On the motion for the Adjournment, Deputy Norton has given notice that he would raise the subject matter of Questions Nos. 46 and 47 on the Order Paper for Thursday, 23rd October.
Committee on Finance. - Adjournment Debate—Dental Benefits.
On the 23rd October I addressed a parliamentary question to the Minister as follows—
"To ask the Minister for Social Welfare whether he is aware of the serious inconvenience caused to insured persons by reason of the suspension of dental benefit; if he will state what steps have been taken to bring about a settlement of the dispute between his Department and the dentists, and how the matter now stands."
In reply to that, the Minister said that there was a dispute and that since the 1st April last no dental benefit whatever had been made available to insured persons. He indicated that in March last he made what he described as a final effort to keep the dental benefit available, but as the dentists at that time would not withdraw some demand which they had made—described by the Minister as "a demand for contracting out"—he had done nothing since March last.
In other words, seven months have now gone by during which the Minister has maintained a magnificent indifference to the hardships imposed on insured persons throughout the country by reason of the suspension of dental benefits. Surely if he is going to adopt that attitude also during the next 12 months, no dental benefit whatever will be available for insured persons for another year? Normally, dental benefits were regarded as necessary in order to provide facilities for dental treatment for insured persons. They have had no such benefit made available to them for the last seven months. This situation may go on for another seven or another 12 months—because the Minister says that since March last he has done nothing. In reply to supplementary questions, he indicated that there was apparently to be no change of attitude as far as he was concerned. Insured persons, therefore, have been denied this benefit for the past seven months, and there is now not even a glimmer of hope that they are going to get it.
People who suffer from dental ailments cannot decide to abstain from going to dentists. They have to go, day after day and week after week, for treatment. As a result, the insured person is not merely paying his national health insurance contribution for dental treatment, but is being compelled to pay the dentist himself, even though he has contributed to a State fund to provide that benefit for him. Even though the Minister may have a personal point of view to defend in this matter, he must recognise that it is a thoroughly unsatisfactory position.
I do not wish to import any heat into this discussion, as it is far too serious for the importation of heat, but I cannot congratulate the Minister on the magnificent aloofness he has displayed. We have unfortunate people on very slender resources being compelled to-day to pay the entire cost of dental treatment, including the entire cost of fitting new dentures. That is a burden they cannot bear except at heavy sacrifice in some other directions —either by borrowing money or by stinting themselves in some other field. Instead of getting half the cost of dental treatment—which is their right under the National Health Insurance Acts or under the current code of social security—they are getting no benefit whatever.
It is clear that the Minister intends to fight this case with the dentists to the last tooth of the insured person. The Department is engaged in a deadly struggle with the dentists. They are not suffering and neither is the Department: it is the unfortunate insured person who is getting all the bullets in this war. If the Minister or the dentists want to wage such a war, it is thoroughly unfair of them to make the insured person the target. The war was not caused by the insured person, but he is the sole victim.
Is not that always the way in a strike?
Usually a strike is caused by the workmen going on strike. In this case the insured persons did not cause it and cannot settle it, they have no influence in the matter. Those suffering from dental ailments are now carrying all the wounds of this battle of high principle between the dentists and the Minister. It is unfair to use-those people as a weapon and compel them to pay out of their own resources to meet these demands. That situation does not reflect credit on anybody. Here in 1952 a war between the dentists and the Government compels the entire insured population to forgo all claims. to dental benefits. The Minister will not deny that they are entitled to a proper dental service and that it is his function and that of the dentists to see that they get it as in the past. It is essential that that should be continued for them in the future. Both sides must try to settle this dispute on terms which will enable this service to be restored.
I asked the Minister the other day if he was prepared to submit this matter to arbitration. He said he was not. On the other hand, the dentists may not be prepared to submit to arbitration either. Is that not most callous indifference by both sides to the insured persons, the victims in this battle of high principle? This war should not be allowed to continue for another seven or another 12 months. The Minister and the dentists should endeavour to settle it between them. If, however, as often happens between two litigants or two sides in an industrial dispute, they cannot settle it between them by discussion and contacts, they should find some other means of settling it.
If the Minister will approach the matter from the standpoint that this thing has got to be settled on some equitable basis, then other means ought to be found of settling this dispute if it cannot be settled by direct negotiation between the Minister and the dentists. It is clearly unfair to the insured persons that this tug-o'-war between the Minister and the dentists should continue imposing, as it does, such serious hardships on the insured population.
I put it to the Minister that he ought to take the initiative. The Minister can afford to be big and broadminded. Often it is harder to appear to be weak than to be strong. The Minister ought to take the initiative in making another effort to get a settlement of this dispute between himself and the dentists.
I have not said, in the course of my remarks, that he ought to concede the claim of the dentists. I am not expressing any opinion on the merits of the dispute between the Minister and the dentists. I want to see the matter settled by direct negotiation, but if it is not possible to settle it that way the only way it can be settled is to refer the matter to arbitration by some independent person or group of independent persons. Both sides can put their case before the arbitrator or group of arbitrators. If we are going to have this service provided in the future a tribunal of one or three persons could, I am sure, find a satisfactory settlement of the matters which are now in dispute. This dispute will have to be settled some time, but if both sides adopt the existing attitude then the insured person is going to pay heavier in the future than to-day.
The Minister ought to have regard to his heavy responsibility, as the provider of these services, for the insured persons who have paid for them, and take the initiative in having a further conference with the dentists. If he cannot resolve the difficulty that way, the matter could be referred to an arbitration tribunal to decide on the merits. Let us have some satisfactory settlement by submitting the matter of the dispute to the arbitrament of a competent and fair-minded arbitration tribunal.
Mr. Byrne
I put a question down in connection with this matter on the day on which Deputy Norton put his question down. The same reply was given. I agree with everything Deputy Norton said but let me give a typical case. I know a girl—she is an insured person—who is waiting and waiting and was about to get the benefits. When this trouble started she had to go ahead. When she felt there was no hope of a settlement, she went to her own private dentist. When the dispute is settled will that girl and others in similar circumstances who went to their own private dentists, paying somewhat more than they would in the ordinary way, get retrospective payments and the grant they were normally entitled to and put it towards the expenses they have undergone? If the Minister says they can do that the grievances of those people will not be such serious ones. If they can go now to the dentist and get treatment knowing that whatever they were entitled to in the ordinary way under the insurance will be forthcoming, it would be a great help.
The matter to which Deputy Norton and Deputy Byrne referred was brought home forcibly to me on receipt of a letter from the mother of a large family whose husband is an invalid. Some months ago, this woman had teeth extracted but as a result of this unfortunate difficulty in the Department she has been unable to obtain her dentures.
Accompanying the letter was a doctor's certificate to the effect that another ailment had resulted in consequence of the fact that she did not have her dentures during those months. She will now have to undergo a course of treatment away from home. This woman, who is the mother of a large young family, was unable to pay for the dentures. I am sure there are other cases such as the one I have outlined. With the other Deputies who have spoken, I would ask the Minister to bring this matter to a conclusion, so that these people will get their dentures before any other evil effects result from the position which now exists.
I think we are entitled to know and the members of the Council of Irish Unions and the Cork Workers' Council are entitled to know, what precisely is the nature of the difference that exists between the Minister and the dentists. I could quote a number of cases to the Minister. A month ago, a young man was ordered to get 16 teeth extracted, and the first thing he had to do was to pay three guineas. I know of a number of people who have had their teeth extracted for the past four months and their doctors have advised them to get dentures. When this dispute is settled, will these people be compensated for the extra charge that will be made on them? What is the cause of the dispute? What is the nature of the dispute between the Minister and the dentist?
The Minister is in possession of all the correspondence from the Cork Workers' Council and the Council of Irish Unions in relation to this matter for months. People who are suffering unnecessarily are entitled to know what exactly is the position.
The strike of the dentists.
In making this case, Deputy Norton has followed the old Labour tactics of trying to make capital out of a very awkward and delicate situation.
That is unfair.
That is a falsehood.
I am quite sure that Deputy Norton and those Deputies who spoke must realise that they are giving every encouragement to the dentists to hold out. The dentists know that they have the Dáil behind them in their demands. Deputy O'Sullivan was anxious to support Deputy Norton but quoted a case that would not come under the scheme at all. Deputy Norton, when Minister, took quite a different attitude, when this thing started in February 1951. A memorandum was issued to the negotiators with the dentists and Deputy Norton said——
On a point of order. The Minister is quoting from a memorandum. I take it that he will table a full copy of it?
Yes.
I do not mind the Minister quoting it at all but if the Minister quotes the document it should be tabled.
That is so.
That is a very interesting practice.
At that time, Deputy Norton took a different attitude. He said that if he got any more trouble with this scheme he would hand the whole thing over to the Minister for Health, that if any further expenditure was incurred under the scheme, he did not want any more to do with it. He talks now about me doing nothing for the past six or seven months.
The dentists not only looked for increased scales, but they asked for this matter of contracting out. I believe that this concession they are looking for is most unjust to the insured person, because they were prepared to accept, if they got it, ten guineas for dentures if the insured person would take the dentures as prescribed under the scheme; but they wanted to be at liberty to say to the patient: "If you come to me as a private patient, I will give you the same dentures as I give to my private patients at £21." They wanted us to agree that we would give the five guineas, whether the patient took the ordinary dentures at ten guineas or agreed to come in as a private patient, and let the unfortunate patient pay roughly £15. I think that is very unfair because I know very well that if a dentist says to a person who goes to him: "Will you have the ordinary dentures or the same dentures as I give my private patients?" the patient will do his utmost to get the best. He will say: "I would rather have the dentures you give your private patient" and will pay this exorbitant price of £15 extra. We made inquiries, and so far as we could find out the extra charge to the mechanic who makes the dentures was in the region of 35/- and not £10 for the private patient's dentures. That is why we would not agree to it.
It is well to know that.
Why should we agree to it? It would be a scandal to agree to it, because I know from experience, from hearing people talking about these things, that when a person goes to get dentures, glasses or for an operation, he likes to get the best and, in this case, will take the other dentures as being much better than the ordinary dentures prescribed by the Social Welfare Department and will make every endeavour to get them. We said to the Dentists' Association that we were quite prepared to negotiate with regard to increased fees and to pay them more than they were being paid in 1948 and more than they were paid in February, 1951, when Deputy Norton could see no reason why they should get more. At that time, he told the people negotiating with him that he could see no reason why they should get more.
I kept the dental service going.
You did. You kept it going until they sent in an ultimatum which had not expired at the time the Deputy expired out of the Department, but that ultimatum was there and we had to meet it. They got an increase in fees, but they were not satisfied. They said they would only take it—it was 15 per cent., a fairly substantial increase—on their working to 31st March of this year and when it came to 31st March of this year, they wanted a further increase of something like 15 per cent., and, as well, this contracting-out arrangement. We said that while we were quite prepared to negotiate with regard to increased charges—we did not think they were really justified but we were anxious to settle the matter—we said we would not agree to the contracting-out provision. If I am pressed by Deputy Norton, Deputy Byrne or any other Deputy to settle the matter, the dentists will get to know that and it will be more difficult to negotiate with them. I am quite prepared to meet the dentists to-morrow, if they are prepared to meet me but they sent me word in the middle of May that they had taken a ballot of their members and that there was a substantial majority against accepting.
Deputy Norton says that this is unfair to the insured person. It is, but I want to make this correction in that regard—the insured person is not paying for these dental benefits. It was an uncovenanted benefit up to the end of September last because there was a surplus coming from the contributions paid up to that time.
Where did you get the contributions?
Now, since 1st October, the contributions are calculated on a basis barely sufficient to meet the benefits, apart from these medical benefits, and these medical benefits will be taken charge of by the Department of Health.
You have £6,000,000 of the insured person's money.
The Deputy knows but does not want to tell his followers behind him, because it would not suit him, that that was actuarially necessary to meet the benefits accruing under the insurance at the time.
It was never necessary after amalgamation and you know it well, if you know anything about it.
The Deputy knows there was an actuarial examination for five years and whatever was surplus at that time was put aside for medical benefits. The medical benefits were paid, and whatever was left was deemed to be actuarially necessary for the payment of benefits. The Deputy is now out of the Department and can make all these demands as a free man, as the heroic Leader of the Labour Party.
He settled the strike.
They are not paid at the moment but that is not going to stand in my way, because I would do everything possible to get these dental benefits restored, and the Minister for Finance provided in his Budget a sum of £500,000 for the payment of medical benefits to insured people. In the White Paper on health which was issued, these benefits are again guaranteed, in a better way, I hope, than in the past. I do not think that anybody in my place would be prepared to give the dentists their demands if they are extravagant, and I consider them extravagant.
I think the only way to meet this problem—unfortunately it will take a little time—is the way we are proceeding to meet it in the Department, that is, by getting local authorities to appoint full-time dentists. These are now beginning to give dental treatment to at least the lower income group, those entitled to free treatment at the moment. As soon as that full-time staff under the local authorities is further increased, we hope to take in the middle income group, and the first class in that middle income group will be the insured people, because they were entitled to these benefits up to this moment. So far as I am concerned, I can assure the Dáil that I will do everything possible to have these benefits restored as soon as possible, but that is all I can say at the moment. What is more, if Deputy Norton or anybody else can get the dentists to meet me any day, I am quite prepared to talk to them.
The Dáil adjourned at 11 p.m. until 10.30 a.m. on Friday, 31st October, 1952.