There are a few items about which I feel I must complain. That is very often the case on these Estimates—all too often we have to complain. Generally speaking, most of what I have to say on this Estimate will be in the form of complaint of one kind or another—complaints confined in some cases to my own county and of a general nature in other cases.
Taking first things first, I will deal now with complaints of a general nature which affect the country as a whole. One of the things I feel is entirely wrong, and it is something which has been going on for quite a time though that is no reason why it should be continued, is the system whereby the Department of Health or the Minister for Health, as the case may be, agrees to increase the salaries or remuneration of certain officers or officials employed by a local authority on health work or in the health section of that authority, such as dispensary doctors and others. This policy has always been irksome to members of local authorities who feel that they, as the elected representatives of the people, should have a direct say in the negotiations leading up to such increases. In most cases down through the years we have never been consulted and we are usually faced with a fait accompli.
Now, this does not apply only in the case of dispensary doctors, but I mention them because they are the most obvious. From their point of view the system is a rather good one because, as I see it, and as I have seen it recently, the doctors get their increase sanctioned by the Department or by the Minister. They there and then proceed to approach the local authorities, not all together or on the one day; they approach the weakest councils first. The weakest councils are picked out for the first attack and, having succeeded with the weaker councils in putting their claim across, their case is strengthened when they approach the next council because they can say: "Oh, such and such a council has already granted the increase" and down the list it goes until eventually the claim reaches my particular county, as, indeed, it has very recently reached it. We found ourselves in the last line of defence between the ratepayers and the increased amounts asked for by these particular people in so far as the ratepayers' contribution is concerned towards the upkeep of our dispensary services and our dispensary doctors.
For the first time that I know of, our council recently rejected the claim of the dispensary doctors despite the fact that it was brought before us on two occasions and the big weapon in the hands of the Irish Medical Association branch in Donegal was that all the other counties had granted this increase and we should, therefore, do likewise. We have not done likewise and we have no intention of doing likewise until the conditions under which it is alleged these doctors are getting that increase actually obtain in our county and in all other counties.
Had this claim been based fairly and squarely, as most claims in recent times have been based, on the suggestion that the cost of living has increased and an addition in salary is necessary therefore to offset any fall in the value of the income, our approach might have been different. Had that been the approach, then I for one, would not have had any objection to paying this increase. My objection to it now is that the claim was based on the allegation that, due to the implementation of the Health Act, 1953, doctors were as a result now finding that their private incomes had been reduced and that this increase of salary therefore would be by way of compensation for that loss.
The fact of the matter is that, far from there being any loss, there has actually been an improvement. They might have been at a loss had the Act gone into operation as was intended by the Minister's predecessor. Possibly then the case could have been made, and probably would have been made, that this was fair compensation. In the meantime the Government changed and the present Minister, or his Government, did not see fit to implement the Health Act of 1953. Therefore, the very case that could be made for an increase to dispensary doctors no longer obtains. Actually the reverse was the position because under one part of the Health Act, which is in operation at the moment, far from being at a disadvantage the dispensary doctors are, in fact, at an advantage.
I refer to the particular section dealing with maternity in relation to the lower income groups. Before the implementation of that section of the Act dispensary doctors were paid a salary for that particular work. Now, in addition to salary, they get five guineas per case so that, instead of being at a loss, they are actually gaining. Therefore, the claim for an increase cannot stand and the method of granting the increase is wrong, because they go to the Minister first and foremost; the matter is discussed and a decision reached and the Minister then informs the local authorities that he, as Minister, is prepared to sanction an increase not exceeding so much.
The line of attack is then defined and the most divided and weakest councils are picked out first. Having succeeded in the weaker councils they move on to the stronger and, as they go, the case gets stronger. Before any such increase is granted or sanctioned the local authorities should have an opportunity of deciding whether or not they are in agreement with the proposed increase. No local authority should be left in the position in which we find ourselves at the present time; in 25 counties and in more than 25 local authorities the increases are being paid. Ours is the only local authority which has refused and we are now being held up as anti-Irish Medical Association. We are not anti-Irish Medical Association purely and simply for the fun of being in that position. If the Minister wishes to inquire he will find that the refusal to sanction the increase to dispensary doctors was not the work of one Party alone. All Parties in the council were against it and voted against it.
I do not know whether the Minister is aware of this, but the last shot fired in this particular dispute between the local authority and the local Irish Medical Association in Donegal was that at the second last meeting of the Donegal County Council we found ourselves faced with the statement that if we did not pay this increase, or were not prepared to pay it, the dispensary doctors would no longer be available, not any one of them, to do emergency relief duty for a neighbouring dispensary doctor; and, as we all know, in rural Ireland that is an absolute necessity so that a dispensary doctor will be available at all times.
Now, that was used and it was directed to us by the local Donegal Irish Medical Association branch. I want the Minister to take note of the manner in which that matter was presented to us and to realise that that was a threat. It was really a blackmailing threat made by those people in the name of their own organisation and one which it was hoped would be sufficient to browbeat our council into giving them something that the previous meeting had decided, in all fairness and justice, they were not entitled to get. That type of manoeuvre is, I think, something the Minister should have in mind if and when he comes again to decide any such question as an increase in salaries to doctors or any other officials of local authorities who derive any part of their remuneration from the ratepayers of those local authorities.
I would ask that the Minister—let his time be long or short as Minister for Health—in dealing with these matters in future would set up some machinery whereby all councils would be represented at some round-table conference and that the claims of any of these groups would be before that conference and that only the unanimous opinion of that conference should be taken as a concrete suggestion for all of us. I think it is only fair to all of us who are members of councils or who may be members of councils in the future that we should not be hamstrung by directives from the Minister or anyone else on what we should pay the officials whom we are helping to pay in any way out of rate money.
Another matter which I think is not only of local interest in my county but is causing quite a lot of trouble throughout different counties is this question of the payment of disablement benefit as allowed and made feasible under the Health Act. This disablement allowance is something that I think was very necessary and fills a long-felt want and the very fact that the present Government did not scrap it and has, in fact, since coming into office, allowed it to come into operation proves that there is no division of opinion as regards this particular section of the Act. However, the good intentions that were behind the introduction of that particular section are in many cases, I am afraid, being nullified or being watered down to say the least of it. My county is only typical of others; the difficulties are there and we find it almost impossible to get around them. One finds we have someone of the full age, over 21, who is totally disabled, maybe residing in a home where there is a father or mother, brother or sister, and that father, mother, brother or sister, if they are other than destitute themselves, if they have any sort of means at all, is regarded as a person sufficiently well off to look after this totally-disabled member of the family.
I feel that there is a certain amount of justice in that approach and that, surely, the first people to lend a hand to any member of a family should be the father or mother or brother or sister if they are able to do so. But if we look at the other side of the picture and realise that if these members of the family say: "We will not look after the invalid", what is the position? That other member of the household is entirely disabled, or has some form of disability that leaves him or her completely and entirely dependent on others and if the members of his family say: "We will not look after this person. We consider it is too much of a drag for one reason or another", the burden is then placed fairly and squarely on the State or the local authority, to maintain that particular person completely and for the rest of that person's life.
The £1 per week benefit that is the maximum payable at the moment under this particular Act is not surely, and cannot be at any time, regarded as really sufficient to keep any one person whether they be disabled or otherwise, and that at best, even where the full 20/- is or could be paid, that 20/- should only be regarded as a help to those who are good enough to look after such persons as those who are crippled or disabled and cannot look after themselves. I feel that even though a parent or parents, brothers or sisters, may be regarded by the local county manager or the health authority as sufficiently well off to look after a disabled relative or member of the family, that is not sufficient reason to say: "Your brother has £6 a week and therefore he should look after you", or "Your sister has £7 a week and she should look after you."
I feel these members of the family are doing a great service in looking after their invalid brothers or sisters at home and are relieving the ratepayers and taxpayers of this country of a much greater burden. The £1 we would pay would be a very small contribution in comparison with the cost of maintaining the person in a home or an institution. I believe that the £1, the maximum amount that can be paid now, should be paid in all cases such as those I have outlined, as an encouragement and sort of compensation to those very good people who retain at home so long as they can and where it is possible to do so the disabled and crippled members of their own families.
I think they should be given some little help, and God knows this help is little enough. It is a pity it is not greater than it is at the moment when the maximum is but 20/- per week if the person is totally disabled. I feel the brother or sister, father or mother, should not be left unaided by the State and left possibly to deny themselves certain comforts and necessaries while trying in the best way they can to look after some crippled relative. The State could help and encourage these people to stay in their homes and be kept at home and could discourage sending those people to institutions. It would be better for all concerned that these invalids should stay at home.
I would appeal to the Minister at least to get in touch with the different local authorities in connection with this matter and if any circular that may have issued in the recent past from his Department is the cause of the stringent regulations that are now being applied, if through any directives from his Department this miserly and niggardly treatment is being meted out, I would appeal to the Minister to undo the damage that has been done in that direction by indicating to the local authorities and the managers —who are really the boss men in these particular cases—that the very severe means test should not continue.
