House of Assembly: Vol114 - TUESDAY 15 MAY 1984
Vote No 14—“Health and Welfare” (contd):
Mr Chairman, before progress was reported yesterday I was replying to a number of speeches. The hon member for Brits made an extremely interesting speech about Carnegie I and Carnegie II. In his speech he drew a comparison between the first and the second Carnegie investigations. It is quite clear that he undertook a special study of the subject. Of course, I replied to him yesterday with regard to the investigation to which he referred. At that stage, therefore, I just wish to thank him for his speech. I can also assure him that I quite appreciate that it was impossible for him to be present here. Therefore he may as well accept what I said yesterday as a reply to his speech.
My good friend the hon member for Meyerton spoke with compassion about the general practitioner and his role in the medical services of South Africa. I am grateful to the hon member for that. I am also of the opinion that they are a group of people whose praises are, perhaps, seldom sung. For that very reason I owe the hon member for Meyerton a considerable debt of thanks. The hon member also advocated that a subsidy be granted to older people while they are still living in their own houses. I think that the hon the Deputy Minister, whose task it will be to reply to questions in regard to the welfare activities of the department, will reply to him at greater length in that regard. It is by no means a matter of our not having sympathy for those people. It is a matter of money that must be available for the financing of welfare work. Nevertheless, I am very grateful to the hon member for that plea he made.
As chief spokesman of the official Opposition, the hon member for Parktown referred in the first instance to the increase in the budget of the department. He also calculated, quite rightly, that the increase in the budget—that is to say, the real money at the disposal of the department—amounts to approximately R300 million. However, if one considers the additional services that can in fact be provided with that R300 million, or that we are supposed to be able to provide, it is surely clear that it is absolutely minimal. Then, of course, there is an additional R8 million from another department which is used in respect of occupational diseases in mines.
There is a slight increase in the amount in respect of the family planning programme. Now, I might just explain to the hon member that this year the family planning programme still consists of three components. The one is totally concerned with family planning, while the second is that of community development, and the third consists of information, training and communication. From next year these three programmes will be specified separately, to make it clearer to hon members. The clinical programme for family planning amounts to approximately R23 million, while the programme for community development amounts to R2,7 million, and information, training and communication—this therefore involves the propaganda necessary to be able to do work—a little more than R1l million.
Various hon members—inter alia the hon member for South Coast, the hon member for Middelburg, the hon member for Rustenburg and the hon member for Bryanston—have requested more money, to a greater or lesser extent. Therefore I am very grateful that this House could take cognizance of the real importance that hon members attach to this population development programme. Indeed, I believe that this was very clear from this debate. As the hon member for Rustenburg put it, the people who are able to do something about this problem in South Africa have already been born. After us there will no longer be people capable of doing something about this problem. That is why I am profoundly grateful that there is so much understanding of the true extent of the problem and that it appears that we are all, irrespective of boundaries, prepared to take one another by the hand in order to tackle this problem and deal with it.
Then, too, I should like to refer to a few things that are really being done. I also wish to indicate how the increase in expenditure is progressing. During the 1982-83 financial year the increase was R24 million. In the 1983-84 financial year it was R29 million, and this year it is approximately R37 million. The programme is geared to communities that lack the knowledge or motivation to plan their families for themselves, and at those who cannot afford to pay for family planning services. The utilization of the additional money is discussed separately under the various items. They are indicated accordingly in the Budget.
What is the extent of the services rendered? The aim is to reach 1 285 000 women this year, to assist them to plan their families. Hon members will realize that this is a large number of people. Moreover, a tremendous amount of work is being done in this regard. I should very much have liked the expansion to be greater this year because we expect to be able to treat in the region of 50 000 more women this year than we treated last year. That is not enough. For that reason I am grateful to hon members who perceive the problems, particularly with regard to the amount of money necessary for the programme.
As far as sterilization is concerned, this is a very important method of family planning for couples who have decided that their family is large enough. Sterilization services provided by both the provincial administrations and the department are constantly being improved, inter alia by the use of the laparoscopic technique which is already available in all four provinces. It is seen to that clients are informed in advance about the procedure so that they are able to take an informed decision. Personal attention before and after the operation is regarded as extremely important. I also wish to emphasize that there is no question but that this operation is performed solely at the request of patients, and this will always be the case. They all agree to it voluntarily. I receive many letters from people who tell me that they must be paid to do this or that. Personally I do not see my way clear to doing that and I do not believe that the Government will ever be in favour of adopting that method. However, we are still experiencing problems as regards treating women who apply for it, if necessary. With the aid of the provinces we shall have to investigate this matter with great circumspection.
Large numbers of women have already been sterilized. Last year the total was 23 000. The numbers are considerable but are still too few. How are these women treated in regard to the family planning programme? At this stage we already have 27 000 service points. This is an exceptional task. There are 13 000 farm services, 5 500 factory services and many others. What about the staff who provide these services? The services are provided on a part-time or full-time basis. There are 203 medical practitioners and 1 487 nursing staff. Then, too, there are 1 137 extension staff. Therefore the family planning services comprise a formidable organization that has already been built up and that we can carry on with. However, this is not enough and that is why we need everyone’s help. In this regard I just wish to mention to hon members the kind of help that we are getting and which we welcome and, in fact, require. In the Western Cape the Foundation for Rural Community Development has already been established. This is an organization of farmers with a board of directors that is appointed. Two are appointed by the South African Agricultural Union. One is Mr Frans Malan of Simonsig and the other is Mr Nico Coetzee, the chairman of the Transvaal Agricultural Union. These people provide exceptionally valuable services. Moreover, they do not merely expect the State to contribute all the funds; instead, the farmers themselves, as groups of farmers, have over the past year collected more than R100 000 which they are using. What with us helping them and the farmers helping themselves in appointing community developers for various groups of farmers, there are already 16 such groups of farmers that are being served on the farms by community developers appointed by the farmers themselves. A very large number of families is involved. As far as the group in Knysna is concerned, 135 families are being served; in Klein Drakenstein the number is 206; in Kareedouw, too, there is a very large number; and in Citrusdal there are 186. This process is still developing, but it is reaching Transvaal too, now. In the Lichtenburg and Warmbad areas use has been made of this organization, and they are doing outstanding work.
In addition to all this we have realized, due to that of the President’s Council report, that what we are doing here is not sufficient. We shall be compelled to harness the strength of the whole of South Africa, big as it is, to achieve success in this field. That is why the Government entrusted the programme for population development to this department, because we realize that it is impossible to succeed with family planning unless one launches an overall process of upliftment.
It was the department’s privilege to launch the programme. The hon member for South Coast told me yesterday that I had chosen a bad date for the launching of the programme. The programme had been advertised some time previously, but then the signing of the Nkomati Accord was arranged and unfortunately they took place on the same day. I trust that both of the programmes launched on that day will in future show that they are of great value to South Africa.
What have we achieved? Last night I referred to the programme launched here at the University of Cape Town, the so-called Carnegie investigation. What is striking in that regard is that with respect to all those things that were blamed for poverty, the question of an investigation into population numbers was never, never touched on. I am not specifically saying that the size of the population is responsible for poverty. Nor am I saying that poverty is responsible for the large numbers; but there is no question at all that there is a combination and a link between the two. Whereas an effort is still being made to determine what the causes of poverty are, the Government has already launched a programme to see whether we cannot tackle poverty within the population as a whole. Therefore I am grateful that all the hon members gave such serious consideration to this matter, and that is why I am grateful that I have already been able to report on what is going on and so on. The department has succeeded in appointing Dr Boet Schoeman as chief of this programme. He is the Chief Director. An interdepartmental committee consisting of senior officials has been established and has already held a number of meetings under the leadership of the Director-General, with the aim of expediting this programme.
What do we wish to achieve by means of this campaign? In a report entitled World Development Report dated August 1980, the World Bank reaches the conclusion that the combating of poverty can only be achieved in the long term if an integrated and comprehensive development approach is adopted which is concerned with human development. In the process the focus must be on, inter alia, the following spheres: Economic development programmes; health programmes to improve general health conditions, including basic health care, water supply, sanitation and housing; education programmes; nutrition programmes; family planning programmes and development at the ground level, that is to say, community development—these are the programmes recommended by the World Bank.
What does this programme which we have tackled with so much courage and enthusiasms in South Africa, involve, and why do we believe that success will indeed achieved if we have everyone’s support? What do we seek to achieve thereby? Here it must be borne in mind that the Department of Health and Welfare does not handle all programmes itself, but is only the co-ordinator in respect of many of them. What are these programmes? Firstly, there is a regional development strategy aimed at promoting developmental co-operation in the regional context between the authorities and the non-Government sector. By means of this strategy the Government specifically wants to ensure the involvement of the local communities and the private sector in the formulation of the development policy, and with the assistance I had from hon members yesterday and am still going to get, I believe that we shall succeed. Secondly, there is an industrial development strategy and decentralization programmes within the framework of the regional development strategy. This aims to ensure an equitable distribution of economic activities in Southern Africa, to create more job opportunities and to ensure a higher standard of living and a higher per capita income. Thirdly, there is the establishment of multilateral structures between the Republic and the independent Black states in respect of a variety of spheres, eg health and welfare and agriculture, in order to promote co-operation with a view to boosting the standard of living in Southern Africa. Then, too, there is the establishment of a Development Bank and the acceptance of a national health facilities plan adapted to the realities of a developing South Africa. From a health perspective, the focus is on the provision of basic services, health instruction, primary health care, community health and hospitals, and a new housing strategy in a positive effort to try and eliminate the present housing shortage in co-operation with the non-Government sector. The self-build principle is being strongly emphasized in the new approach. In the seventh place, there is a new approach to education and training, with reference to the HSRC investigation into education. Apart from that, there is the fact that the Department of Education and Training is already engaged in 200 literacy programmes for adults and places a high premium on the training of Black teachers. In the eighth place, there is the manpower training as co-ordinated by the National Manpower Commission and the Department of Manpower; in the ninth place, there is constitutional reform in order to accommodate to political aspirations of all groups at all levels in an orderly fashion, and, in the tenth place, a population development programme, its chief aims being the task of boosting the standard and quality of life of all people. This population development programme has specific objectives;
- 1. To stabilize a population of 80 million by the end of the next century.
- 2. Accelerated social and economic development in in order to achieve parity in the development levels by the middle of the next century.
- 3. A total fertility rate of two children per woman.
- 4. Orderly spatial distribution. The chief component of which the programme is comprised, firstly, the acceleration of social, economic and physical development, particularly in the spheres of health, education, economic programmes, housing programmes, urbanization and rural development.
In the nature of the matter, it will be necessary in terms of the population development programme to concentrate on specific goals in this broad terrain which will best serve the objectives of the population development programme. An effort will have to be made and serious attention will have to be given to community development, family planning programmes and the IEC programme; that is to say, the information, education and communication programme. In order to extend this programme, the department recently advertised 70 posts with a view to giving these people posts in the various parts of the country where they will be able to assist with this programme; in the first instance community developers, but also with regard to every aspect I have mentioned. I can say today with profound gratitude that we are being overwhelmed by applications from people who would like to help. At this stage we shall not be able to accommodate all the people. They are not just anyone. Most of them have degrees, some have Masters’ degrees, and they are people who have already made a study of the subject. This programme is still in its infancy, but to me it represents a message of hope. People who are inspired and want to help are taking part in it. Community development associations are being established at various places in the country. This is taking place on such a scale that one cannot keep up and visit all of them in order to shake hands. However, I say with profound gratitude that if we can continue in this way I am convinced that an inspired people that wants to solve its problems will, in fact, be able to do so. I say this with sincere gratitude for the wonderful support and inspiration given by the senior officials of the department, and here I include the Director-General with his three Deputy Directors-General, Dr Schoeman, who is in charge of the programme, and Dr Rossouw who has for years been in charge of the family planning programme, and all the other officials. One is sincerely grateful for what they are doing, and I am convinced that the programme has a future.
I have now almost reached the end of what I want to say. The hon member for Parktown asked a few additional questions, inter alia in connection with the cost of a medical practice, and made certain suggestions, eg that doctors should be able to advertise their services. Perhaps prices would then rise even further. The hon member also discussed group practices. I am not going to say anything about that, because these are matters that are not controlled by the Government but by the Medical and Dental Council. If the hon member wants to discuss those ethical problems with that council, I shall not prevent him from doing so. However, I do not know whether it will work. I have my reservations about what would happen if medical practitioners could advertise and one doctor offered his services at a lower price than the next.
That is a weak answer.
And the question the hon member asked was a silly one.
What did he want to advertise?
A colleague asks what the hon member for Parktown wants to advertise. I do not understand either.
Read my speech; perhaps you would understand then.
I listened to the hon member’s speech, and now he wants me to read it as well! [Interjections.] The fact remains that I did not criticize the hon member’s speech. I am merely stating that if he wants to discuss the matter with the Medical and Dental Council, I have no comment on that.
But you are the Minister.
I know that I am the Minister in question. But does the hon member not realize that this council is an autonomous council and that they regulate the practical side of things? Where is it stated in the Act that the Minister regulates the practical side? That is not how it works.
That, basically, is all I want to refer to at this stage. If further questions are put to me, I shall reply to them with pleasure, but as regards the best of the debate, and more specifically welfare, the Deputy Minister, under whom this falls, will deal with the debate.
Mr Chairman, we now come to that part of the debate where we move to welfare matters. It is therefore not my intention to react to what the hon the Minister has said.
At the outset I would appreciate it if Dr Retief could convey my thanks in particular to the pension personnel in his department for the very efficient and courteous way in which they have handled my numerous queries.
The hon the Minister announced the appointment of a select committee to look into certain pension matters. We in these benches welcome it. We have called for such a committee in the past, and I can assure him that the PFP will serve on this committee with a good deal of enthusiasm. The decisions or lack of them on the part of this committee will have a profound impact on future developments in South Africa.
It is clear to me that we cannot continue with our present system of welfare and pensions. This is a point which must be made clear to all South Africans. I say this for a number of reasons. The hon the Minister referred to demographic trends and the need to limit population growth. If one looks at the composition and structure of the South African population, one can see the reason why one cannot continue into the future with the system of the past. Such an examination shows a number of inescapable facts. The first is that people are living longer. The statistics show that in 1920 the average life expectancy of a White male was 55,6 years. In 1980 it was already 66,8 years. Women always live longer than men, and the life expectancy of a White female in 1920 was just under 60 years and in 1980 it was just under 74 years. The second important point is that, with the improvement in medical knowledge, particularly with regard to geriatric medicine, retired people are living longer. The average life expectancy of a male, when he retires at the age of 65, is now 15 years. A female who has reached the age of 65 can anticipate living for another 19 years.
What are the implications of this? There are two important implications. The first is that there is going to be a tremendous increase in the absolute number of aged people. The Human Sciences Research Council provided me with some statistics in relation to people over the age of 65 years. According to those statistics, in 1980 we had approximately 1 million people over the age of 65—this is for all race groups. They estimate that by the year 2000 there will be 1,8 million and by the year 2020 there will approximately 3,6 million. In other words, within approximately 40 years there will be approximately a three-and-a-half-fold increase.
There is a second implication, and this is the one that is often ignored. It is that the aged are forming a bigger and bigger proportion of our population. At the present moment one out of 13 Whites is over the age of 65. By the year 2020 it will be one out of seven. These ratios are very favourable compared with overseas countries. People overseas have become very concerned at the tremendous escalation in the costs of pensions and welfare. There they have worked out a ratio which they call the Old Age Dependency Ratio. That is the ratio that measures the number of retired people for every worker. In West Germany the ratio is at present 0,46. In other words, for every person who is working, half a person, so to speak, has in fact retired; It is estimated that by the year 2020 that ratio is going to be 0,89. What we are saying is that for every person who will be working and who will be in labour force in West Germany, one person will in fact be retired.
There are two points that arise from this. Firstly, there is going to be a tremendous increase in the number of people who will require old-age benefits. The second is that there are going to be a small proportion of people working and paying taxes—and that is the key—to provide for the services. The deduction that flows from this is that more and more of the resources of the countries concerned, which includes South Africa, are going to have to be channelled into looking after the aged. Just consider the tremendous cost in South Africa of social old-age pensions. Over the last 10 to 11 years the cost in absolute terms has increased sixfold. We are paying six times as much now for the social old-age pension system as we were paying 10 to 11 years ago.
Perhaps an even better indication of the position is obtained by looking at what proportion this is of our gross domestic product. Ten years ago it was taking less than ½%; today the social old-age pensions account for roughly l½% of the gross domestic product. That is a threefold increase in 10 years. This is, of course, not unique to South Africa. We have seen what has happened overseas. I have mentioned repeatedly in the House the position in the USA where their welfare systems pays out R24 million more per day than it is getting in. In a country like Holland 42% of their national income goes just to pay for old-age and welfare benefits. In South Africa we are lucky because welfare and pensions account for approximately 7% of our gross domestic product. So, compared to overseas countries, we are still in a fortunate position.
There is one fundamental factor we cannot ignore in South Africa. That is that in South Africa the cost of providing for these benefits comes out of income tax unlike in the United States where a contribution is taken from both the employer and the employee and that is then used to pay for those benefits. In South Africa, with the exception of something like the Unemployment Insurance Fund, we do not actually deduct for the social security benefits of South Africans. We take the necessary money out of taxes. The result of this is that the burden for providing for the vast majority of these services begins to fall on a smaller and smaller proportion of the people. If one looks at the tax structure in South Africa one finds a number of important characteristics. The first is that the proportion that is being paid by individuals is increasing. This is an important factor. Secondly, one must also look at who is paying individual income tax in South Africa. In 1981-82 roughly 5% of all individual income tax collected came from more than 1 million taxpayers. In other words, 50% of those who paid tax were contributing 5% of individual income tax. The exact figure was 5,38%. A mere 33 000 odd tax payers accounted for 22% of all individual income tax collected. The top 10% of individual tax payers actually account for more than half of the individual income tax that we collect. One cannot continue with this. If we continue to take more and more money from these people we are eventually going to kill their motivation. There is a limit to how much one can actually tax people. If one kills the motivation of these skilled people then the whole economy is going to suffer. If we do not take steps now we are going to find ourselves in a similar situation as many overseas countries.
In the United States social security contributions are now running at 13,3% of salary, half from the individual and half from the employer. They have been doing studies and have come up with three different scenarios, namely optimistic, intermediate and pessimistic. The experts there tell us that the best they can hope for is the intermediate scenario.
Order! I am sorry to interrupt but the hon member’s time has expired.
Mr Chairman I rise merely to afford the hon member the opportunity to complete his speech.
I want to thank the hon Whip for the opportunity.
Experts in the United States agree that the best that they can hope for is the intermediate scenario. They estimate that whereas the cost is now 13,3%, by the year 2010 it will rise to 16,6% and by the year 2030 to 25,4%.
Let us look at the pessimistic scenario. There they estimate that contributions could rise to 21,4% by the year 2010 and that it might rise as high as 45% by the year 2050. In other words, 45% of a person’s income will have to be used for paying for social security benefits.
I believe the message that we as legislators have to get across to South Africa is not whether we can continue with the present system. We cannot. If we do we are going to go bankrupt. People must realize this. What we need to do is to focus the debate on what can be done to overcome the problem. I think there are two critical areas in this regard.
The first area that one has to look at is the 40% of the working population who do not belong to pension funds. That is an important point.
The second point is whether those people who do belong to pensions funds will eventually be receiving the benefits from those pensions funds. We know there is an awful lot of money wasted. According to a recent report some R364 million—if I remember correctly—was paid out on resignations. That money tends to be wasted because people do not invest it.
I should like to raise two specific issues with the hon the Deputy Minister. The first relates to a letter which I received from a constituent of mine. It relates to the increase in the annual registration fee of social workers from R21 per annum to R60, in terms of Government Gazette No 8974 of 25 November 1983. I should like to quote from the letter:
Mr Chairman, I think the lady has a very good point because it seems to me that an increase in the fee from R21 to R60 per annum, nearly a 300% increase, is fairly substantial. Social workers have to pay their registration before 30 June, and I would urge the Minister of Health and Welfare to look into this matter and, if possible, to reduce the fees.
The last point that I should like to raise is in regard to the increase that was granted to civil pensioners. Those who retired between 1973 and 1981 got a higher percentage increase than those who retired before 1973. I think the reason for this, as given by the hon the Minister in reply to a question, was that previously those who retired before 1973 got a higher percentage increase.
Mr Chairman, I have lots of problems with percentages, and the basic problem that I have is that one does not spend percentages but that one actually spends rands. Who really needs the money? If one gives the man who retired on a pension of R150 an increase of 20%, it would mean an increase of R30. If one gives the man who retired later and receives R500 per month an increase of 10%, he would get R50 more. Therefore, in absolute terms, he has more rands to spend. Who therefore really needs the money? I think it is the people who retired before 1973 who really need that money because they retired on a smaller pension.
Mr Chairman, the hon member for Edenvale make a very interesting contribution, and I agree with many of the things he said. For example I think it is time the Government took a look at our pension schemes, in order to make the necessary amendments and improvements to them. We know of course that this is already receiving attention.
I should like to congratulate the hon the Minister and his department most sincerely on this attractive and informative annual report. Mr Chairman, you probably noticed that several hon members used information from the report in their speeches, and in my opinion this is a feather in the cap of the department and really does it credit. I also want to thank the hon the Minister for his efforts to make medicine cheaper. We learned from our colleagues that they do not agree with everything, but they have every-right to do so of course because they know more about medicine than I do. I also found it very interesting that the hon member for Witbank said here last week that in certain places it now costs more than R800 to buy a grave. One frequently hears the allegation that it is too expensive to become ill; now it seems to me that it has also become too expensive to die. [Interjections.] I therefore trust that the hon the Minister’s efforts to make pills and spectacles a little cheaper will succeed.
I should now like to turn to the hon the Deputy Minister and talk more specifically about welfare matters and in this respect I want to associate myself with the hon member for Edenvale and the hon member for Meyerton who have already discussed this subject. We have great appreciation for what the department is doing for our senior citizens, and in particular we appreciate its involvement in making them happy in the autumn of their lives, and the auxiliary measures aimed at meeting their needs. I particularly appreciate the new policy, namely to keep elderly people self-sufficent for as long as possible; to keep them in the community for as long as possible and to allow them to participate actively in community life. This is a very interesting direction which the department would do well to maintain. If one isolates the aged in homes as we know them today, we know from experience that they are inclined to become depressed. On the other hand, as long as they are able to fend for themselves in a little place of their own, they are far better off. According to the annual report of the department there are at present 356 subsidized homes, with approximately 25 000 occupants. It is estimated that it costs the State about R20 000 per bed when new facilities are created. In 1963 117 089 people received social pensions. It is interesting to note that only 30% of these people were men. It is therefore clear that the life expectancy of men in South Africa is far lower than that of the women, and I wonder whether the hon the Minister could not take a quick look at this problem too. [Interjections.]
Civil and other pensions are revised annually by the department. We are grateful for this too. Recently it was announced that pensions were to be increased from R152 per month to R166 per month. When we consider these 177 000 pensioners, we find that according to the annual report an amount of R337 million was paid out to these pensioners. Over and above these pensions the State also subsidizes old-age homes as follows: A resident in category A receives a subsidy of R111,64 per month. A resident in category B receives a subsidy of R170,94, and a resident in category C receives R328,55 per month. The total subsidy paid to old-age homes and children’s homes is estimated at R48 million for this year. It is therefore clear that elderly people in homes are well cared for. They are properly housed. They are also cared for properly, and usually they do not pay more than two-thirds of their pension income. For this they receive full board, proper care, their laundry is done for them, etc.
We know that pension contributions are only an aid. Although it is not within the means of the State to simply keep on increasing pensions, I nevertheless want to make an appeal, not for a general increase, but for assistance to old people who are still self-sufficient and living in their own homes. Old people with little money, who have to buy their own necessities of life, who have to pay for water and electricity, and added to that the maintenance costs of their homes could, I feel, come into consideration for additional aid. Could the hon the Minister not make some kind of concession to these people? This principle is already recognized in cases where, for example, a person applies for a pension for the first time at the age of 70. Such a person is accorded recognition in the form of an adjustment, which is made because he waited a few years before he applied for a pension. In this way people can be encouraged to be self-sufficient, and this will also alleviate the pressure on homes.
The State will also benefit from this in other ways. Over and above the money the State spends on homes, it also makes a considerable contribution by way of the money supplied by Community Development. This department provides money for the erection of homes at an interest rate of 1% per annum. In some cases the interest rate is as low as one twentieth of 1% per annum. If one takes this into account, I think that the State would benefit by giving people who are self-sufficient and have in their own homes some kind of recognition.
I should also like to draw the attention of hon members to the fact that a subsidy of R58,4 million is paid to the 78 registered children’s homes, in which 40 327 children are accommodated. It is, however, alarming to take cognizance of the fact that only 1,52% of the children in those homes are orphans. Of those children 95,92% are the victims of the incompetence and inability of their parents to provide them with a proper upbringing and a decent home. It is equally alarming to note that during the past five years there were 90 000 divorces in South Africa, involving 123 000 children. I think these figures are certainly alarming and require the urgent attention of the church and the authorities.
As far as civil pensions are concerned, we are grateful for the memorandum presented to us. The hon member for Edenvale has already elaborated on this at length. I just want to make the observation that it is clear from the report that this fund is basically sound and that it is well administered. But I share the concern that it is a pity that people are still allowed to withdraw their pension money by resigning in order to obtain these funds to buy a car, go on holiday, pay their debts or for some other reason. The payments by their employers then accrue to this pension fund. When they retire these people frequently become social pensioners instead of being self-sufficient civil pensioners. For that reason I want to congratulate the hon the Minister on the appointment of the Select Committee on Pension Benefits and Rights, and I should like to quote the terms of reference of this committee to hon members. They are as follows:
- (a) The manner in which satisfactory pension benefits could be provided for or assistance could be given to that section of the public which has no or insufficient pension cover;
- (b) the compulsory preservation of pension rights by means of transferability or otherwise;
- (c) the commutation of a part of lump sum benefits into annuities.
I hope that this committee will report to the hon the Minister as soon as possible and that its recommendations will soon lead to legislation which will put an end to this phenomenon. I think it is clear that we are dealing with two problems here. In the first place there is the group of people who do not belong to any pension scheme and in the second place there is the group of people who use their pension benefits for short-term benefit.
Mr Chairman, the hon the Minister will pardon me if I return to a health matter for a moment. I let the hon the Minister know that I was unable to be present in the House yesterday.
I want to refer briefly to last year’s debate on this specific Vote. I also want to take this opportunity to state clearly and unequivocally that I wish to express my strongest condemnation and want it placed on record that we are not satisfied with the way in which the hon the Minister replied to the relevant debate last year. On that occasion the hon the Minister described my speech as rubbish and reprehensible, and added that he did not feel it was necessary to reply to it. In this Committee the hon the Minister may insult me as much as he pleases, but he is also insulting the voters outside, because that was the reply received by a large number of voters on behalf of whom I ask questions here. The hon the Minister may not believe me but some of those voters live in the Free State.
The hon the Minister did not consider it necessary to reply because we on this side of the Committee had certain fundamental objections, for example—and these were relevant in that debate—to the transplant of gametes, the human reproductive cells, from one person to another on an extramarital basis, as well as to the provision in the Act that these may be imported. It is after all true that this can happen. If it is not true then the hon the Minister must tell us. We should like to know from the hon the Minister whether, in terms of the provisions of this legislation, transplants of this kind did in fact take place during the past year, and if so, how many took place. It is of no use to dismiss this matter as rubbish. Surely the voters of South Africa have every right to know what is happening in this connection. They expect the hon the Minister to reply to this and to give a straight answer. After all the voters of South Africa contribute to the extent of R1 690 million, which is the budget of this department.
What also aggrieves me about last year’s debate is that I conveyed my sincere congratulations to the hon the Minister and wished him well on his handling of this Vote for the first time, and the hon the Minister did not even condescend to react. I would say that that was just plain unmannerly of him. However, this is not very important; I shall leave it at that.
I also referred to other matters to which the hon the Minister did not consider it necessary to reply. I referred inter alia to the State’s tendering system for medicines which in my opinion definitely plays an important role in the excessively high price of medicine in the private sector, a price which the public has to pay. I see that this entire matter was again under discussion recently when the hon the Minister addressed the annual general meeting of the Pharmaceutical Society. He appealed to pharmacists to sell medicine at cost and only charge professional fees. He asked them not to commercialize ill-health and appealed to them to investigate the entire matter of the high costs of medicine. This is a commendable and praiseworthy request …
It is a matter the Medical Council should deal with.
However, it evoked divergent reactions from spokesmen in the pharmaceutical industry. The chairman of the Pharmaceutical Society said he agreed wholeheartedly that the emphasis should be on the profession rather than on the profit motive, but that there had to be a profit motive. A large pharmacist in Johannesburg said that it was the wholesaler who was making too much money. A leading wholesaler in his turn said that there had to be a profit in the manufacture of medicine, and if the State wanted them to provide it at cost price, the State should take over all medical services.
This is a matter for the Medical Council.
The Medical Council has nothing to do with pharmacists.
I want to ask the hon the Minister a question. Wide-ranging and divergent opinions have been expressed on this entire matter. In the course of the debate yesterday the hon the Minister himself touched on certain aspects of the high cost of medicine. This is not a simple matter. There is a wide spectrum of possible causes. Then there are still alleged malpractices in private institutions, and the hon the Minister also mentioned this. That is also a problem.
If one looks at the analysis of any medical scheme offering medicinal benefits, one finds that the payments with regard to medicine are the highest of any category of payments made—not the specialist, not the general practitioner, no payments in regard to any discipline in the medical world are as high as those in respect of the medicine itself.
Therefore my question to the hon the Minister is this: When is the State going to come forward with a proposal to restore order to this sector of health services? I want to add, emphatically: “without the total socialization of this sector”. Year after year we ask when we are going to receive the report of the Browne Commission. That commission also has to make recommendations in this regard inter alia. I repeat that I do not believe it is the pharmacists who have to look into this matter; it is a matter for the State.
I should also like to hear the hon the Minister’s comments on the allegation that the State distributes 80% of South Africa’s medicine annually, for which it pays R220 million, whereas the private sector only distributes 20% of the medicine annually, but pays R230 million for it. It is also alleged that it is in fact the State’s tendering system which has resulted for example in the State being able to purchase a pack of tablets of a certain kind for 89 cents, whereas the Trans-med Medical Scheme, which also buys in bulk, pays R3,13 for it, the wholesaler sells it for R14,40 and the consumer eventually pays R23 over the counter for it.
If this is true, surely something is radically wrong here. If it is true that the tendering system of the State is responsible for this anomaly, then it is up to the State to take the necessary remedial steps. We want to know from the hon the Minister what the State is doing or intends to do about this.
The next matter I want to touch on briefly is the alarming fact that during the past year we have had to deal with maize imports from the USA, and particularly from some southeastern states, which were severely infected with the Asperegus Flavus fungus, so seriously that 13 of the representative samples taken from 14 holds of four different ships off-loading maize in Table Bay, contained as much as 100 microgrammes per kilogramme of aflatoxin B1. Now we know that in the coming year, as a result of the drought in South Africa, we shall probably have to rely heavily on imported maize. We also know that these levels of aflatoxin are not sufficient to cause direct symptoms of poisoning. What does, however, concern us is that even a small quantity can play a very important role in causing cancer of the aesophaqu and liver, particularly in people who are carriers of the hepatitis B virus. There are many thousands of them in South Africa.
We see this as a real and serious problem, and we want to see the necessary steps being taken to eliminate this sword hanging over the heads of the population of South Africa from a health point of view, a long-term health point of view.
The maize that was condemned was declared unfit for human consumption. It is nevertheless necessary for special measures to be adopted to ensure that this large quantity of infected maize does not find its way into the human food chain because it can do so in an indirect way. For that reason I feel that the Government should be aware of this problem and should give the population the assurance that they are not going to be exposed unnecessarily to poisoning by aflatoxin B1.
In conclusion I should like to refer to a single matter in the department’s annual report. This concerns Annexure 43, which gives details of abortions and sterilization in terms of the Abortion and Sterilization Act during the period 1982-83. If we consider abortions, it is provided in section 3(l)(b) of the Act … [Time expired.]
Mr Chairman, because this is, strictly speaking, a welfare debate I shall not react directly to the hon member for Pietersburg. I do want to say though that many of the arguments he raised here this afternoon have been raised here on various occasions, for example the gamete matter was thoroughly debated last year, as was the matter of aflatoxin. The hon the Minister explained this matter quite fully in this House earlier this year.
I want to associate myself with a topic which was raised by the hon member for Edenvale and several other hon members. I have here a newspaper cutting with the caption: “130-jariges werk dat dit klap en vry selfs nog.” This report is about an unusual Russian community near the Caspian Sea and their amazing activities. I have here another report with the caption: “160-jarige wil derde vrou vat.” That is the foolhardiness of an Egyptian. To me these newspaper cuttings are typical of a phenomenon, the full implications of which we have not yet realized. I am thinking here of the phenomenon that the life expectancy of people is increasing rapidly and for various reasons, including the progress being made by medical science and technology. Until recently the average life expectancy of a human being was only 35 years. In the Roman Empire at the time of Christ it was only 23 years. Since then, and particularly in the times in which we live, life expectancy has increased rapidly. In 1920 a man’s life expectancy was 55,61 years. In 1950 it was 64,57 years and today it is 68 years. A concomitant fact is that the population is getting older. The hon member for Edenvale also referred to this. By the end of the century elderly people will constitute 10% of the total White population, and by the year 2020, 15%. In my opinion this phenomenon that the ratio of the number of elderly people to the rest of the population is increasing, requires a totally different approach to elderly people than the one that is being adopted at the moment.
I want to refer briefly to a matter which has already been raised. I maintain that this phenomenon requires a different approach from society. If the State were to continue to pay out old age pensions at the present rate, it would have to pay out R5 000 million by the year 2000, which it obviously cannot do.
I am therefore glad that this matter has been referred to a select committee. I feel that there is, however, also another approach with regard to the aged which will have to change radically, namely the phenomenon or practice that when people reach a certain age they are compelled to retire.
I feel that urgent attention should be given to this practice of requiring people to retire merely because they are 55 or 60 or 65 years old. I want to motivate my request. In addition to adjustment problems, retirement also creates psychological problems. It is not always easy to accept that at a given moment, on a specific day in the year, one is going to be pushed aside merely because one has reached a specific age. With this system of compulsory retirement at 55 years or 60 years we are actually making people old before their time. I feel we are the cause of people who could have been useful quickly losing interest in life.
There is a second reason for my request. South Africa has a shortage of skilled workers, but we see our way clear to allowing thousands of people who have experience and expertise to retire on pension every year. I do not think this is logical.
We have to do away with this system of compulsory retirement. It is not true that one’s ability deteriorates the moment one turns 65. Politics serves as an excellent example of this. Mr Ronald Reagan’s chances of being re-elected President of USA for a second successive term are very good, and he is 72 years old. If he had lived in South Africa, and had not chosen politics as his career, he would have retired on pension 12 years ago and today he would have had to keep himself occupied at one of the service centres subsidized by the State. Another superpower is also controlled and governed by a man who is 72 years old, by the name of Constantine Chernyenko, although he does have a bit of a problem with emphysema. In Iran no one tells the Ayatollah Khomeini what to do and he is 81 years old.
However, it is not only in the world of politics that people fare exceptionally well in spite of their advanced age. Dr Oswald Smith, the well-known theologian from Canada, convened 20 world missionary conferences at the age of 80 and still accepts invitations to preach. At the age of 90 Bernard Shaw wrote two of his most famous dramas and Verdi composed many of his masterpieces when he was 80 years old. Goethe completed his famous Faust when he was 80 years old. Titian painted his Battle of Lepanto when he was 98 years old. It is not true that ability begins to decrease when one reaches a specific age, and I want to ask that this entire tendency to compel people to retire be re-considered. I feel the only factor should be merit. A competent worker who reaches retirement age should be reappointed on merit without any change in his conditions of service. This will undoubtedly lead to a far better utilization of manpower and human potential.
I can remember that in my student days at Stellenbosch there were many complaints because the 33-year old Jannie Engelbrecht still played for the Stellenbosch first team. Dr Craven would say the younger man first had to prove that he was better than the older man. If they were equally good he preferred the older man because, there is no substitute for experience. The same principle should also apply in the public and private sectors when it comes to compulsory retirement. One hopes that this principle will also be applied when they pick the Springbok team.
In this connection one should also take cognizance of the standpoint of John Wayne, the famous American actor, who gave evidence before a Senate committee in the USA investigating the matter of compulsory retirement. At the age of 69 he made The Shootist, probably one of the best cowboy films I have ever seen. It dealt, inter alia, with age. I want to quote him:
I agree with these words of John Wayne and I hope that serious attention will be given to this matter.
There is a final matter in connection with my constituency I should like to refer to. I also want to put this matter to the hon the Deputy Minister. In my constituency there is a centre … [Time expired.]
Mr Chairman, generally I concur with the remarks made by the hon member who has just taken his seat but I am sure he will forgive me if I do not follow his line of debate.
I concentrated my speech yesterday on the population growth and the consequences which we would have to face if we neglected this very pertinent question. Today I also want to concentrate on one subject, namely welfare and what it costs the State. During my speech yesterday I mentioned a figure of cost which I would like to come back to. For the year 1982-83 the welfare promotion costs to the State were R1,9 billion. For this year, 1983-84, the costs have risen to R1l,5 billion, which is an increase of R66 million, or 6%. If all factors remain the same on a pro rata basis, which is hardly likely, and one compounds the figure for a 10-year period at 6%—which in my opinion is extremely conservative—one arrives at a figure of more than double this year’s budget, namely R2,69 billion. For the purpose of this calculation I have disregarded the fact that the non-White community will make greater demands in the future and the amount will therefore be much larger.
The question should therefore be asked where such finance will come from at this rate? We are already a reasonably highly taxed country as far as income tax is concerned and our possibilities of additional taxation are distinctly limited, basically to GST. However, this also has its limitations. We should therefore start tapping other sources of revenue.
This brings me first of all to horse racing. It is said by the fundis—there is one sitting in front of me, the hon member for Umhlanga—that horse racing is the sport of kings and that it is the second largest industry in South Africa. For the information of hon members, the four provinces of the country in the year 1982-83 realized from horse racing R85,9 million, which is approximately 11% of what the public spends on betting. A gross amount of approximately R800 million is therefore spent by punters on the sport of kings. The betting tax for the various provinces for 1982-83 was as follows: Natal, R14,6 million; Transvaal, R50,2 million; Free State—they seem to have only mules and donkeys there—R4,8 million, and the Cape Province, R16,3 million. The total is R85,9 million. Sir, what is the definition of a “bet”, the practice which gives the provinces a substantial amount of money by way of betting tax? I have referred to a dictionary in our parliamentary library and the following definitions were given:
Then I looked at the definition of a “wager” and found the following:
Now we come to the word “gamble”. We have an Act, passed by Parliament, called the Gambling Act, Act No 51 of 1965. Its long title reads:
I want to ask the hon the Deputy Minister: If betting on horses to the tune of R800 million per year is not a gamble, what is?
Let us cast our eye a little further, to bonus bonds. When they were first introduced, they were a very successful venture, but only because one had the chance—and I stress “chance”—of one’s number coming out of a monthly draw and consequently of receiving a bonanza cash prize. Consider our neighbouring states and their casinos. Those casinos are raking in large sums of money, and there is no doubt about that it is all South African money. Let us look at, say, a medium-sized casino. I would estimate that the daily average taking over a year is approximately R250 000. If one multiplies that by the number of days in the year, one gets very close to R100 million. If one then multiplies that by the number of casinos, one gets close to the figure that is spent by the punters on horses every year.
In this regard I just want to refer to this week’s Business Times. There we find an article with the heading: “Sol-Sun banks on gamblers for 50% lift”. I quote from the article:
This is money that is leaving South Africa. We are not getting any taxation on it. In fact, we are losing hands down on the total situation. We are not even a starter, and that is because of an outdated ideology. Right now even Soweto is thinking of a casino. In that regard I refer to an article which appeared in The Citizen on Monday, 7 May. It is headed “Casino for Soweto? Mayor is not saying.” I quote from the article:
It goes on to say:
The newspaper quoted (the mayor) as saying that Dr Piet Koornhof, the Minister of Co-operation and Development, had told him to make Soweto look like London and New York and that was what he intended doing.
That is another promise.
Yes, that is another promise.
Sir, I believe that the National Party is now a mature party, as are most of the Afrikaner people, and that the time has come for a mature approach to our outlook in this regard. The Kappiekommando will always be with us, as will certain opinions of some of the churches. Lotteries have been used for thousands of years as a means of raising government revenue. The first reported government lottery was instituted by Caesar Augustus to rebuild Rome. In 1612 King James authorized a lottery to help finance the colonial settlement. The Congress of America in 1776 instituted a national lottery, and individual lotteries were used to finance roads and other public projects and to help erect Harvard, Yale, Browne, Dartmouth and many other prestigious academic institutions. Thomas Jefferson once said—hon members must listen to this very carefully:
One can ask: How much revenue will a state lottery produce? Statistics in America for 1982 indicate that the per capita lottery profit is approximately $19 or about $19 million for each million of the population. South Africa’s population is approximately 26 million. The profit should therefore be in the region of R500 million—and that excludes the participation of the TBVC countries. A further question is: How will a State-run lottery affect the economy of the State? The answer is, obviously, positively. Almost all lottery rands will stay in the State. Of those rands, 45% will be given to the people with winning tickets, 5% will be paid to local merchants as commission for selling tickets and 40% will end up in the State Treasury as lottery profits. The balance of 10% is used to pay lottery employees, rent, administration costs, etc. Some people say lotteries are supported by the poor for the most part, but statistics in America disprove this. Studies indicate that the overwhelming majority of ticket purchases are in the middle and upper income groups. Time unfortunately precludes me from giving more details, but I respectively ask the hon the Deputy Minister, firstly, to ask the Human Sciences Research Council to conduct a nation-wide survey on the attitude of the public to a national State lottery, and, secondly, to initiate a select committee to investigate and report on the need and desirability of such a lottery. There is a certain guarantee that if we do not start a national lottery one of the TBVC countries will, and again we will be losing unnecessary South African cash to our neighbours, cash that can be used to our own peoples’ advantage on welfare projects.
One last thought to entertain. In the future the Prisons Department is going to leave Robben Island. What an ideal situation to create an international playground for the jet-set! With a little imagination and a relaxation of the Gambling Act Robben Island could become a veritable goldmine for the Treasury and the funds could in turn be used to promote our own welfare in South Africa.
Mr Chairman, since the questions of the hon member for South Coast were all addressed to the hon the Deputy Minister, he will pardon me for not reacting to his argument.
In the time at my disposal, particularly in view of the department’s fine annual report, I want to discuss the subject “Our family life at the crossroads. South Africa’s number one priority”. However, allow me to say at the outset that I do not associate myself with those who only want to find fault with our families and who only emphasize the negative things in our family life. I certainly do not associate myself with the negative rhetorical idea of crying wolf, as one sociologist put it. There really is cause for concern about the family, in South Africa as well. No one can close his eyes to the fact that there is a proportional increase in the number of divorces taking place annually. The White divorce rate per thousand married couples, for example, increased from 3,9 to 16,8 from 1980 to 1982. As far as Coloureds and Asians are concerned, the figure increased from 5,1 to 10,1 and from 2,4 to 5,2 respectively from 1978 to 1982. As far as Whites are concerned, the figure indicates that one out of every 60 marriages ended in the divorce court in 1982. Often there is an alarmist kind of speculation with divorce figures in South Africa which would supposedly amount to one out of every six or one out of every three marriages. To reach this figure, the divorce rate is calculated in relation to the number of marriages in the corresponding year, whilst there is not a direct link between the number of marriages in any particular year and the number of people who are exposed to divorce. Since there is a constant increase in the divorce rate on the one hand, it must be pointed out that, on the other hand, South Africa has a relatively high marriage rate in comparison with most other Western countries, viz 10,0, 7,9 and 8,6 marriages per thousand people for the Whites, Coloureds and Asians respectively. Of course, this contradicts allegations that selfishness, materialism and many other things are the cause of people no longer wanting to get married.
The family remains the natural and fundamental united group of the community and it is entitled to the protection of the community and the State. Man’s primary needs are satisfied mainly within the shelter of the family and it is there where fundamental values are inculcated. However, my remarks about the permanence of the family do not mean that there is no cause for concern about the family, that it cannot justifiably be claimed that family life has reached a crossroads, as the increase in the divorce rate proves. The number of unmarried White people living together, for example, is increasing at an alarming rate. According to the HSRC report the figure has increased fourfold since the 1970 census, from 12 211 to 53 260 in 1980. This unquestionably points to changing values in certain sections of the community and to the evasion of responsibility with regard to marriage and the family. Welfare organizations also claim that as many as one third of their case reports deal with the single parent problem, whilst cases of child battering or abuse are also on the increase.
People have repeatedly expressed their appreciation to the Government because, in view of the report of the Science Committee of the President’s Council, it has declared its intention to meet its responsibility with regard to developing and improving the quality of life of all the population groups. Family planning, which plays an important role in this undertaking, was dealt with in full by the hon the Minister, as well as by the hon member for Middleburg. I shall therefore confine myself mainly to the department’s expert welfare services and, in particular, to the mammoth task being carried out by the professional social workers.
The department has 287 posts for social workers in its 35 external offices so as to provide the community with a direct service. Altogether 36 709 people were given advice or were involved in short-term treatment in 1983, whilst 7 425 people received long-term treatment. Apart from this, the subsidies of the department also make it possible for social workers from a network of welfare organizations to provide the family with services. If there is one group of professional people whom I believe do not always receive the recognition and the gratitude they deserve for the professional service they render in respect of the social functioning of people it is definitely our dedicated and competent corps of social workers. They are professional people who perform a labour of love within a professional code which accepts man as God’s creation, created in his image, and who therefore has a unique intrinsic value.
With a view to the quality of our families in the future, I ask that the process of community development be tackled in all earnestness, and this can only be done by getting the entire community involved in this process—in the language of the new dispensation—as an own affair. Fundamentally and scientifically, this matter can only be dealt with as an own affair. Within the cadre of community development I also ask—and I think it is logical—that community work as a method of social work, after group work and case work, be extended in all earnestness. This will mean that in the training of social workers more attention will have to be given to this method at universities. However, it also means that the subsidization of community work will have to be given high priority, and this is what I am pleading with the hon the Minister for.
With a view to the improvement of our family life I ask firstly, for organized and co-ordinated research in all fields of family life. Secondly, it is essential that cultural and recreational activities in the family context be encouraged, since the quality of families can be improved by this. By this I do not mean new organizations, for example, the recently established Volkswag—which in any case is politically inspired and orientated, a cry of despair for political gain—but better utilization of the many existing organizations. I am also of the opinion that existing facilities, for example, school halls, can be better utilized in this regard. Thirdly, it is emphasized that the provision of a suitable home should be a primary objective in the physical and social planning of the community. Fourthly, I plead for better guidance of the youth in our schools, as well as in post-school institutions, with regard to marriage and family matters. At the same time, however, more attention must also be given to the non-formal education programmes, for adults as well. In the fifth instance I plead for a shift in emphasis, which at present is still placed mainly on the family with social problems, to preventive services.
In conclusion, I think it is desirable that particular attention be given to the training of marriage counsellors, whilst the recognition, registration and subsidization of trained marriage counsellors as associated workers in terms of the Social and Associated Workers’ Act, 1978, deserve attention. It must always be borne in mind that the community and the people are just as strong as their families. Consequently, services to the family are always an investment.
Mr Chairman, I am in fact rising with hesitation after having sat and listened to the hon member Dr Pieterse’s speech. I think that in the light of his speech I really should remain seated, since I have such a modest contribution to make, or such modest requests to make— after such a comprehensive and, I could almost say, noble subject raised by the hon member—that I think my requests are almost of less importance. However, the hon the Minister will soon realize that my requests are in fact practical.
I have looked at the explanatory memorandum issued by the department, and I found that the Budget for the forthcoming year exceeds the expenditure of the past year by R304 321 000. This represents an increase of approximately 22%. Social pensions represent an increase of R14 410 000, or more or less 5% of the increased expenditure. I emphasize that I am referring is to increased expenditure.
I want to point out that the concessions that were made only come into operation in October this year. It is therefore perhaps a misrepresentation to refer only to the 5%. I want to point this out because, firstly, I do not advocate a welfare state. I wish to make it very clear that, in association with the plea made by the hon member for Edenvale, I am in favour of methods being sought to limit the payment of purely social grants or pensions—or whatever we want to call them. However, today I want to place two categories of social pensions under the spotlight, and I also want to make a plea for their improvement.
Firstly, I want to refer to family allowances. After the last increase, a maximum of R43 per month is paid per White child. When the child reaches school-going age, the amount is increased by R8 per month. I want to ask the hon the Minister to increase this amount. I believe that a school-going child costs his parents more than R8 per month more than a non-school-going child. Furthermore, the amount of R8 per month remains constant for a school-going child, regardless of whether the child is at primary or at high school. I would therefore respectfully argue that it is unrealistic to pay the same allowance for a high school child as for a child in the primary school. We must remember that for all practical purposes a high school pupil is really an adult. As far as accommodation and food is concerned, such a child’s needs are precisely the same as—if not more than—those of an adult.
Of course, we must remember that old age pensions amount to more or less R150 per person per month. It is clear to me that the amount of R53 per month for a child at high school is completely inadequate.
I now want to come to another aspect of social pensions, and that is when a wife earns a salary and her husband could come into consideration for a disability grant, or some other old age pension, for example, and when only one quarter of her income is taken into account in establishing the means test. I should like to illustrate this by way of an example. If a wife earns R400 per month, for example, only R100 of her salary is taken into account in determining whether or not, for example, her husband is entitled to a disability grant, which in this case will in fact be paid to him. However, if the opposite were the case, his entire salary is taken into account in determining whether his wife qualifies for a disability grant, an old age pension, or whatever. The position in common law is that the duty to support is reciprocal. It rests with the husband as well as with the wife. If the husband is indigent, it is the wife’s duty to support him, just as it would normally be the husband’s duty to support his wife. That position also obtains in our statutory law. In the event of a divorce a husband can also demand maintenance from his wife, for example. I am aware that this does not generally happen in practice, but this is in fact the legal position. I would respectfully argue that there is no reason for this distinction. I therefore wish to suggest that it is unnecessary. I do not really know how to describe it, but I cannot understand the motivation for this. I therefore think that the same concession that applies to a husband whose wife has an income should apply to the wife whose husband has an income.
Mr Chairman, the hon member for Port Elizabeth North dealt with problems that arise in regard to disability grants and the tests applied in that regard. I also wish to deal with the means test as far as social old age pensioners are concerned.
Before doing so, however, I wish to refer briefly to an aspect that was raised yesterday by the hon member for Parktown and to which the hon the Minister chose not to react. I am referring to the question of cheap reading spectacles being made available on a large scale to the public. The hon the Minister of Health and Welfare said yesterday—it was given wide publicity in the newspapers today—that he and his department intend taking medicine to the people. Everyone knows the exorbitant prices that one has to pay for spectacles today, and the hon member for Parktown asked why cheap reading spectacles, where both eyes are the same, cannot be made available. However, the hon the Minister gave us no indication in regard to his thinking in this respect. It has been estimated that approximately 87% of people over the age of 40 years are presbyopic; in other words that they suffer from long-sightedness because of age and a weakening of the eyes. The idea of making cheaper reading spectacles available to these people is not a new one. I am informed that this is being done in America and I am also informed that the Ophthalmological Society in South Africa is basically not opposed to such a suggestion. If that organization has no objection to a suggestion of this nature, I suggest that one would require a fairly convincing argument from the hon the Minister as to why this practice should not take place. One knows that brulettes are made use of widely in this country. The hon member for Park-town wears them himself. If there was no prohibition in terms of the Act, as the hon the Minister knows himself, one would be able to buy these from between R18 and R20 over the counter at any shop in town that would care to sell them. There was a time where in Durban, for example, cheap reading glasses with a magnification of up to plus 3,5 were available at places like the OK Bazaars and a shop called The Hub. It was widely made use of. People obviously will not buy the first reading spectacles that they get. When one goes to buy them, obviously one would test different reading spectacles with a different strength. The ones that do not fit one, the ones that are uncomfortable, one will not take.
If we are only going to cater for the First World purchaser of spectacles who can afford R200 plus, we are ignoring the majority of South Africans who, because of eye weaknesses, cannot read and are perhaps a danger on the road, merely because the hon the Minister wants to apply First World standards to this particular aspect. In the East, in Taiwan and Japan, I am informed these requirements do not apply. There are thousands of people who at the moment cannot read properly and who do not have the full benefit of their life the last few years because they cannot afford these glasses. It is correct that there are clinics and hospitals where the indigent can go to get cheaper reading spectacles, but it is difficult to get access to those places. Thousands of people do not know about them. Once it is made known that spectacles are generally available over the counter, it will be of great assistance.
The people who are knowledgeable about this, the Ophthalmological Society, according to the Sunday Tribune, dated 15 April, support this. I would appreciate it if the hon the Minister could give us some idea of what the department’s thinking is on this particular aspect.
I should like to come back to the means test. The select committee which has been appointed will no doubt come forward with legislation. Irrespective of what the select committee proposes, whether it proposes compulsory pension contributions, whether it proposes transferability of pensions, the means test will have to remain intact and in force for the next 20 to 30 years because the person who is now in the middle of his working life will, when he retires, not reap the full benefit of any new pension dispensation which may be introduced through this House. Therefore the hon the Minister and the Deputy Minister need to have a continuous critical look at the means test for social old age pensioners.
I believe that there are two important defects in the means test as it stands now. I think that it therefore needs to be changed. Firstly at present the means test discriminates against those low-salaried people who during their working life provided for a small pension. Secondly it favours those who saved cash during their working life over those who contributed towards pension funds. Why do I say that? I shall try to motivate it. If one takes as the first example an individual who during his working life provided for a pension because he was a member of a pension fund, once he retires, he may get a pension of, for example, R161 per month. He does not qualify for an old age pension in terms of the means test. Somebody who did not provide at all for his retirement, however, is entitled to a pension of R152 per month plus free medical services, plus an annual bonus, plus a free television licence, plus the many benefits which municipal and city councils give to those persons. In other words the overall package for the person who did not provide at all for his old age, is much better and worth much more than that which the person who throughout his working life, tried to and did contribute towards a pension. That is discrimination against the person who did make provision, and this aspect ought to be looked at and dealt with in relation to the means test. Recognition should be given to those who do contribute towards a pension fund, and one way of dealing with it would be to deduct an amount from a pension before applying the means test. If, for example, one were to deduct R50 from income earned through a pension before applying the means test, that would at least accommodate those people who during their working lives made provision for a pension. Another example is that of a person who saves R40 000 during his working life and who then invests it in participation mortgage bonds at 18,5% interest. Such a person gets a return of R7 400 per year, which is R616 per month. In addition he still qualifies for a social old age pension. Let us say that he gets the minimum pension of R76. His income would then be about R692 per month. However, a person who earns R161 by way of a pension to which he contributed and who receives the same sort of interest on an investment, is in a much worse position. Because of an asset which he can invest at a high interest rate, he would have a higher income than a person who never belonged to a pension fund. The means test therefore discourages people from belonging to a pension fund, while it ought to do the opposite. This should be done, particularly if one is moving into a dispensation where it seems as though pressure will be brought to bear upon people to belong to pension funds. The means test should facilitate the step into that dispensation by encouraging employed people to belong and to contribute to pension funds. The current means test says to the low-earning individual that it is not worth while belonging to a pension scheme. [Time expired.]
Mr Chairman, the hon member for Durban Central started by speaking about reading spectacles that one should be able to buy over the counter. The hon the Minister will reply to him, but I just want to say that I think it is possible. I recall that several years ago I left my spectacles at home one morning and that at one of the supermarkets quite close to Parliament I bought myself a new pair of spectacles. I did not pay R18 for it like the hon member for Parktown, but a mere R4, and I am still using them today.
The hon member also referred to certain anomalies in the means test and stated that it discriminates against the person who has provided for a small pension when he retires and who has also built up a small capital sum by way of savings. That is not strictly correct. That was the position until the year before last. Then the maximum social pension payable was in excess of the means test. I think the maximum pension payable the year before last was just more than R1 600 per annum, while the limit set by the means test was just over R1 300 per annum. That has now been altered and for the current financial year the amount set by the means test is R1 920, more than the maximum pension which is R1 824 per annum. In doing so we have accepted a new principle in the application of the means test limit, namely that it will have to be adjusted whenever pensions are increased, as has happened in the most recent Budget. The new means test limit will be increased from R1 920 per annum to R1 992.
The hon member made a few other remarks which I believe he should have addressed to the hon the Minister of Finance.
*I now want to turn to what the hon member for Meyerton had to say. Unfortunately he is attending a sitting of the Standing Committee and apologized for his absence. He discussed the question of housing subsidies for those among the elderly who do not live in old-age homes. I should like to reply to him in depth. The hon member for Walvis Bay championed more or less the same cause. He did not request subsidies, but for some form of concession to those people who live in their own houses and find circumstances difficult. Therefore, in replying to the hon member for Walvis Bay I shall also reply to the hon member for Meyerton.
The hon member for Nigel discussed the elderly with great compassion. He referred to the pioneers who blazed the trail, and to the fact that what we are today and what we have achieved, we owe to them. He made a very striking remark, viz that whereas one parent can look after five children, it does not seem as if five children together can look after one parent. Alas, it is true that with the growing prosperity of our people, bigger houses and bigger garages for more cars are being built; there is place for everything and for everyone except for father and mother in the twilight of their lives; they have to go to an old age home.
The hon member also asked whether, in view of the increase in the GST from 7% to 10% from 1 July, the pension allowance of R14 could not be paid from the same date. The two biggest items of expenditure for the elderly are housing and food. As far as housing is concerned, GST has never been imposed in that regard. Moreover, expenditure in respect of housing has stabilized to a reasonable extent in recent times. As far as food is concerned, GST on certain basic foodstuffs is being abolished with effect from 1 July so that in fact, from 1 July the elderly will be in a more favourable situation than they are now. The hon member does not say whether, if we were to increase the pension after nine months, the next term which would have to start on 1 October again, should be 15 months. Therefore the hon member will understand that it is not such an urgent matter to pay this allowance from 1 July.
I want to congratulate the hon member for Witbank wholeheartedly on an exceptionally good speech. He pointed out that the percentage of elderly people in old age homes in South Africa is the highest in the world. I do not think that this is something for us to feel proud about. With us the figure is 8,3% and in other Western countries it varies from 2% to 4%. The highest other figure to which the hon member referred in this regard relates to Canada, where it is 3,9%. In the richest country in the world the USA, 2,8% of elderly people are in old age homes. In the United Kingdom the figure is only 1,8%. The matter of care of the aged in old age homes is totally over-emphasized in this country. However, there are new ideas about this, here and in the rest of the world, and we are moving away from this. In the new homes we are building, for example, we no longer make provision for the A and B categories of elderly people, but only for the C category, the infirm elderly person.
The hon member raised another extremely interesting matter. He referred to the issue of the occupation of beds in provincial hospitals. The hon member came to speak to me this morning and handed me a bulky file. He has done his homework and has researched this matter painstakingly. He has written letters to all four of the directors of hospital services, and he showed me schedules of each hospital in the country and the occupation of beds in each of those hospitals. It must have taken him a long time to do all this. He requested that we give thought to the construction of new hospitals. He will understand that this is not in my field; however, the hon the Minister will reply in that regard. My involvement is confined to his proposal that empty beds in our provincial hospitals be made available to the elderly. I think that he has a very valid argument in this regard. I think it is imperative that in these times, in which the watchword is rationalization, we should also rationalize our services, buildings and resources. I think that his argument is a very sensible one, viz that since our resources of capital are scarce, we cannot build old age homes at R20 000 per bed when there is a hospital nearby with several empty wards.
I want to say to the hon member that what he has advocated is already being done, although on a very limited scale. It is already the policy of the department that infirm elderly people who do not require intensive medical care and nursing services, be admitted to provincial hospitals if there are beds available in those hospitals and where there is no place in old age homes for those infirm elderly people. The department then remunerates the hospital at a daily tariff. Unfortunately, in certain provinces this tariff is substantial and we cannot afford it. In Transvaal the tariff is R40 per day. We cannot pay R1 200 per month for an elderly person. In the Cape it is R18. In Natal it is R12 per day—that is far more reasonable. In the Orange Free State, where the Minister is the leader of the NP, the figure is R8,70 per day. We can send these people to the Orange Free State. [Interjections.]
The hon member for Witbank made certain suggestions and it seems to me that this is something that I shall have to discuss with the hon the Minister and the officials. It is also necessary that we discuss it with the provinces. The hon member made a very strong case and we shall follow this up. I thank him sincerely for all his research and for his very valuable and constructive proposals.
†I come to the hon member for Edenvale. In the past I have spoken in very glowing terms about the hon member’s contributions. He has again made a positive and constructive contribution. He speaks with feeling about a subject on which he is very knowledgeable indeed. I cannot help remarking that there has been a tremendous change in the tone of these debates compared with the past. I recall that in the past there was only one approach to these debates: Pensions are totally inadequate.
They still are.
Of course they are inadequate, but the approach of the hon member for Edenvale and of other hon members is that in the future our social programme is going to be beyond our means. I say that that is a very responsible approach.
The hon member for Edenvale referred to the relevant select committee and said we simply cannot continue on the present basis. He made some mind-boggling projections on the demographic situation at the turn of the century. He referred to the fact that there will be more people who will be requiring old age benefits on the present basis and fewer people who will be paying taxes. The hon member is a member of the select committee. I am sure that he is a very valuable member who will make a valuable contribution there. I wonder whether he has not already told us what the answer to this problem is. That is that we simply cannot avoid introducing a compulsory pension scheme and making the conservation and transferability of pensions compulsory. I think that is a foregone conclusion. I do not want to anticipate the findings of the select committee but I would be very surprised if it were to find anything else. I think the whole problem that the select committee must solve is how to market this. That is the big problem that it must come to grips with. It must be marketed in such a way that it does not disrupt the labour force.
The hon member referred to the question of the registration of social workers and made mention of the fact that registration fees have been increased from R21 to R60. Neither the hon the Minister nor I determine these registration fees. The fees are determined by the Council for Social and Associated Workers, an elected body. The registration fee of a statutory council such as for example the Medical and Dental Council is R80. The council which the hon member referred to has incurred expenditure. It has also had staff to upkeep up till now. Our department has been providing them with office accommodation. They approached me recently and asked whether I could not be of assistance in finding them some other accommodation. We were successful in finding them a site very centrally situated in Pretoria where they are soon to erect a building. These things cost money. I believe the more than 800 registered social workers—those working in private organizations—are getting good value for their money.
The hon member also referred to the increase in civil pensions for the group who retired between 1973 and 1981, whose pensions have been increased by 10% plus a further 10%. He referred to the fact that those who retired before 1973, thus on a still smaller pension, only received 10%. He said I must not give him percentages because people cannot eat percentages. He wants me to give him figures. I am going to supply both. I am going to be very generous. I am first going to give him some percentages. I have an example of someone who retired in January 1976. His pension increase over this period was 90,6%. That puts him 53,5% below the CPI. The increase in his pension has not kept pace with the CPI. The pension of someone who retired in January 1968 will have increased by 402,3%. That is a tremendous increase. That puts him 58,6% above the CPI. So much then for the percentages which one cannot eat.
I want to give the hon member some figures from a letter which I wrote last week. These are not fictitious figures but actual figures. The gentleman concerned—I will not say who he is—retired on 1 February 1970 with a pension of R461,62. By 1 July 1973 this pension had increased to R619,48 and by 1 April 1984 to R1 728,32, inclusive of the 10% increase. Then we have Mr B, who retired on 1 July 1973 with a pension of R619,48—the same amount which Mr A received on 1 July. They both started with the same pension. By 1 April 1984, Mr B’s pension was R1 453,68, which includes the 10% plus the additional 10%. Hon members will therefore see that Mr A is R274,60 per month better off than Mr B. The hon member will however understand that it is unpopular and we have received many queries in this regard.
Mr Chairman, may I ask the hon the Deputy Minister whether he could make these comparative figures available to the chairman of the various pension groups for their records?
Yes, Mr Chairman, I would be happy to do so.
*The hon member for Walvis Bay made a very good speech. He discussed the self-sufficiency of our elderly people and asked that we keep them in the community for as long as possible. After that he joined the hon member for Meyerton in asking that we do something about elderly people who are not in old age homes. It is true that the State spends a considerable amount on elderly people in old age homes. In the case of a person receiving a pension of R152—and that is not the maximum; it can even rise to R155, and from 1 October it will increase to R166, plus, possibly, an additional R15— who lives in an old age home for the infirm elderly, apart from his pension of R152, a subsidy of R328 per month is also paid to the old age home for his accommodation there. This brings the monthly amount we spend on such a pensioner to R480, and that is not all. That old age home was built with funds from the Department of Community Development by way of a loan on which, as the hon member rightly said, the interest is 0,05%, viz virtually for nothing. Nowadays it costs us at least R20 000 to make a bed available for an infirm elderly person in such an old age home, and we borrow that money at approximately 15%. The interest rate on a loan of R20 000 for one bed is R3 000 per annum, or R250 per month. Therefore, if we add this R250 to the R480, it means that the Government spends R730 per month on a single elderly person, and this is a considerable amount. Therefore no one dare ever say again that we neglect our elderly people.
The hon member asked whether we could not do something about the other elderly people, and that sounds quite logical. However, we are already doing a considerable amount for them without paying direct subsidies. I am afraid of direct subsidies, because that is a monster which simply escalates. I have seen what is being done overseas. Those people warned us and said that if we wanted to start on the slippery path of a welfare state we should begin with housing subsidies. These are things that continue to escalate. For example, it must be done for all population groups, and it is abused. Nevertheless there are indeed ways in which we subsidize the elderly too. The Department of Community Development provides loans and subsidized interest rates. Moreover, houses are built for the elderly at a subsidized interest rate.
In determining the means test the value of a house is set at R9 800. This is done irrespective of the true value of the house. As a result of this low valuation it has been possible for many elderly people to qualify for a pension. This, of course, is another indirect form of subsidy.
The other day I visited someone’s house. The owner told me that he had just been offered R80 000 for that dwelling. For the purposes of a pension, the value of that house is only R9 800, however. That man’s wife works, but only 25% of her salary is taken into account in determining the means limit. As a result that man qualifies for a social pension. If we were to take the market value of that house into account he would be far above the means limit and would never have been eligible for a pension. Therefore this is indeed a form of subsidy. There are other forms of subsidy too. For example, there are tax concessions by local authorities, visits by nurses, visits to provincial hospitals, services provided by service centres, meals on wheels, and so on. All this is available to elderly people who live in their own homes. This is the crucial idea at issue here. We want to keep people within the community as long as possible. I believe that this is what the hon member for Meyerton and the hon member for Walvis Bay had in mind as well. We must keep our elderly people in the community for as long as possible.
In the few minutes I still have at my disposal, however, I should just like to speak about how we can keep our elderly people in the community for longer. I want to point out that a change in direction, an adjustment of course, may be detected as regards the care of the elderly. There was a time when the only answer we had was old age homes. Nowadays the approach involves more than old age homes; we consider how to keep elderly people out of old age homes. I think that by isolating too many of our elderly people in old age homes we are attenuating and impoverishing our society; old age homes which are regarded as a kind of foyer to heaven, where the elderly simply have to sit and wait for the day the angel of death comes to fetch them. I believe we should get away from that approach. We should get away from smothering the elderly person with our love and then having him looked after in an old age home. That is not in his interest, nor in ours.
The elderly person must not simply be a consumer somewhere in an old age home. The other day I provided the figures with regard to what the elderly can consume. The elderly person also wants to contribute towards the community. In this way he can and will grow old gracefully, and in his years of retirement will be able to make his greatest, finest and most fruitful contributions. The hon member for Randfontein spoke so eloquently about people who created their greatest and most immortal works at an advanced age—the statesmen, the philosophers, the poets, the musicians and other people. I could elaborate on that. However, I believe we should get away from the approach that we should build an old age home in every town and on every green hill. This attests to a superficial approach. We have already built 365 such old age homes, and I believe that that is more than enough. Proportionately it is the largest number of old age homes in one country in the entire world. I want to quote what a Dutch Minister of Culture, Recreation and Social Work said:
And then he advocates—and this is the modern world’s answer—service centres for our elderly people. It is a pity that we have as yet only 58 service centres in our country. However, we have several clubs for the elderly and I trust that some of those clubs will develop into full-fledged service centres. There are four components of a service centre. One needs one’s building, where a variety of services are presented, one’s welfare organization which undertakes that service, and then one also has one’s members, and fourthly, the services offered. As far as buildings are concerned, the State makes ample contributions; loans at 1% are provided for those buildings. However, I do not think that we should always only lend money. There are innumerable unused church halls and other premises in our communities that could be used for this purpose. I think that if we could use a large hall like the Skilpad Hall for such an important purpose … [Interjections.] … we should be able to achieve a great deal more. Instead of coming along with tales of murder, those people could then mobilize in order to perform en masse this important community work which the hon member Dr Pieterse spoke of in such glowing terms. After all, we should then have contributed towards a finer and better South Africa. Then we should not merely have been disparaging and negative. [Interjections.] Thus there are many of these halls that we could use for this purpose.
In the third place there are the members, people who pay membership fees for the sake of their self-respect. They have to appoint their own management to manage that service centre. We do not do it. We must not simply do everything for the elderly. We must also give them the opportunity to take the lead in this regard. We must do things with them.
There is also the issue of the services provided, and there are a wide variety of them. There is social intercourse. That is the big problem of the elderly—the loneliness of those people. There they can be among people like themselves. There are recreation facilities as well as indoor and outdoor games. There are facilities such as educational programmes, film shows and a meal a day. An important component is a geriatric clinic. Then, too, there is a library, handwork, etcetera. I could also have spoken about the question of garden care, meals on wheels, nursing and help in the home. What a task! My goodness, Sir, I can just hear my friend Marie van Zyl of the Kappiekommando, and I wonder whether one should not get her to visit these people. This is an important task to perform in the interests of our elderly and in the interests of a better South Africa.
Sir, I shall let that suffice and I hope to reply in due course to the other hon members.
Mr Chairman, before the hon the Deputy Minister knew what I was going to speak about, he had already answered me. It seems to me that he is very clever. I shall therefore be very brief, Sir, and if my introduction sounds a little strange, please do not ask me to resume my seat, since I shall hurry.
On 15 June this year the hon the Prime Minister opened a new complex costing almost R5,5 million for the blind at Worcester. An amount of R1,25 million has also been set aside for the establishment of a new complex for the deaf in the future, and we say thank you very much for this. These two institutions, viz the De la Bat School for the Deaf with 190 pupils and the Pioneer School for the visually handicapped with 290 pupils, serve the entire Republic, as well as our neighbouring states. These two institutions resulted from the Institute for the Deaf and the Blind which started on 15 June 1981 with one pupil. That was an act of faith, and a fine team effort on the part of the Church and the State. The contribution of the State amounted to 71%, and that of the Church was 29%
I now come to the point. Things are going well at the schools. The State’s contribution is large—almost R6 000 per child per annum—and this amounts to almost R100 000 per child to complete his school career. However, if a blind or deaf person leaves school and he is mentally normal, he is more than capable of holding his own in society and he also enters the labour market with great success.
However, a percentage of these people are mentally handicapped, and the blind person, in particular, is doubly handicapped. It is the end of the road for them if other provision cannot be made. In 1936 the management of the School for the Blind accepted as their responsibility the rehabilitation of adults with multiple handicaps when the workshop and homes were established for that purpose. This was a major undertaking which, once again, was tackled with faith.
However, I should like to emphasize that thus far all the demands have not been able to be met. Everyone asks continuously, and we realize that the State gives substantial assistance, but the allowances and pensions for those with multiple handicaps are not sufficient to meet their training requirements. These people have suffered tremendous losses in the process because the intensive care, which is indispensable, cannot be provided.
I should like to request the establishment of a unit for those who have multiple handicaps, with special facilities to provide for the needs of this group of people as well as the provision of specialized staff who can work in their own field, but also as a well-co-ordinated team. This will mean that the entire aftercare unit for the visually handicapped will be a true home for every occupant.
At present some of those who have multiple handicaps have to be sent home when they leave school, since there is simply no place for them at the homes, nor do they have any training facilities. The numbers are growing everywhere. Whereas earlier there were only a few, this year 9 such people were turned away and sent home. It is the end of the road for them, since it has already cost R100 000 to get them through their schooling. The same applies to the School for the Deaf.
Once again, I come to what the hon the Deputy Minister has heard so much about, and that is the adjustment of subsidies with regard to salaries and cost-of-living allowances for the aged. We are very grateful, but there is a problem. Those who are in the income group of R300 to R450 have problems, particularly when they become weak, since no subsidy is paid if their income exceeds R300. Who can afford a private nurse on that amount? The unit cost of a home which houses mainly category C occupants, is R425 per month in the rural areas and between R450 and R500 per month in the urban areas. I should like to request that the economic ceiling be increased from R300 to R450 per month. This contains an advantage in the sense that more people will qualify to be taken up in a home, since although the unit costs of such a home are high, it is still cheaper than taking the person up in a private hospital where it costs R43 per day, and there are usually no beds available. In contrast, it costs R14,20 per day in a home for the aged.
I shall let this suffice. I still have a number of problems, but I think the hon the Deputy Minister’s head is saturated with questions by this time. I am grateful that the hon the Deputy Minister has said that we should keep these elderly people in the community for as long as possible. We hear about the aged, the sick, the underprivileged, the widows and orphans every day. For the first time the other morning I heard a prayer being said for the lonely widowers in the old age homes. A widower is the loneliest person in an old age home. An elderly woman can still remain active, but an old man, and particularly a widower, is just like a little potplant which dies if one does not put it outside in the sun every now and then.
Mr Chairman, we on this side, and I am sure hon members on the opposite side as well, greatly appreciate the feeling with which the hon member for Worcester pleaded the case of the person who has multiple handicaps. They are people who find a home and a safe haven mainly in his constituency. I think his speech was typical of his dedication to his constituency and his people. If I had more than the three minutes my Whip has allocated to me, I would have praised the hon member a little more.
I should like to turn to another matter, viz the value of the little green pension book which old age pensioners receive. It is a wonderful document, since, apart from the pension, it offers the elderly so many other benefits. It opens up many doors for our senior citizens by way of perks. The most important of these is probably that the holder or owner of such a little green book has access to medical treatment at our hospitals and day hospitals. Inter alia, it also offers them a discount on television licences and so many other little things. I have many pensioners in my constituency who over the years have slowly, and perhaps with a great deal of sacrifice, gathered together a little nest egg. However, such a person finds that the interest he receives is just enough to disqualify him from obtaining an old age pension in terms of the means test. Perhaps he belongs to a private pension fund from which he does not receive too large a pension, but as a result of that, he is disqualified due to the means test. The cut-off point at present is a minimum pension of R76, which will increase to R90 in October. My old people now tell me that they are not necessarily asking for a larger pension, or even to be granted an old age pension. They are only asking for R1 per month in pension money so that they can get hold of that little green book. I therefore want to address an urgent plea to the hon the Minister and the hon the Deputy Minister today please to do something in this regard. In terms of the means test everyone’s pension is scaled down according to his income until the minimum of R76 per month is achieved. Today I want to ask that we continue scaling it down until the minimum amount of R1 is reached, so as to determine what someone’s maximum permissible income is. After reaching the present lowest payment of R76, the department can simply pay a pension of R1 in all cases without having to pay the in-between amounts calculated on the scale, just so that people can get hold of that old age pension book. We would then be showing these pensioners in the lower income group that the State does not penalize them because they have looked after themselves, however poorly. The department has already found a method of assisting former public servants in this category by permitting them to become members of the Public Servants Medical Aid Association and the State itself pays the membership fee. The people in my district on whose behalf I am making this plea have learned to live and be satisfied with very little. All I am asking is that they should be given medical security, something which has now become one of their most important expenses. They can obtain that medical security by obtaining that little green pension book.
Mr Chairman, I can identify myself fully with the plea delivered by the hon member for Tygervallei. I, too, have family who should like to obtain this little green book.
†I would like to refer to one or two items which were referred to in yesterday’s debate and in debates earlier in the session, particularly the Carnegie poverty inquiry. The hon the Minister stated yesterday that it worried him that his department, the Medical Research Council of South Africa and the CSIR had not been represented at this conference. He also said yesterday and repeated it today that it worried him further that the population increase had not been mentioned there. However, there was a Press report in which the organizer, Dr Francis Wilson, stated that in fact an important paper on poverty and contraception was delivered at the conference by a senior medical officer of the Western Cape Regional Office of the hon the Minister’s department. There were also a number of other papers presented by medical personnel attached to various branches of the State Health Service.
Secondly, the Medical Research Council was represented and two persons attached to it delivered papers. The CSIR was also invited, but unfortunately a representative could not attend.
I would like to refer to the attitudes of both the hon the Minister and the hon the Prime Minister a little earlier to this Camegie inquiry. As a social historian, I find them extremely depressing, particularly in view of the attitude of the National Party and public representatives to the first Carnegie inquiry into the poor White question in the late 1920s and early 1930s. That was a political inquiry and in its reports it reflected badly on the duties of and functions carried out by the Departments of Agriculture, Welfare and Education at the time and made certain recommendations. It is indeed unfortunate that the hon the Prime Minister asked why an inquiry should be carried out in South Africa and not in the rest of Africa. That was not the attitude when the poor White situation was investigated. I wonder whether we concern ourselves enough with the public relations image which is presented by the National Party at this time.
I would also like to refer to the hon the Deputy Minister’s remarks regarding the entire situation of civil pensions and the letter which he wrote on Friday. I respect his letter and the figures which he quoted, but I feel that there is an obligation which rests on the hon the Deputy Minister to ensure that civil pensions keep pace with the inflation rate and the consumer price index. The people referred to were State employees who gave their good working years to the State and it therefore behoves the State and the Government to ensure that they are properly cared for.
The philosophy of the Government appears to rest on the precept that persons, whilst in employment, should take care to provide for their retirement years. That is all very well, but I want the hon the Deputy Minister to investigate the matter in particular as it applies to people in particular posts who retire. In the Budget this year it was announced that people receiving civil pensions would be granted a 10% increase, and then there was the additional 10%. According to the hon the Deputy Minister’s figures the person who retired in 1970 received R461 per month. By 1973 he received R619. A person who retired in 1973 receives R619 per month and this runs through to the present discrepancy of R274. Were these people occupying the same posts?
Of course not.
I believe this is the key to the question. I want to refer to a post in the Public Service, namely Inspector of Schools. I traced the history of an inspector who retired in the early 1950s. There are still some of them alive today. I carried out a survey and followed it through to the pension which these people are receiving today. One finds a tremendous discrepancy of 25% as compared with present pensions. I believe that this is shameful. It reflects the kind of position the State has allowed to develop over a number of years. I believe that what needs to be done is that this kind of differential according to posts retired from must be investigated and that the exercise the Minister of Finance announced once, in 1982, namely that of differentially raising pensions, must be carried through. I believe that this is the only way in which one can adequately compensate those persons who retired 25 to 30 years ago and enable them to keep pace with the kind of inflation rate we are experiencing. In that year an additional percentage-point increase was paid for each additional year on pension.
I should like to turn from that area to the whole question of the public relations exercise associated with this. The hon the Minister referred to a letter he has received. I guarantee virtually that all the hon members in this House received letters from civil pensioners asking “Why?”. What I am talking about here is the appalling public relations exercise. There has been little or no public explanation for the refusal to grant an extra 10% to the pre-1973 group or to those civil pensioners on Funds other than the Government Service Pension Fund. I suppose it is no particular problem for us in these benches but …
Order! The hon member for Worcester is not allowed to read a newspaper during a debate.
Sir, I am sure that the hon the Deputy Minister has only to consult his R20-per-month predecessor to realize what public opinion will do with this.
I should like to turn very briefly to the Civil Pensions Stabilization Account and its use. This account was created in 1980 and is funded by gathering a 7% contribution from the service bonus of State employees together with a matching three-fold contribution from the State. When this was created, it was said that it was for the purpose of augmenting the pensions of retired employees as and when necessary. What has it been used for, however? It has been used to pay additional sums to persons already retired who did not contribute to that Stabilization Account. I believe that this has placed the Fund in a very grievous financial position where the State is now having to take steps to increase the amount of money paid into the GSPF. The Stabilization Account has become, in the words of the Public Service Association, “not much more than a transito account”. For example, of this year’s civil pension benefits R1,7 million comes from revenue and R72 million from the Stabilization Account. That Stabilization Account is being drained and I call on the hon the Deputy Minister to take action in this regard in that all pre-1980 civil pensioners should receive increases from revenue and not from that Stabilization Account.
The Government Service Pension Fund at the present moment has assets totalling just over R5 000 million. This makes it, I believe, the fifth largest financial institution in this country. The investment of its moneys and those of other State pension schemes is the responsibility of the Debt Commissioners. I would, however, call on the hon the Deputy Minister to give serious consideration to the possibility of using a certain percentage of these moneys as loan capital for the purchase of houses by State employees. At present many building societies are not making funds freely available for young married State employees to purchase their first homes. The advance of capital from this fund is risk-free since in such cases the State is also paying a high percentage of the repayment sums on the mortgage loans. This is a matter which can easily be resolved between the hon the Deputy Minister and the hon the Minister of Internal Affairs. I am aware that this matter was investigated 17 years ago and was not supported by one of the Deputy Minister’s predecessors, but I urge him to look into this matter of advancing loan capital for the purchase of homes.
Finally, in terms of decisions on the individual funds themselves, the possibility of combining the GSPF and the fund for temporary employees should be looked into most urgently. [Time expired.]
Mr Chairman, I spoke just now of the tone of the debate and I had high praise for the responsible attitude of hon members, but the young hon member for Pinetown, the newest hon member in the House, seems to be the glaring exception. [Interjections.] I think it ill behoves a young man to employ in his vocabulary words like “appalling” and “shameful” and to refer to “his R20 a month predecessor”, someone who was standing in public life when he was still a toddler. [Interjections.]
I will still be in public life when you will be in the old-age home.
No, the hon member will not be in public life long. In the years I have been in public life I have seen these young upstarts. [Interjections.]
Mr Chairman, on a point of order: Is it parliamentary to call the hon member a young upstart?
Sir, I was not referring to the hon member. I was referring to other hon members I had seen who were upstarts.
Order! I think the hon the Deputy Minister was referring to the hon member. I would suggest that he should use another term.
In that case I will withdraw the remark. Perhaps I did not express myself as I wanted to. In the years I have been in public life I have seen upstarts with an extremely …
Sir, I am not referring to the hon member. I am referring to members who are no longer in public life. I have seen erstwhile members of Parliament no longer in public life who had the same aggressive tone as the hon member, and they have failed in the greatest test of any person in public life, namely the test of time. Those people cannot last. I want to give the hon member for Pinetown some very sound advice: Some reticence and a modicum of humility would suit him very well indeed.
Order! I think the hon the Deputy Minister might consider whether the question of humility is relevant to the Vote under discussion.
Sir, I was referring to the aggressive tone of the hon member. I said it lacked humility for a starter. I want finally to express the wish that I hope and sincerely trust that the hon member will mellow with the years. [Interjections.]
The hon member calls himself a social historian and referred to the fact that pensions were not keeping pace with the CPI. I quoted the relevant figures in my reply to the hon member for Edenvale. I pointed out that except for the group who retired between 1973 and 1981 pensions did keep pace with the CPI. In fact, it was in excess of the CPI. The same applies to social pensions. Since 1970 social pensions will have increased from R35 to R166 on 1 October. That represents an increase of 392% as against the increase in the CPI of 316% over the same period.
The hon member also asked whether the two persons whom I referred to who both received a pension of R619 on 1 July 1973 held the same positions. Of course not. Pensions are not comparable. One must take into account the salary as at retirement, the contributions made during the lifetime, and also the pensionable years. The system has changed constantly. We changed the system in 1970, again in 1971, and we improved it again in 1981. It is simply not comparable. There was a country in the world where it was thought that all pensioners could be placed on the same basis but after a couple of years that pension fund went bankrupt. It is simply not feasible.
*I now come to the other hon members, Sir. The hon member for Randfontein made a fine speech asking that old people be kept in the community as long as possible. It is a fact that the days of one’s life are not days of playing, mourning or resting, but rather working days, for as the day is long we have to do the work He gave us to do. I think this should be the wish of each and every one of us. When my final hour comes, I must be toiling, for I must not rest. The hon member referred, inter alia, to a centre in his constituency, and then his time expired. I am, however, very curious to know what he wanted to say, and I am privately going to ask him about this. If I can help, I shall gladly do so.
†The hon member for South Coast made a request to which I cannot accede. He asked that we should introduce gambling and asserted that should we do this, we would have all the money in the world.
I did not say that.
The hon member spoke about the millions that would be available for welfare and health services.
I did not say that we would have all the money in the world.
No, when I referred to all the money in the world, I was merely speaking figuratively. I must state that I will not be prepared to accept tainted money, and I look upon money obtained from gambling as tainted money. I believe gambling is counter-productive. [Interjections.]
Mr Chairman, may I ask the hon the Deputy Minister how he then views the provinces accepting what he calls tainted money? If the provinces did not take the money they receive from betting tax, they would be broke.
Mr Chairman, that is also tainted money but unfortunately we are dealing here with vested interests. There are thousands of people employed in the racing profession, if I may call it that, and we simply cannot undo this overnight. I would not be in favour of that, and neither would I be in favour of the casinos the hon member is pleading for because I believe it is tainted money which is involved there. I also still believe in the scriptural injunction that one should earn one’s living by the sweat of one’s brow …
What about bonus bonds?
The hon member suggested that we should refer this matter to the HSRC and to a select committee. However, I do not think it is necessary as we do not want Robben Island to be converted into a Las Vegas.
I think you are frightened of what the results may be.
The hon member Dr Pieterse is undoubtedly the foremost expert in this Committee on this subject. He began by telling us that he was not one of those people who associated themselves with the prophets of doom who predict that the world is heading for disaster and that our family life is collapsing. One does, of course have these alarmists, and recently I read an article written by one of them. He complained endlessly about modern society, pointing out that everything was going to rack and ruin. He was also particularly hostile to young people who, according to him, were superficial and only interested in sport. He had all manner of complaints about the youth and foresaw a dismal future for us if we produced people of this calibre. I must, however, add that this article was written in 1908. This is therefore what our great-grandparents thought about their society, and we find such people in every generation.
The hon member spoke about marriage guidance and the ever higher divorce rate. A few years ago a certain Dr Mace and his wife, visiting our country, gave many reasons why the divorce rate in our country was higher than elsewhere. The hon member also gave one or two reasons for this phenomenon, saying we should see it in perspective. He also said, inter alia, that we had more marriages and therefore also more divorces. Dr Mace, however, said that one of the most important reasons was the fact that we had many servants in South Africa. He said that when a husband and wife quarrelled, and then washed the dishes together in the evening, quite a few of those problems or disputes were resolved. They did not, however, get an opportunity to do so because there was a servant who washed the dishes for them.
The hon member made certain suggestions. He came up with a whole series of proposals—I think there were five in all. I am going to study these proposals, because I definitely cannot reply to them off the cuff. Then the hon member concluded his speech with the resounding statement that a community is only as strong as its component families. It is true that the quality of a people can never outstrip the quality of its component families. That is why—in the hon member’s own words—our highest priority is to have families of quality in this country. We are going to study the proposals he made.
The hon member for Port Elizabeth North spoke about children’s allowances. When people talk about subsidies and tell me they are inadequate, I usually do not agree with them. I do, however, feel that in this case the hon member has made out a very good case. I do wonder whether the subsidy he referred to is not a rather meagre one. It is R43 plus R8. We definitely cannot increase it this year, and I do not even know whether we shall be able to do so next year. I do, however, promise to discuss this with the officials. I shall also consult the Treasury. I feel the hon member made out a good case for increasing this subsidy.
Then the hon member spoke about another matter, namely the matter of a wife’s earnings, only 25% of which is taken into account in calculating her husband’s pension, whereas the wife, when her husband is the breadwinner, does not enjoy that privilege. The hon member raised all manner of legal arguments with which he totally confounded me. I am really not qualified to argue with him about this. I just want to point out that in our country it is traditional for the man to be the breadwinner. The hon member also wrote me a letter about this aspect. I am going to entrust this matter to people who know more about the subject than he does. I am going to ask a legal expert to reply to him, and he will shortly be getting that reply. I do not, however, think we have the money to make this concession.
The hon member for Worcester asked two things of me. To the first I am going to say yes, and to the second I am going to say no. The hon member spoke with great compassion about those with multiple handicaps. At the Pioneer School in Worcester they share accommodation with those with single handicaps—viz the blind. This should not actually be the case, because they need certain other services. They do, for example, need more medical services, and also more paramedical services, physiotherapists and occupational therapists. Their education also costs more, and they also need specialized workshops. I received a memorandum on this from the hon member. It just so happens that I have just replied to him on this point today. I wrote to tell him that under his guidance I would gladly receive a deputation from the Pioneer School, so that we could investigate these proposals and requests they have addressed to me.
The hon member went on to ask that we increase the subsidies to our homes for the aged. They are, of course, already extremely high. At present they total R328 per month for category C aged. The percentages by which the subsidy has been increased since 1980 are as follows: For category A aged it has been increased by 135,7%, for category B aged by 120,7% and for category C aged by 108,9%. This is the increase over a period of three years. These are extremely large increases.
I remember that when I joined this department in 1982 the Director-General complained to me that they were already spending R26 million on subsidies for homes for the aged. Do hon members know what that figure is today? It is now R48 million. Limits will have to be set on this. The hon member and I are both taxpayers. We do not object to part of our tax being used for this purpose. It is an honour and a privilege to have part of our tax used to refine and improve the lives of our aged, particularly because so many aged find themselves on the rocky roads of hardship.
We do, however, object when many of those elderly people have children of independent means who do not make their contribution. The other day I spoke to a director who controls several of these homes for the aged. The first people he calls in are the children. After he has asked them why they cannot care for their father or mother, and they have given him a satisfactory reply, he finds out from them what financial contribution they can make to the care of their parent in the home for the aged. I think this is the correct approach. The fact is that the subsidy is high because in some cases the administration at our homes for the aged leaves much to be desired. In the vast majority of cases we have only the highest praise for the quality of administration. Let us be honest, however. There are homes for the aged where the administration is in an absolutely deplorable state. Because we are dealing with the taxpayers’ money, it seems to me the time has now come for us to take certain facts into consideration when people apply to erect a home for the aged. We shall have to take their administrative ability into consideration. Can they start a community organization? Can they exploit the resources in the community, including the material resources? At the moment we provide 100% loans for these homes for the aged, but I think the time of such loans is past. At the moment we have a R60 million programme for the building of homes for the aged, homes which are under construction or still in the planning stage. If we could get those bodies to contribute 10%, we would have had a further R6 million. We have also found that those bodies that also contributed a quid pro quo, also paid a deposit, had far fewer administrative problems. I think we should insist on this.
How do I see the development of old-age homes in future? I said a while ago that we were only going to provide for category C homes. The hon member for Walvis Bay referred to those elderly people who could no longer afford to live in their own homes, which have become to large for them. They are indeed living uneconomically. I do not think that a three-bedroomed or four-bedroomed house is necessary for children who may pay a visit once a year. I think our welfare organizations could take the lead in this regard. I deal every week with utility companies, private bodies and welfare organizations mobilizing that capital in the community. Many of those elderly people living in large houses sell their houses. They therefore have some capital. A unit is built for them in which they can live for the rest of their lives. At a later date the State can supplement housing; I am not referring to homes for the aged but to housing for the subeconomic group. In the third phase we build a service centre and, in the fourth and final phase, we build a home for the debilitated aged. This is our new approach, and the vast majority of the organizations receiving loans from us will have to do things in this way. We believe that they will be responsible bodies with far fewer administrative problems.
The hon member for Tygervallei referred to the green pension booklet, and this is the final matter I want to discuss. It is true that the green pension booklet does open doors for people. It does, however, cause us many problems. I think we have learnt one thing. If one makes some or other concession to a certain category of people, one must also be able to justify not granting that concession to other people. We have endless problems with this. We increase the pensions of one category of people and we receive many complaints from other categories. This is always a precarious thing to do. I would feel happier if all social pensioners paid standard amounts for their television licences and so forth, whilst we increased their pensions. I think this would cause fewer problems.
The hon member also suggested that since the minimum pension we pay is R76 per month, we should pay a nominal pension to certain persons so that they can also obtain that booklet that opens doors for them. These are actually concessions other departments have to decide on. That is where the hon the Deputy Minister of Foreign Affairs comes into the picture, because he controls radio licences. Other hon members also talked about provincial hospitals and other bodies over which other authorities have a say. This department does not have any say where they are concerned. All I can say is that we shall study that proposal of the hon member.
It was a pleasure to have listened to hon members, to the many constructive contributions they made, to the particularly high standard of debate and to the particularly valuable ideas that were aired. It is a privilege and a pleasure for us to work with such people. I thank them most sincerely.
Mr Chairman, at this late hour I should like to come back to the subject of community development, which has been discussed at some length in this debate. Several of the hon members have referred to it. Last year, the hon the Minister also referred to it and announced a new scheme, as it were. I myself have said a great deal about it. The hon the Minister referred to it again today. I just want to say— having listened to the hon the Minister’s remarks about the regions in which these community development projects have been launched, and his reference to the region where I come from, where I was born and bred, namely Klein Drakenstein, a name which he pronounced so beautifully—that I do think I should correct the hon the Minister. We have to work hard for our money in our part of the world, and the result is that we do not have much time left for talking. We do not say “Klein Drakenstein”; we say “Kleidraensteen”. [Interjections.]
We are able to say with deep gratitude today, as the hon the Minister has also done, that the progress in this sphere has been surprisingly positive. In many districts, the farming communities have seized upon this as the only real solution to social problems, especially those which we experience in the rural areas. The latest development has yielded further positive results. Communities have begun to stand together, and they have tried to act in concert and to co-ordinate their efforts. Recently I was privileged to be present at such a meeting which was held in Paarl and which was attended by Whites and Coloured people. The speaker that night was Dr J P H Rossouw, the department’s Chief Director of Community Education. I should like to congratulate the hon the Minister and the department on such an official, who really impressed us that night. I make no apology for repeating some of his remarks, because the fact is that we hold many views in common.
The development of people is a priority in Africa and is of cardinal importance to our country, with its many problems. This development can only succeed if it is regarded as a matter of common interest by all organizations and persons, and, I would add, if a Government takes an interest in it. It is certainly not necessary to spell out the needs for development. Every community in the world, no matter how advanced, still has its quota of people whose quality and standard of life may be regarded as unsatisfactory.
These underprivileged people can easily threaten the social stability of the other members of that particular group or community and hinder the general development of the group. Unfortunately, it sometimes happens that such communities have no built-in mechanism for improving their condition. In this connection, I should like to endorse the sentiments expressed by the hon the Minister in a speech at the national conference on community development held on 31 August 1983. The hon the Minister raised this subject in that speech.
If a community wishes to develop, it is absolutely necessary that it should make use of self-help. People should in the first place be taught to understand their own situation, therefore. They should understand the threat they have to contend with and what their opportunities are, and they should decide independently about the steps that can be taken with the aid of their own resources. Such a community will naturally turn for help and advice to outside organizations, to the private sector, for example, and of course to the Government. Fortunately, the private sector and the Government both realize the urgent need for these projects. An amount of R1,6 million has already been allocated for these services, but I want to plead that this amount should be considerably increased in due course. In particular, it is a pleasure to thank the department and the officials concerned for their enthusiasm, energy and skill, and for the fact that they do not regard this merely as their daily routine. Since the hon the Minister has already shown himself to be so enthusiastic about this great endeavour, and since he is assisting his officials by word and deed, I am convinced that we are going to see splendid results. I am equally convinced that we may pass constitutions and enlarge this complex of buildings, and that all this will be of no avail if we do not succeed in this sphere.
We have already progressed to the point where the Government has announced several important economic, physical and community development strategies at the national, regional and local levels. The department has already been appointed as the co-ordinator of these programmes, and we are grateful for that. The hon the Minister said that no government could force people to develop. With this great strategy, we must enable people to develop in as many spheres as possible. It is a fact that matters such as education, training and the improvement of economic conditions can be mutually beneficial. In respect of all this, it remains extremely important that all efforts should be co-ordinated, and this is the task of the State. All organizations must act in concert and must ensure that the people themselves are involved at all times. In fact, any attempt at community development relies in the first place on the contribution made by the people from that community itself. An important reason why this is essential is the strong feeling of solidarity which exists in such communities, especially among less developed communities.
The improvement of people’s quality of life is a challenge and a wonderful opportunity. It enables people to plan for the future, to keep on renewing their lives and to adapt to a demanding future. People create new visions for themselves, which give rise to new courage and energy. They also enable people to escape from a culture of poverty, something which is of the utmost importance in South Africa. I should like to quote the following from Dr Rossouw’s speech:
I should like to emphasize the following:
It is a prerequisite, therefore, that there should be an understanding of the essence of community development on the part of the Government and of economic and voluntary sectors. In addition to enthusiasm and money, it also requires faith in human nature, a belief in human dignity and human potential, and a belief that communities can and will develop the insight required to do what must be done. Furthermore, it requires the belief that a human being and a community have that sense of their own dignity which cries out for development, something which we so often fail to recognize.
I am convinced that the various communities that we are specifically talking about will make a concerted attempt to achieve these commendable objectives. With the help of an enthusiastic department and a Minister who believes in this, who understands this and who dedicates himself to this, I believe that we shall be successful. Therefore it is a privilege for me, having been involved in these projects from the outset, to thank the hon the Minister and the department even at this stage for what has already been done and what we believe they will do in the future as well.
Mr Chairman, I take great pleasure in speaking after the hon member for Wellington in the closing stages of this debate. I am saying that the debate is nearing its end; I am certainly not referring to the dying moments of the debate. There is no such thing as dying moments in the Health debate. It is true that the debate is nearing its end, but the positive way in which the hon member approached the problems with regard to the matters which he raised and the positive way in which his community approaches matters in the Klein Drakenstein and elsewhere shows what a positive attitude there is in the country with regard to these problems, and it shows that this positive approach is also present in this House. In other words, when this debate is over, the Department of Health and Welfare and hon members who take a specific interest in health will continue to devote themselves in a positive way to the great task which has to be performed.
Reference has been made in this debate to the importance of the population development programme, and I want to come back to this. This is one important aspect which has emerged in this debate. The other one is the cost of medical services. If I had to give the hon the Minister a theme for his period of office, it would be that he should exert himself for the successful implementation of the population development programme and that he should attempt to keep down costs to a level which will enable every person in this country to receive medical treatment. The matter should be viewed in its entirety and medicine as such should not be over-emphasized. By that I do not mean that medicine is not important. I want to refer to a few statistics in this connection. It has rightly been remarked that medicine as such is an extremely important component of the total expenditure on medical services. I have obtained certain statistics from the department which indicate that the expenditure on medicine for provincial administrations in the 1982-83 financial year was as follows: Transvaal, R46 682 000; Cape Province, and it is interesting that this figure is higher than that of the Transvaal, R49 923 000; Natal, R15 100 000; and the Free State, R12 606 000. If the total amount is added to the R26 360 000 spent by the department itself, it gives us an amount of R151 573 000 which was spent on medicine by the State during this period. The SA Transport Services spent approximately R24 million and the Defence Force spent R15,6 million on medicine. If all these amounts are added up, almost R200 million was spent on medicine by the State in its various facets.
The annual sales of medicine by the private sector in the Republic in 1983 amounted to R311 million on ethical medicine and R164 million on proprietary medicine, adding up to a total of R475 million. This is in terms of retail prices. I do not think the State’s expenditure is in terms of retail prices. If the expenditure of the State were calculated in terms of retail prices, the total amount would be five or perhaps ten times as high.
In the light of this, there cannot be any doubt about the fact the price of medicine is a tremendous factor in the price of medical services. The medical profession, and general practitioners in particular, have been pointing out this problem for years. In February 1980, Dr John Smith made certain remarks in an article entitled “Health for all by the year 2000” in the South African Family Practice, which is the official magazine of the South African Academy of Family Practice/Primary Care. In this article, he pointed out—the hon the Minister, too, has quite rightly referred to this—that we were headed for a real catastrophe unless something was done about this matter. This was said four years ago, and in February this year, the same Author commented on a book by Peter O’Neil entitled Health Crisis 2000, which had been published in London and in which this world-wide problem was identified. The medical profession is seriously addressing this problem, therefore. The Medical Association of South Africa has already proceeded to the formation of the so-called Cost Awareness and Peer Review Committees. The idea is that the doctors themselves are going to investigate these matters through these committees. The hon the Minister remarked that doctors were not really aware of the cost of the medicine which they prescribed. I fully agree with that. I have seen a partner of mine prescribe medicine which cost R25 for the treatment of a patient’s cold. Many doctors are really not aware of the price of prescribed medicine. This is one of the problems that have to be addressed. I must say that these cost awareness and peer evaluation committees formed by the Medical Association have spread through the medical world like wild-fire.
Certain doctors objected to them. The doctors are very much like the farmers; the farmer’s word is law on his farm and he wants to run it as he sees fit. Many doctors practise in the same way. They do not like outside interference; this has been the case over the years. However, we feel that in this case, it is not a question of interference. The doctor, and the general practitioner in particular, can play an important role in reducing the cost of medical services. I want to say, therefore, that the Medical Association has really acted very responsibly in this connection, by making doctors aware of the cost of medicine.
I just want to give an example by quoting from a speech which the hon the Minister made in Bloemfontein about a week ago and to which I referred yesterday as well. Referring to an awareness of the cost of medicine on the part of doctors, the hon the Minister said:
I conclude with the appeal that I made yesterday. I am addressing this appeal to the hon members and not to the hon the Minister, so I do not expect any reply from the hon the Minister on this. It concerns the hon member who is asked at a political meeting, “Why is medicine so expensive?” and who then replies that he knows that it is very expensive and that he will do something about it. I have examples here of what doctors and politicians say, but I do not have time to quote them now. That politician must then bear in mind what the hon the Deputy Minister said, namely that the empty beds which the hon member for Witbank suggested should be used for elderly people would cost the State R40 a day or R1 200 per elderly person per month, to be paid to the province. The hon the Deputy Minister said that the State could not afford this. If we politicians cannot solve that problem of the hon the Deputy Minister’s, we cannot tell the private sector that medical services and medicine should be provided at very low prices, while this does not apply in any other sphere. The trolley on which a patient lies was sold at a profit. The same applies to the blanket, the sheets, the bed on which the patient lies, the food he eats, and the paper he uses. Every single item was sold at a profit. If we bring down only the price of medicine, we shall not have addressed the problem in its totality.
Mr Chairman, the hon member Dr Vilonel has once again raised the question of the cost of medicine and of medical services. I dealt with this matter in some detail last night. That does not mean that I am reproaching him for having raised the matter again. It is such an important matter that one could keep on talking about it. The hon member also did it in a very responsible way. In fact, when this debate began yesterday, I tried to spell out how we could perhaps organize the future health services in South Africa in such a way that they would be within the reach of all, while the State would nevertheless be able to afford it. I talked about the community health centres and said that we should try to keep people out of hospitals by giving them proper information and advice and by treating patients on an ambulatory basis so that they do not need to go to hospital. They can be assisted by nurses. We could do other things as well. We are examining the whole spectrum of health services to ensure that everything is kept within limits.
Hon members, including the hon member for Pietersburg, have referred to the fact that the State buys large quantities of medicine and that the man in the street who has to buy his medicine at the pharmacy has to pay high prices for it because the State gets its medicine too cheaply. In the first place, the allegation that the State buys 80% of all the medicine in the country is not true. The figure is approximately 66%. I admit that this is not the ideal situation. However, the fact is that the State does buy medicine, and it does so at a tender price. Each province also buys its own medicine, each own at its own tender price. Then there is a general dealer price as well. So there are at least six wholesale prices of medicine in South Africa. These are things that have to be rectified. However, we have made a start by seeing whether it is possible to do away with generic prescriptions. The whole world is anxious to know whether this is possible. With the help of the Medical Council, we have now succeeded in doing this. I should like to address a request to the South African public in this connection—I should appreciate it if the Press and the SABC would help me in this—and that is that they should please ask their doctor whether he does not have cheaper medicine available. In all likelihood he will find that he does, if only he will have a look. It is as simple as that. We can do a great deal to alleviate this problem without official control. I thank the hon member for having raised this matter.
The hon member for Wellington referred once again to the population development programme. I thank him for doing so. The Rural Foundation consists of people who are active in his area and who have already done a lot of work there. I greatly appreciate what those farmers are doing and the initiative they have taken. I am also very grateful for the hon member’s contribution in that connection.
†The hon member for Pinetown quoted from a statement which was issued last night by Prof Wilson, contradicting what I was supposed to have said. I have seen that Press statement, but there is one thing that Prof Wilson does not do. He does not claim that the Department of Health and Welfare was invited. The fact is the department was not invited. He says the department was never refused attendance. The fact is that the regional office of the Department of Constitutional Development and Planning inquired on behalf of all the departments whether they would be approached or invited to the conference. They were told that no department was really welcome because the conference was only meant for people who were involved in investigations in that field. That is not new to us. There is another issue in this regard. Prof Wilson said that the CSIR was invited but unluckily it was too late for their representative to attend. We telephoned Dr Garbers, the director of the CSIR, beforehand and asked him whether he had been invited, and he said that he had not been invited. We also telephoned the Medical Research Council and spoke to Dr Van Heerden, the deputy director, and according to him there was no official invitation extended to the Medical Research Council.
It is possible that an individual attended. As far as we know Dr Rossouw attended but he was certainly not invited to attend. He was invited to take part in a panel discussion when the organizers realized that he was present. That type of thing does happen, but Prof Wilson would not have had any explaining to do and he invited representatives of those departments and institutions in South Africa who are daily in touch with poverty in South Africa. As far as I am concerned the position was: Please do not confuse me with facts.
*The hon member for Durban Central spoke about spectacles. I also have the letter from the lady of the Sunday Tribune, and she writes the following, among other things:
[Interjections.] This lady also approached the hon member for Durban Central, and he complied with her request. [Interjections.]
†I wrote the following letter to the lady in which I stated the official position as it pertains today:
This issue has been referred to the Medical and Dental Council because there is the view that spectacles up to 3D are not very detrimental to the eyesight. The Medical and Dental Council has referred the matter to the Ophthalmological Society but as yet they have not received the opinion of this society and therefore I also do not know what their opinion is on this matter. However, we should be careful of one thing and that is to state in Parliament: You can do it but I cannot, namely to use certain very cheap spectacles for certain races who cannot afford the more expensive type. That is what the hon member suggested.
I did not bring race into it at all.
No, the hon member did not. He did, however, speak of the Third World situation in South Africa.
The hon the Deputy Minister himself bought spectacles like those.
Yes, I know he did. However, we must never create the impression that we want to give other people spectacles which are inferior to those that we ourselves would be prepared to accept. That is what I want to warn against. I want to emphasize again that I am not aware, as this lady says, that this is the standpoint of the Ophthalmological Society in this regard. If we receive confirmation of this standpoint, and if the Medical and Dental Council also gives its approval of this, I shall not have any objection. After all, the principle is that if people can obtain cheaper spectacles in this way, let them do so by all means. This is the situation which exists at the moment. I shall give further attention to this as soon as we have learned what the finding of the Medical and Dental Council in this connection is.
The hon member for Pietersburg put a few questions to me. His first question concerned the Browne Commission. I am no more able to answer that question than he is. When one appoints a commission and it does not complete its work, while one has to keep asking and asking, I do not know what to do. What is one to do? All one can do is to wait until the commission has completed its work. This is a problem which I have in this connection.
As far as the question of the medicine is concerned, I have already told the hon member that we are investigating the tender system at the moment. In fact, we shall look into the matter again.
The hon member for Pietersburg also referred to aflatoxin in maize. I have discussed the question of aflatoxin in maize at some length on a previous occasion. The fact is that aflatoxin is a fungus which develops in grains, and especially in grains which are stored in moist conditions. The real problem today is that the Americans harvest their maize when that maize is not nearly as dry as our maize is when we harvest it. The reason is that South Africa is virtually the only country in the world where maize is produced on a large scale for human consumption. The Americans do not like to eat maize. They use maize as fodder. That is why it is quite adequate for their purposes, and they can also store their maize in moister conditions; not entirely without consequences, of course.
It is only the NP that has consequences.
What nonsense are you taking this time? [Interjections.] A short while ago you were reporting the pharmacists to the Medical Council. What is the matter with you? [Interjections.]
Oh, you would not understand, even if I told you. [Interjections.]
Mr Chairman, the fact is that to the best of my knowledge, the Maize Board is trying to ascertain whether they cannot perhaps import maize from some other source. They are making inquiries in every possible country in the world. However, the only source we are absolutely sure of is America itself. It is possible, therefore, that the maize which we import from America is in fact contaminated by aflatoxin.
However, there is one thing we must not lose sight of. The question of aflatoxin has developed into a major problem—perhaps I should rather say an apparently major problem—for one specific reason. It happened precisely because the Department of Health did its work properly. If the department had not done its work, if it had simply allowed the imported maize to be distributed in the country without conducting any tests, no one would have known about it. In that case, it is likely that no one would have been the wiser. However, because Department of Health did its work, because it conducted proper tests on every consignment of maize which reached South Africa, it became public knowledge that a problem was being experienced with aflatoxin in imported maize. For this reason, the problem will continue and we shall have to test every consignment of maize and the hull of every ship, because there is no other solution. We shall have to keep a check on the position as far as possible. We are aware of the problems created by the continuous ingestion of aflatoxin. However, the Department of Health and Welfare has no control over maize and wheat products kept on farms and in the Black states. It is not humanly possible to test those products. We do not know whether those products are contaminated by aflatoxin, but it is simply impossible to visit every village or kraal and to test all the maize or wheat products stored there for aflatoxin. Therefore we shall control the situation to the best of our ability.
The hon member also said that he had made a speech last year and that I had not replied to it, but had simply said that he had talked rubbish. I am sorry that he has raised the matter again, because I still think so. [Interjections.]
You still have not replied to him.
I am going to reply to him now. As is customary among the hon members of the CP, that hon member did not attend the debate in which legislation was discussed. He came along afterwards, when the legislation had been passed, and criticized the legislation. The hon member went further and drew a parallel between that health legislation and the Government’s spinelessness with regard to Sunday sport. Then be began talking about family planning, but from family planning he switched abruptly to the Whites who are not having enough children, which is a matter which gives rise to much concern in South Africa. The problem which the hon member was bemoaning that day, however, was that the Whites were not having enough children because there was no future for them in South Africa. Young people no longer saw a future for themselves in South Africa, as a result of the policy of the Government, which was simply giving everything to the people of colour, and the Whites no longer had a future in this country.
That was what the hon member said. He should go and read his words again. I shall not tell him again that he was talking rubbish; I shall simply salute him this time. [Interjections.]
May I ask a question, please?
Vote agreed to.
Business interrupted in accordance with Standing Order No 22.
Progress reported and leave granted to sit again.
The House adjourned at