Deputy Davin has given notice to raise a question on the motion for the adjournment.
DAIL IN COMMITTEE. - OFFALY DISPENSARY DISTRICTS—OBJECTIONS TO REORGANISATION SCHEME.
I want to draw the attention of Deputies, and particularly of the Minister for Local Government, to the dissatisfaction that has been caused in Offaly—in the constituency of Leix and Offaly—by the reorganisation of dispensary districts carried out by the Commissioner who has now taken the place of the county council that has been abolished by the Minister. Some time ago the Commissioner summoned to the county council offices the three doctors serving in the Offaly area and, by an agreement between the Commissioner and the three doctors concerned —as far as I know this was a most unusual proceeding—the dispensary districts were reorganised in such a way that in certain towns in Offaly, in one case at least, the people are now obliged to drive a distance of seven miles if they require the services of the dispensary doctor. The town of Kilcormack has a population of about 500 people, composed mostly of workers and poor people. If any of these people require the services of the medical officer, it means that under this reorganisation scheme they will have to travel a distance of seven miles for him.
took the Chair.
Deputy P.J. Egan, with whom I have been acting in this matter, asked the Minister a question yesterday about it, and the effect of the reply given was that modern methods of transport made it possible, in these days, for people to travel longer distances than they were able to do formerly, whether they required a doctor or anything else. There are two maltings in the town of Kilcormack, two saw-mills, a convent, and several smaller places in which a large number of workers are employed. It may be all right for the individual who is lucky enough to have a motor car, or who is able to hire one, if he has to travel in the middle of the night a distance of seven miles for the dispensary doctor, but the case I want to put before the Minister is this: that ninety per cent. of the people in that town are mostly workers and poor people and are not in the happy position of being able to engage a motor car if they are obliged to call in the services of the doctor. They could not afford to hire a motor to go the journey of seven miles for a doctor, and hence this reorganisation scheme has proved a very serious matter for them.
I have also to complain of the method adopted to bring about the existing arrangement and to express the hope that we shall receive an assurance from the Minister that this reorganisation, which is most unpopular amongst all classes, will be reviewed and reconsidered by him. The medical officers in Offaly, as elsewhere, subject to the sanction of the Local Government Department, have a certain salary laid down for them. It is, I think, from £250 to £300 a year, to which is attached certain increments. The three medical officers in Offaly agreed to an extension of the old areas, and thereby received an additional £50 a year each in salary. That addition of £50 a year to the salaries will, I understand, only apply to the doctors who occupy the positions at the present time. If I know anything about the medical association and its intentions, I believe it is quite an improper thing for three medical officers to come along and agree to the extension of their existing districts, and thereby save £150 a year for the Government. These doctors actually took the responsibility of doing away with one dispensary district which would give employment to another medical man.
I am not raising this for any purpose but to bring to the notice of the Minister the fact that this reorganisation has been carried out in a most improper way without consultation with the priests or the people affected by it, and I hope he will now be able to remedy the matter without further delay. I might mention, in the case of Kinnitty, that a person living one and a half miles from that town, if he wants to get a doctor, will have to provide the means of conveying him from Kinnitty to Roscrea. It is in the poorer classes that I am interested principally, the people who obtain medical attendance on red tickets. The well-to-do people, of course, can go into the town of Kinnitty and fee a doctor if they require one, but the poor are unable to do that. If the residences of medical officers are to be changed, I think the doctors should be compelled to reside in the most thickly populated centre in their area. I have already referred to the town of Kilcormack. Poor people there, if they require the services of the doctor, have to travel a distance of seven miles for him, and as very often happens they may have to make that journey in the middle of the night. That is one of the hardships which this reorganisation scheme has imposed on the poor of that district.
I hope the Minister will see the injustice of this reorganisation scheme to which he has given his sanction, and that he will now review the whole matter in the light of the facts that have been brought to his notice. I would ask him to realise that the complaint in this matter is not from any particular section. It is a complaint, and a justifiable complaint, that is voiced by every section in the area concerned, and it has created an amount of agitation over the whole district. All classes are dissatisfied with this scheme which has been imposed on the area, and I trust the Minister will now see his way to respond to the wishes of the people and not make this reorganisation scheme a permanent one merely for the sake of saving the small sum of £150 a year. I understand that, in reality, the saving only amounts to the one-fortieth of one penny in the pound. The people would much prefer to meet that charge and to have the old arrangement of the dispensary districts restored, rather than have the new reorganisation scheme permanently imposed upon them.
I rise to support the views expressed by Deputy Davin in this matter. I happen to have a considerable personal knowledge of the district in question. It is undoubtedly true that the new district, which is being handed over to the charge of one doctor is a rather big one for him. Formerly there was a doctor in Kilcormack dispensary district and another in Kinnitty. The two districts have now been amalgamated, and in this amalgamated area one doctor is to operate. From my own personal knowledge of these districts I really do not think that one doctor will be able satisfactorily to look after the public health in them. It is quite true that modern methods of transport enable a doctor to get around more quickly than heretofore. In one particular area of this amalgamated district, if a person got sick in the night, it would mean that the relatives of that person would have to travel a distance of 12 miles for the doctor. It may not be that distance as the crow flies, but going by road it would certainly be a distance of 12 miles. I do not think it is fair to ask poor people to travel that distance in the night for a doctor. The area of the old Kilcormack dispensary district was 33,000 statute acres, and of Kinnitty 28,000 statute acres. I am not quite clear as to how much of these two districts has been included in the new area for the one doctor, but from what I know I believe that the area that the one doctor will have to serve will be too large, and that it will require more than one man to reach it. I would join in the appeal to the Minister to review all the circumstances in connection with this scheme. It is true that the change made has caused a great deal of dissatisfaction in the district. It was put into operation without any consultation being held with the priests or prominent people in the district. I hope that the Minister will see his way to meet the wishes of the people in the matter.
I am much impressed by the case made out by Deputy Davin and Deputy Egan. I can assure them that if the case has not been fully inquired into already, I shall be prepared to give consideration to the representations made by them. But we have not acted in a hasty manner in this matter at all. We sent a medical inspector down to the country and he inquired very particularly into the circumstances and the position there. After looking into these matters very carefully and consulting the Commissioner and also the doctors in the surrounding districts, he came to the conclusion that the area could be very well covered with a doctor less than was required for the district heretofore. As I have already said, it is no criterion to go back and say that for 60 years a doctor was required in this particular district of Kinnitty. Transport has changed very considerably since then. Every doctor in the country has a motor car at his disposal now. As well as that, in any case of emergency there is a telephone in every Civic Guard barrack, where people can get into touch with the doctor in any particular case of urgency. I think we cannot place too much reliance on the arguments that patients may have to travel ten or twelve miles under the new arrangement. In other counties in Ireland such things happen and in some counties it is no novelty to have to travel 30 miles. In the County Mayo and other western counties the distances are even greater.
Does the Minister approve of that?
In those particular counties you have to approve of it, because you could not afford to have any more doctors in the areas. The Deputy says we are only saving £150 a year by this change. That is only for the present. We felt it was necessary to give some remuneration to the men who are there at the present time, when we were adding to their district. The Local Government Department have ample powers to insist upon these particular doctors performing these duties without giving them any remuneration if we so desire. We can arrange the salaries in the areas of the dispensary districts just as we like.
Dr. Hennessy will look after that in the future.
I do not think he will disagree with that because he knows we have such power. We are interested in trying to bring about that the regular ordinary payments for dispensary doctors should not fall below £250 a year. We are doing everything to see that the salary is raised up to that, which we consider a minimum, and on the other hand, we are not in favour of increasing the payment of a dispensary doctor beyond £350. We desire to level the salaries all round. In future years we will make a saving of £150 in connection with this matter and although that is only a small thing in the £ still it is only by taking care of the pennies that we will save the pounds. There is a kind of outcry on this matter at present, but of course there is always some vested interest affected and there is always an outcry in a case of that kind, but I believe that in a very short time we will hear very little more about it. I believe the great majority of the ratepayers in the district will welcome rather than oppose this change.
Is the Minister aware that the request which Deputy Egan and I have made in this matter comes from the ratepayers who will have to pay for the service?
Will the Minister approach this matter from the point of view of the people likely to be sick and will he discuss it from the point of view of the needy people and whether they are likely to be as well served under the new arrangement as they have been? After all it might be as well to consider the requirements of the sick when dealing with medical services. It should at least be borne in mind that the value in cash saving at one end may have to be put against the other side in the balance which is the lives and the sufferings of individuals. Perhaps the Minister will approach the matter from that point of view— whether the service rendered to the sick is going to be as efficient in the future under the new arrangement as it was in the past.
That matter has been gone into very carefully by a medical inspector competent to express an opinion and who decides matters of this kind, and he recommended that by dividing this up between the other dispensary districts the interests of the sick will be as well looked after as if the old dispensary arrangement was left. We have come to the conclusion that there was not sufficient work to keep one man occupied in the old dispensary district of Kinnitty, and it is for that reason that he recommended the change.
Will the Minister be prepared to admit that the residence of the medical officer should be in the centre of his district where there is the greatest population?
Under the present arrangement the residence of the doctor is to be in Kinnitty, which is the largest town.
What about Kilcormack? Does the Minister know the population of Kinnitty and Kilcormack?
What is it?
The population of Kilcormack is about 500.
What is the population of Kinnitty?
About 200?
There are many towns of over 500 population that have not a doctor. It would be a good thing if we had a doctor in every town or village, but we could not afford it.
Is the Minister prepared to overrule and override the views of the ratepayers, or does he say he is not prepared to consider it in future?
The matter was decided after very careful consideration. I do not want to give an undertaking that I see no possibility of carrying out.
Question put and agreed to.
The Dáil adjourned at 8.50 p.m. until 12 noon on Friday, 20th March.