious economic analysis of how to curtail expenditure increases in a way consistent with delivering an effective health care system to people would suggest the way to do it is by putting effective administration systems into hospitals, in particular, into the health care system as a whole and by unifying the whole system so that the distinctions between public, private and semi-private care are eliminated. A unified health care system, and in this case we are talking about a hospital care system — which is based on salaries for the staff who work in that system if accompanied by effective administration — and let us remember that in many hospitals there is no administration; each individual consultant runs his own operation and nobody runs the whole business — would lead to effective reductions in the rate of increases in health care expenditure while having the additional benefit of developing a hospital care system whereby people are clearly treated on the basis of need and queue jumping and the things now associated with our hospital care system would be eliminated. The argument that charges are in some sense a deterrent to abuse is nonsense on the face of any evidence that I have seen except in cases where patients attend because they cannot afford to go to their GPs. This cannot be described as abuse but rather a necessity.

When one looks at the hospital care system it is interesting to note that it is paid for in the main through general taxation paid by the entire population. It [2179] is paid for in addition by the 1 per cent income levy for hospital care which is paid for by all those in gainful employment, although in most cases it is not collected from farmers. One would have thought that imposing charges on the entire population for a hospital care system for those who are sick would be enough, but additionally we are going to impose a third charge on those people when they are sick. This is one of the most regressive decisions we have ever had to debate.

There is nothing in the Bill that sets a limit of £10 per out-patient visit for all time; this amount can be increased by regulation at any point in the future when it happens to suit a Minister for any reason. If we go down that route we will simply be dismantling all of the gains such as they are which have been made in relation to the provision of health care on the basis of need as opposed to the basis of ability to pay. It is only since the sixties that we began to make serious progress towards the idea of health care on the basis of need as opposed to ability to pay.

Let us remember that not long ago — in the sixties — we began to make serious progress towards the idea of health care on the basis of need as opposed to ability to pay. Now it seems we are about to dismantle all that and this is being proposed by a Government with no mandate to do so. Were they to contest an election today or tomorrow on the basis of this proposal, they would be roundly defeated in my view.

Much has been made by the Minister of State and the Minister for Health that exceptions will be made on grounds of hardship. I thought we had managed to move away from this discretionary notice of access to hospital care free of charge on grounds of hardship. I thought we had managed to do away with the situation where a person who has not a medical card because his income might be above the income limit but who is not wealthy would have to go cap in hand to the CEO or to a health board official and argue his [2180] case, revealing all his circumstances, in order to get into a hospital without paying the £10 out-patient charge. I thought we were now dealing with matters on the basis of entitlement and not arguing the toss with a health board official and revealing every detail of one's life before one was given the right not to pay this £10 which the person might not be able to pay.

Since there is no sign of the regulations — and Senator Durcan has made a serious argument this evening about these regulations — I wonder if the Minister could tell us what are the likely criteria the CEO might take into account in determining hardship in these cases. I understand there are hardship provisions in most legislation dealing with the delivery of services, but what are the likely criteria for hardship that one would reasonably expect a CEO to take into account when it comes to deciding whether somebody should pay either £10 a day for in-patient treatment or £10 for an out-patient visit?

I wonder about the method of payment. Is it suggested that we will get to the point — and I believe it is — where one will not get hospital treatment unless one puts the money up front? That is the case in the United States system of hospital care. If one introduces a system of charges for hospital care on an out-patient or in-patient basis, does one not speedily move to the point where one says no entry without putting money on the table? What is the method of payment envisaged under this Bill? Will people have to pay in advance? Will they be billed after the event? If so, will they be pursued if they do not pay? If half the hospital going population have to be pursued, will the Minister not find it desirable to move towards payment on demand? I suggest that that is the way we are going and that is a retrograde step. I believe this system is inoperable but so far as it can be operated, it will do enormous damage to the concept of treatment on the basis of need rather than ability to pay.

I am the first person to speak for the Labour Party and I wish to formally tell [2181] the House that we will be opposing this measure, as we will be opposing the more regressive measure of charging people three times for in-patient treatment — through income tax, the health levies and daily charges. The whole thing seems nothing short of farcical.

Professor Dooge: I would like to distinguish between two aspects of the Bill before us. First, this Bill enables charges to be made. This was in the Fine Gael proposals and is something to which the Fine Gael group in the Seanad cannot object, but this Bill is doing this in a particular way. Senator Durcan has already outlined the misgivings of the Fine Gael group to the way this is being done. Earlier today we passed the Social Welfare Bill which the Fine Gael group did not oppose and I would like to draw attention to section 10 (2) of that Bill which reads:

Notwithstanding subsection (1) of this section, regulations made wholly or partly under section 76(1)(b) of the Principal Act before the passing of this Act and in force at such passing shall continue in force until revoked.

If there had been a similar provision in the Health (Amendment) Bill, which we are now discussing, the views put forward by Senator Durcan on behalf of our group, and drafted by him, would not have been necessary.

Early in his introductory speech the Minister said:

The Bill seeks the powers to enable the Minister for Health to make regulations setting out the charges to be made and the categories of people to which they will apply.

These regulations when made will be laid before the House.

Senator Durcan pointed out that in the interval between this evening and the time when those regulations are approved there will be a lacuna, there will be no regulations, and there will be no categories defined. I think Senator Durcan has made more than a prima facie case for the retention of the existing [2182] regulations until the Minister makes the new regulations which he proposes to make under this Bill.

If the Minister accepts Senator Durcan's point of view and the amendment which proposes that the existing regulations remain in force, there is nothing in this Bill to prevent the Minister from changing those regulations in any way he thinks fit. But I think there is a very substantial case, as in the case of the Social Welfare Bill, for the categories to be left exactly as they are in the interim.

As I said, it is open to the Minister to change those categories and to change the degrees of entitlement in regard to those regulations. Those regulations must come before the Dáil and before the Seanad to be elected next week. They can give their judgement on them but we, as a subsisting Seanad, still have our duty to perform. Senator Durcan has persuaded me in what he has said tonight. To be quite frank, he did not persuade me earlier today but he has persuaded me now that this subsisting Seanad has a duty to maintain the existing categories until the categories are altered by the enactment of new regulations.

I would, therefore, say to the Minister in all seriousness that he would be very well advised to accept this amendment since the Bill can only be implemented by regulation. In fact, acceptance of the amendment will not delay to any substantial extent, in all probability will not delay it to any extent, the implementation of the regulations which the Minister wishes to impose. This is the clearcut way of approaching this particular problem. The Minister in the course of his speech made a remark with which I do not agree. He said that the reality — he was referring to the reality of our situation — has been made perfectly clear over the past few days and it was made clear without any of the fudging which was the hallmark of the previous administration.

I was under the impression it was the refusal to fudge the issues that removed the Fine Gael Party from office. Therefore, I cannot agree with what the Minister says in this regard but I can appeal [2183] to him that if he is critical of what he saw as fudging in a previous administration to avoid at all costs any fudging in regard to the legislation he is now proposing to the House. If he does propose to us legislation which repeals previous legislation and regulations made under those Acts, there is an element of fudging involved. I am speaking here in all responsibility and in support of what the Minister seeks to do and I ask him to think most carefully on what he is going to say in reply to this debate with regard to the existing regulations which define categories.

I said at the opening of business today that the Fine Gael group would not obstruct the Government in regard to the business they wished to push through but I want to say now in regard to this particular issue that if we were to press our amendment on Committee Stage we would not be obstructing the Government. We would be helping them to avoid a mistake.

Mr. Magner: I do not think it is possible for Fine Gael to assist the Government any more than they have been doing since last Tuesday. However, I am glad to say we are making some progress. I am sure the Minister in his wildest dreams never thought he would be coming into this House proposing this legislation — not even in his worst nightmares during the election campaign did he think that. In his speech he said that infants up to the age of six weeks are already provided for under the 1970 Act. I want to thank him on behalf of all the six-week old infants in the country and now I want to talk to him about all the seven week old infants who fall out of their cots. That infant is caught for the £10 charge.

The reality is that he will not get the money. It is as simple as that. A successful politician spends very little time in the casualty department of hospitals. Perhaps they may in the future but until now they have not and yet the Minister of State says that the use of casualty departments for minor ailments is a misuse of that facility. That is a very subjective judgment, because what is a [2184] minor ailment? Traditionally, the casualty departments of hospitals have been used by people who fall or by children who cut their legs and have a wound that requires stitching. Is the Minister serious when he says that that person can call on their GP at 1 a.m. to have a wound stitched? The reality is that GPs today have almost forgotten to practise. They have not stitched wounds since they left medical school. It is not done any more. Now it is being reintroduced by Fianna Fáil. Maybe the job search programme is to send all those GPs back to school for a couple of weeks so that they can stitch people in the future. This is crazy legislation.

Look at who you have got in casualty departments. On a Friday or Saturday night all over the city of Dublin you have men carted in by ambulances of the fire brigade and the health boards. Where are they going to get £10? They will not pay it. The people the Government are trying to catch do not use these services. The reality is that the Minister is not going to get the money. He is also creating another bureaucratic monster. For instance, a person will pay the one £10 for the first visit arising from a particular condition. That means the person will have to get a receipt stamped and duly authenticated because if he goes to another hospital which, might be nearer they may want another £10. This legislation is for the birds.

Mr. O'Leary: They will stamp the wound.

Mr. Magner: Probably. The Minister must look with envy at his old portfolio as spokesman and how nice it would be to be talking about RTE. They have given him a crown of thorns. He said as far as the health services are concerned that given the limitations we must ask ourselves how do we maintain the essential levels in standards of care and that one option was that we should cut the services to meet the available resources.

The previous Government talked about a crisis in the public finances and about how difficult it was to hold the [2185] system together. Nobody got more abuse in the other House than Deputy Desmond who tried to make reasonable economies while, at the same time, maintaining the integrity of the health services. Who comes into this House tonight to blow it away? A young progressive tiger from Fianna Fáil. As I said, he must be living through a very bad period after just a week in office — and he has my sympathy — but nobody deserves it more than his good self.

There are options to funding the health service but they are options which neither Fine Gael or Fianna Fáil were prepared to take up. There is a huge category within the medical service who actually own it, and it is for them, not for the patients, it is for the GPs and consultants because that is where the money is. Earlier we were told of a 25 per cent increase in health contributions. I do not have first hand knowledge of this but I am told there are clubs in London who operate the same system as the Minister, when you pay the first time and you think you are in, you are not, but you must go through another door and pay again.

Professor Dooge: Like Madame Cyn.

Mr. Magner: Exactly, like Madame Cyn as the Leader of Fine Gael said. One never gets what one pays for except one pays for it three times. Today the Minister's Minister increased our health subscriptions.

Mr. Durcan: Not just yet.

Mr. Magner: The Senator might even vote at the end of all this and break a habit in a week. The reality is that 25 per cent of an increase was imposed today and we still do not have a health service and the people must pay again. Has the Minister considered the other category, the person who goes to hospital, must pay £10 a day for the week's stay and on being discharged is told to report to the out-patient section? Has that person to pay another £10? I agree with what Senator Durcan said about regulations, that there should be clarity and lack of [2186] fudge. Nobody knows what is going to happen to this legislation except, and this is definite, that it will not be paid by the majority of people.

It is heartening in a way to know that what the country, and the Government of the last four years, understood to be a crisis was discovered by Fianna Fáil last Tuesday. The books were open to everybody, except Ministers of State. I am sure that if Minister of State saw the books and knew the Department, he would have had a different conversation with the Taoiseach. This legislation will die. It will not get out of this House tonight with the assistance of the Labour Party. Of course, it may get out with the assistance of Fine Gael despite the huffing and the puffing that they are not going to vote for it. Their problem is that around the country their councillors will have to decipher where they stand on this issue. The Government will get the Bill but only with the help of Fine Gael.

Professor Dooge: Only with the Fine Gael amendment.

Mr. Magner: We will see. It will be interesting. We will support that because at least it is working at 50 per cent motor power as against being stopped in the water.

Mr. O'Leary: And 50 per cent of our power is better than 100 per cent of Labour power.

Mr. Magner: That may be but we lost very few lifeboats in the last election although Fine Gael lost 17 so I would not be too cocky if I were Fine Gael. They are dropping down and there is a crowd on the other side of them called the PDs who might dive abroad that ship pretty fast.

Professor Dooge: They are not here tonight.

Mr. Magner: There are not too many Fine Gael Senators either.

[2187] Mr. O'Leary: I should like to congratulate the Minister of State on his appointment. The last time he was Minister of State he did an excellent job in the Department he was in. He was one of the successes of the last administration. I wish him every success. Anything I have to say is not directed at the Minister or the commitment which I know he has to whatever job he gets from the administration of which he is such a loyal and efficient member. I can understand the position of three groups of people here but there is a fourth group I cannot understand. I can understand the position of the Labour Party because they made their position in this matter quite clear. They were against charges of this kind, they went to the people and got a mandate. I was interested to hear what Senator O'Mahony said about mandates. A party do not only get a mandate by getting a majority of seats; they get a mandate even if they only get one seat; they get a mandate for whatever the party's policy is. The Labour Party stood on the basis that they would not support this kind of legislation. They have that mandate and I respect their position in voting consistently.

Fine Gael also have a mandate and that is where Fine Gael are different. Fine Gael have a different mandate. They have a mandate in respect of supporting charges even though charges like this are subject to a lot of the criticisms and the reservations expressed by other Senators. In so far as we get our authority indirectly from the people, Fine Gael have a mandate to support this legislation.

Fianna Fáil have no such mandate. I can understand the position of the Government in this matter because they are faced with the reality. I can see a chasm opening up between the Government on the one hand and the Fianna Fáil Party on the other. I recognise, understand and appreciate it. Of all the positions to be in during the course of that opening chasm the worst position is that of Minister of State with one leg at each side of the chasm and as it gets wider and wider being in a more uncomfortable [2188] and impossible position; an extremely dangerous position. That is the problem for the Minister of State. It is only a man of his considerable ability who will be able to perform the necessary physical gyration to maintain a foot in both camps during the course of the oncoming holocaust.

Fianna Fáil have no mandate to introduce this policy or any other policy to which they have been lately converted. We all understand that policy issues arise in health and in other areas and that Governments have to adjust for those policies and make up policies on issues that did not arise at all before the election. This is not one of those policies. The Government, in respect of their attitude towards health, are trying to perpetrate on the Irish people a fraud, a political fraud. They are trying to fight an election on one set of policies and implement another set of policies. If anything has caused problems in Ireland it is parties doing that. I am not excusing the Fine Gael Party or the Labour Party from that position in the past. Tonight all I can talk about is what is happening now. What is happening is that the Government are overtaking the policy of the part from which the members of the Government are drawn.

Do Senators remember the slogans all over the country about health cuts and who they were damaging? It is no wonder that the Minister is having such poor support from his side of the House on this. That is just one of the difficulties in having a party policy which is totally at variance with a Government policy when the Government and the party are one and the same party. At least on the previous occasion there was the opportunity of blaming the other party but Fianna Fáil cannot even do that. They find themselves in the position where the political policy of their party is being turned on its head by the Government. The vengeance which the people visited on Fine Gael and Labour will be chicken feed compared with what they will visit on Fianna Fáil when they go to the country on a divided and contradictory policy.

The Government have no mandate for [2189] this or any other policy which they did not put before the people. On the other hand we have a mandate for it. My good friend Senator Magner gloried in the fact that we lost 17 seats.

Mr. Magner: No, I did not. Fine Gael attacked first.

Mr. O'Leary: Senator Magner mentioned the fact that we lost 17 seats. If we did that was the verdict of the people on our performance and our policies. We got 51 seats.

Mr. Belton: That is three times 17.

Mr. O'Leary: In matters mathematical I will always bow to Senator Belton. He is quite right. There is no point in Labour throwing their hands up in horror at Fine Gael implementing Fine Gael policy.

Professor Dooge: Hear, hear.

Mr. O'Leary: What else would you expect Fine Gael to do but to implement their own policy? You might not agree with the policy. You might think it is foolish or wrong, but you cannot say that we should not support our own policy.

Professor Dooge: Hear, hear.

Mr. O'Leary: What the Labour Party are quite right in objecting to is the fraud which was perpetrated on the people by a party promoting a series of policies which, without any change in circumstances, they jettisoned as soon as they achieved power. That is a recipe for the destruction of democracy.

Let no one be under any misguided notion; we will support our policy. As my colleagues have said, we are entitled to improve the policy further. We are certainly entitled to have a joust with the parliamentary draftsman — I am not speaking of the individual but the service which has helped to draft so much defective legislation. The Minister cannot pretend — I am sure he will not because he is a reasonable man — that an amendment passed by the Seanad cannot be approved [2190] in the Dáil next Tuesday. In the meantime he can work away on his regulations. He can work away in County Roscommon and be busy over the weekend writing out the regulations for further orders. He can have the regulations ready when the stamp of approval is given to the amended legislation.

I support my colleagues in their acceptance of the thrust of this. As regards the merits of the suggestion I recognise the difficulty of physically collecting the money. We have experience of charges like these being difficult to collect. The warnings which Senator Magner has given should be taken seriously. The Minister must ensure that he has administrative procedures which will be flexible enough to deal with emergencies and which will be firm enough to ensure people pay their fair share. Senator Magner made a valid point in that regard.

As regards the administrative matters concerning the second and subsequent visits, the vast majority of them could be handled in a relatively simple way. What comes through clearly is that in areas like health, better value for money is a better way to go about it rather than introducing charges. I leave it to the Minister to investigate how to get the best value for money in the health service. Any additional charge, even one which has the support of the section of the community which voted for Fine Gael, has limited use in breaching the yawning gap opening up in the health area between the resources available and the needs of the people.

This is an interim measure proposed by the previous administration and ratified by the people in so far as they supported Fine Gael. Obviously in so far as they did not support Labour or Fine Gael it was not ratified. I have dealt with the extraordinary position in which Fianna Fáil find themselves regarding its implementation but that is a matter for them. I warn them that the vengeance of the people on those who mislead the electorate with regard to their policies can be a very destructive and potent force.

As it is regrettably necessary and [2191] because it is consistent with our previously announced policy the Minister will have no difficulty in getting support for the principle of this legislation from Fine Gael. I have no doubt that in return for such support the Minister will consider such reasonable amendments as Fine Gael may consider necessary to protect properly the interests of those we are elected to serve.

Mr. Ferris: The Minister said he was pleased to have a second opportunity to be in the House today. I am sure he now regrets having to bring this legislation before us. What the Minister is suggesting is in line with what our colleagues on this side were honest enough to tell the electorate they intended to bring in. The Minister will realise that we are being consistent in opposing the concept of charging people for services to which they are entitled by law.

This is not the first time Fianna Fáil have suggested charging for out-patient services. A charge of £5 was suggested before. Under the 1970 Act the out-patients service was provided free of charge because people had contributed to it through the PRSI system or had medical cards. The guidelines are reviewed from time to time and from year to year by a group of hospital administrators and chief executive officers. I must say with all due respect to the Minister that there is no way this type of legislation, necessary as he will try to convince us can be operated in the hospitals and the out-patient departments irrespective of what he and the Government want to achieve in this regard. In the Minister's budget speech he confirmed he had hoped to save £6.7 million in the Health Estimate by creating a charge like this. I honestly feel it is impossible to achieve and I will try to explain the reason to the Minister.

As a member of a health board from 1973 to 1985, I know any effort to change the hospitals admission system, whether it be casualty or general practitioner referrals, was resisted always by staff, who, as the Minister will agree, are [2192] already overworked. Most hospitals are understaffed. There is no level of administrative staff available in the hospitals, particularly at out-patient departments, who will be geared to apply this charge or indeed will try to collect it. How does the Minister propose to define a first visit or a second visit? What privacy will be available to people when confronted by a member of the administrative staff to do a means test at the out-patient department?

The important announcement of the Minister, that CEOs would have an area of discretion, presumes immediately then that this charge will be collected after the event has happened, after the person is dispatched home from out-patients. Chief executive officers sit in a central office up to 20 acute hospitals and fifty or more district hospitals or other semi-acute hospitals in their region. I respectfully suggest that if there is an area of discretion available to a CEO. Patients in an out-patient department will use this section to avoid payment and then the health board will have the greatest difficulty, if not the impossible task, of trying to collect it afterwards. We suggest that any legislation that can be abused like that is bad legislation.

If the Minister had come before us today and suggested to us as a responsible House that he intended to charge persons outside the hospital services card bracket he would have had our co-operation because already they are considered to be in the higher income bracket of £15,000 or more. If they were availing of an out-patient or an in-patient service at public ward level we would have no objection to that concept because they are already paying consultants' fees and they are paying VHI to cover them for private wards. However, to have a blanket charge for people in the categories above medical cards and still with a hospital services card is unfair. It is unfair to expect the support of the Labour Party in this House for reducing hospital services. I suggest that it is inoperable because there is no staff structure I am aware of geared towards or agreeing to collect this amount. I foresee confusion [2193] when people arrive at an out-patient department.

The Minister said that in out-patient departments there are people with minor ailments. He said that non-emergency cases were using the facilities to a large extent. I suggest to the Minister with all due respect that nobody arrives at an out-patient department who is not a casualty or has not been referred there by a GP. I do not know of any out-patient department in any hospital in this country who accept people off the road so to speak — apart from casualty cases — without a referral from a doctor or a GP. The Minister will accept that the previous Minister's efforts to collect money that was outstanding from the self-employed, when he brought in a £100 fine for those who had not paid their health contributions excluded people who were subject to trauma or a tragic accident on the road. People, because their life was at risk, would be admitted without the £100 fine even if they had not paid their health contributions. Now we are talking about charging people who not alone have paid their health contributions but have contributed through PRSI and taxation and all the other things. Today after increasing the level of that charge the Minister is making an additional charge. I suggest this is probably illegal and unconstitutional. If the PAYE sector were as well organised as the IFA this would finish up in the High Court because there will be cases where people will have to pay three times for the same service which, in fact, is now a diminishing service.

Over the past four-and-half years in particular, and indeed from 1974 onwards there were many Labour Party Ministers involved in the health services. I am pleased the Minister acknowledged that although the service costs have risen to a staggering £1.3 billion, in that period there have been significant improvements in the standard and quality of care which is highly desirable. During Deputy Desmond's period in office I never heard one word of praise from the former Opposition Members who are now in Government about the standard of health [2194] care he delivered and the positive way he grappled with a major health bill while trying to keep the structure of the health services together. He tried to achieve economies in a specific way. He outlined to health boards by way of letter or recommendation areas to which they could address themselves, and major economies were effected over those periods. I was part of that process; we had a limit with regard to our health board allocations. When we got less than we wanted we called it a cutback: that is politics. We realise that the intricate structure of the health boards and services we had to deliver at county and regional level were protected by a previous Minister without the triple charges for services to which people are entitled. Their contributions were deducted by their employer.

If the Minister or his colleagues in Government were serious about collecting the money outstanding from people who could and should have paid these contributions, these charges on the most yulnerable would not be necessary. I would query also how he can implement a charge for children of six weeks and upwards. Will people have to produce birth certificates at the casualty department? I am pleased pregnant mothers are exempt. I think every Health Act so far exempted maternity cases and pregnancy cases from all charges. Of course we have always excluded people with medical cards or people suffering from permanent illness, whether psychiatric illness or congenital illness. That is quite right.

We feel there will be tremendous problems analysing the eligibility of people as they arrive at an out-patient department. If the Government are trying to achieve a saving of £6.7 million they should address the problem of the person who sends the patient there in the first instance, namely, the GP. If the general practitioner decides that somebody needs to go to an out-patients department for more elaborate tests than he could give in his surgery, or in the case of a casualty somebody should be there. If we want to address the problems of the hundreds of people who are out-patients on a weekly [2195] basis, on a twice weekly basis or on a daily basis in many acute hospitals consultants will have to be asked to stop recalling people to out-patient departments.

Having performed a normal appendicitis operation, instead of dispatching the patient to the general practitioner, which would normally be the case, they say: “You are doing well but I want to see you again in a month”, and immediately the whole system falls into place. A nurse notes that he has to be seen again, another visiting card is written out, an ambulance is sent out, or transport is made available, simply because the consultant wishes to have another look at the patient. He deals with hundreds of cases per day and spends literally two to four minutes looking at the patient and says: “You are doing nicely and I will see you again in two months”. If we are to address the problem of the abuse of the out-patient departments — and there are some abuses — it must be addressed by the professional people whom we have to trust to make a decision on whether people should be there or whether they could be dealt with effectively by the general practitioner. I am quite sure the vast majority of general practitioners would prefer that the person would be referred back to them. The first evidence that a general practitioner had that one of his patients whom he had referred for an operation had the operation, was when he saw him walking down the street. Patients are still being referred back to the consultant instead of to the general practitioner. This is an anomaly that is putting stain on the health services and health budgeting. We must not charge people who cannot afford to pay. They may be just above the medical card limit. I shall confine myself to those two areas because I am extremely worried about them.

The Minister will not be able to collect this charge. It is a window-dressing effort to stop people from going into out-patient departments. The Minister meets these people as regularly as I do at our clinics which are free. Very few of them want to go into an out-patients department or, [2196] indeed, into a hospital bed unless they really have to, It is one of the most traumatic moments in people's lives when they are told they have to go into hospital. Let us not penalise them. Let us not dissuade them from going in. Let us not enact legislation to make people neglect themselves. This is a retrograde step and I am disappointed that the Minister is trying to get it through the House.

As my colleagues in the Labour Party have said, we will be opposing this Bill. We feel that the amendment suggested by Senator Durcan is worthy of our support and we will be supporting it if we get to that section. We will be opposing the section as it stands.

The Minister may be thinking that the new Seanad will be more forthcoming. He will certainly have more problems on his side of the House. We know the electorate and we can determine the number of seats Fianna Fáil are likely to get. Having said that, I wish good luck to all those who aspire to be Members of this House. Irrespective of numbers, the Minister will always find this House very constructive in dealing with legislation and will not oppose it for the sake of opposing it.

We are opposing this Health (Amendment) Bill because it is against the concept of everything we have ever stood for. We always hoped there would be a free health service for everybody and that the consultants would agree to that and would be paid a salary by the State to provide it. Mr. Corish found this was impossible and we finished up with a two or three tiered health system: the medical card, the hospital services card and the VHI system.

Now the Minister is putting in another tier for people who have already contributed to this service and I am sorry about that. I understand the economic reasons, but economic reasons do not always justify the end result and we feel that the wrong people are being attacked in this way. Their incomes are at risk and we are putting a further tax on them for a service which, up to now, they were entitled to receive free of charge. During the election campaign these placards and [2197] publicity posters caught my eye: “Who suffers from health cuts? The poor, the old, the sick, the underprivileged”. Many people in this category, just above the health card limit, are still quite poor. If you are married and earn just over £100 a week, you do not have a medical card. Generally speaking there are fairly stringent levels for deciding when a medical card is given and these have been tightened up because all Governments are trying to curtail the cost of the health services. It is fairly tight when you have a medical card. To go a step further and exclude those people is not justified and for that reason we cannot support the Bill.

Minister of State at the Department of Health (Mr. Leyden): I should like to express my appreciation for the contributions of Senators in this Second Stage debate. Before I refer to Senator Durcan's amendment I should like to mention some of the contributions made generally to this debate. Senator Fallon, the Fianna Fáil spokesman on Health, contributed to the debate and made some useful points about the legislation. Senator O'Mahony made some points to which I would like to refer. He made a point about the use or so-called abuse of the out-patient services attached to hospitals and clinics. It is generally accepted by those who administer the service that there is an over use of the service, and the casualty departments in particular, and that some people attend at those clinics instead of going to their general practitioner.

I should like also to make the point to the Labour Party members that there was a charge in existence in the Western Health Board, North Eastern Health Board, and perhaps other health boards, of £5 per visit. I was required on one occasion to pay for 12 visits to the local hospital because of an accident in my home when a boiler exploded. The service is in operation and was in operation under the former Minister, Deputy Desmond, and he did not seem to have any objection to it at that stage. When did [2198] the Labour Party discover that these contributions existed?

Mr. Ferris: Does the Minister want an answer? Deputy Dr. Woods introduced them and health boards who were politically motivated maintained them, but they were illegal.

Mr. Leyden: The Fine Gael Party put forward the proposal in their budget which was put before the electorate and, as far as I can recall, during the election campaign we never made any commitment to withdraw the £10 out-patient charge. In fact, it would have been extremely beneficial for us to do so but we did not use that proposal in the campaign so it is quite consistent for us to bring this charge forward particularly as we are aware and conscious of the massive cost of the health services. We have to do something to assist in the payment of the health bill.

Referring to further points raised by Senator O'Mahony, the actual estimated revenue from the out-patient charges for the remainder of 1987 is approximately £6 million and about £9 million in a full year. We hope to have in place, in cooperation with the VHI, a very attractive package which will be available to the people who will be affected by this charge. The actual package will be so attractive that I feel the majority of people who would be in the categories affected by the proposed charge will be covered and will have coverage by the time this comes into operation.

There is also the important hardship clause which I mentioned in my Second Stage speech. Section 45 of the Health Act, 1970, provides that the CEOs of the health boards have the discretion to deem people who may find it difficult to pay eligible for the services. That discretionary power is contained in the existing Acts and applies to this charge, but I must make it clear to Senators that it is a once-off charge for a particular ailment. It is not an ongoing, repetitive charge for that ailment, whereas the GP service carries a repetitive charge for each time [2199] the patient visits his doctor. It is a reasonable request for a contribution in the very difficult circumstances which we are facing in the health services. The alternative is a further major cut in the health services to the people. That is what we are facing. We either make this charge or face a further serious drop in the level of service in the health services. We are not over-enthusiastic about having to impose this charge.

Mr. Durcan: You certainly were not.

Mr. Leyden: We have no alternative. It is far preferable to the charge proposed by the Fine Gael Party as well of the £1 per prescription——

Professor Dooge: Nonsense.

Mr. Leyden: ——Which was proposed in the general election campaign. We have decided to delete that charge on medical card holders who are the least well off people in our society——

Professor Dooge: All the brothers and sisters benefited.

Mr. Leyden: ——and cover 1.2 million people approximately in the overall population. Nearly 40 per cent of our population are covered by medical cards, so it is the 40 per cent who would be affected by the £1 prescription charges. That will not arise because we have decided not to bring forward that legislation.

On Senator O'Leary's point regarding the collection, I agree with him that it is possible to arrange for a straightforward administrative system to collect the charges. These are already in place in some of the health board areas and I have had personal experience that it is for the best when it comes to the health services. The bill was sent, but one was not charged at the point of entry and no one will be refused hospital services as a result of this £10 charge. I want to assure the Seanad that this will be the case in reality, that where services are required they will be [2200] provided and we will have to work out a system then to arrange for the collection. The system will be very easily worked out with the health boards for the collection of the £10 fee from people using the facilities at out-patient departments. Coupled with that we will have in place the very attractive VHI system which will cover the out-patient charges for those who will be in that system.

Therefore, let us not exaggerate the administrative areas. We must look at it in a positive way and realise that a system will be in operation and is in operation for the collection of the charge.

Senator Ferris made the point that he had no real objection to the £10 for those over the £15,000 category. I think I am not misrepresenting the Senator's point of view by saying that. Let me point out that this applies also to that category and strangely enough, that category were availing of the free services which was being provided by the State and it was available to them. This £10 is a small contribution to make to assist in the continuation of the hospital services.

I come to the amendment which has been tabled by Senator Patrick Durcan. The provision of subsection (3) differs in only one respect from the original subsection (3). The change consists of the deletion of the words “not included among the persons referred to in subsection (2)”. The reason for this change is that since 1979 the entire population is included in subsection (2). The Bill now before the House substitutes subsection (3) for the original subsection (3). The legal advice which I have received is that the diseases and disabilities prescribed by the Minister under the original subsection (3) continue in force on the enactment of this Bill. The necessity for the amendment does not, therefore, arise. That is the legal advice which has been given to me by my Department and I wish to assure the Senators that the amendment is not required in the circumstances. That is why the parliamentary draftsman in drawing up the legislation did not include this provision.

Acting Chairman (Mr. Daly): I am [2201] sorry, Minister, to interrupt you but this should be on Committee Stage not on Second Stage.

Mr. Leyden: I am referring to the debate by the Senators. I am sorry. May I refer back to it later?

Acting Chairman: Yes.

Professor Dooge: It may shorten Committee Stage if the Minister can convince us now.

Mr. Leyden: I am restricted by the Acting Chairman in this.

Acting Chairman: If the Leader of the House says you may go ahead that is all right with me.

Mr. Fallon: It was not made clear by the other side that if the Minister gave guarantees or assurances in his reply, then there would be no need for an amendment on Committee Stage. Hence the Minister is replying.

Acting Chairman: The Minister may continue.

Mr. Leyden: I want to thank the Senators for raising the point. I want to say if I may, aside from the issue involved, that I have tremendous respect for the Seanad. This is my third occasion to address it as Minister of State. I spoke here as Minister of State in the 1982 administration. Those who object to the Seanad and the continuation of the Seanad would be wise to come here and [2202] see how it operates. It is an effective and very economic part of our Oireachtas system and affords an opportunity for Ministers to discuss with the Senators reservations which they may have. In this case the matter was not referred to, as far as I am aware, in the Dáil and certainly not in greater detail than here this evening. I want to assure the Senators that I am very conscious of the amendment which they propose, but I am giving them a categorical assurance, with the legal advice which is available to me from my Department, that this amendment is absolutely unnecessary. In the circumstances the amendment should not, therefore, arise.

The regulations, which are in draft form and which I am not in a position to enlarge upon, were mentioned in my speech. I assure the House that they will be laid before the Houses of the Oireachtas and the Oireachtas will have an opportunity, as is required under the law, if they wish, to have those regulations debated within 21 days thereafter. Those regulations will be placed in the Library of the House, and will be available for inspection there. In my Second Stage speech I have given an outline of the exclusions and I assure the Senators that the amendment is not required. That is the advice given to me by my Department.

I wish to thank again the Senators who have so able contributed to this debate. It has been a pleasure for me to have been here this evening to have this very good debate in relation to this Bill.

Question put.

The Seanad divided: Tá, 13; Níl 5.

de Brán, Séamus.

Fallon, Seán.

Fitzsimons, Jack.

Hanafin, Des.

Hillery, Brian.

Hussey, Thomas.

Kiely, Rory.

Lanigan, Mick.

Mullooly, Brian.

O'Toole, Martin J.

Ross, Shane P.N.

Ryan, Eoin.

Ryan, William.

[2203] [2204] Níl

Ferris, Michael.

Harte, John.

McGonagle, Stephen.

Magner, Pat.

O'Mahony, Flor.

Tellers: Tá: Senators W. Ryan and de Brún; Níl: Senators Harte and Manager.

Question declared carried.

An Cathaoirleach: Next Stage?

Senators: Now.

Agreed to take remaining Stages today.