On the motion for the Adjournment, Deputy O'Malley gave notice of his intention to raise the subject matter of Question No. 5 on yesterday's Order Paper.
Adjournment Debate. - Terms and Conditions of Service of County Surgeons.
I asked the Minister for Health yesterday whether he suggested that representatives of the Irish Medical Association should meet representative officers of the several health authorities to discuss the terms and conditions of service of county surgeons; if he would state his reasons for making the suggestion; whether the suggested meeting took place and, if so, what was the result of it; and whether the Association informed him, before instituting their present boycott, that they were dissatisfied with the result of the discussion with the county managers.
The information which I received yesterday from the Minister was that exactly one year ago, in June, 1958, a very friendly meeting took place between the representatives of the I.M.A. and the City and County Managers Association. The Minister informed us that the decision at that meeting was that the I.M.A. were to go away, prepare a memorandum and submit it to the City and County Managers Association. From that day to this, according to the Minister, we have the frightful position that the Irish Medical Association have instituted this boycott but have never made the representations which they agreed upon with the City and County Managers Association.
Is the Deputy trying to make mischief or peace?
I am trying to make peace.
It seems to me that the Deputy is very much like trying to make mischief.
If the Deputy would only sit down and listen, he might hear something. The position, as it obtains at the present time, is intolerable. The vast majority of the doctors in this country, whether or not they are members of the Irish Medical Association, are highly responsible men. They are doing tremendous work and are most anxious to have the position clarified generally. Unfortunately, we have this small clique, called the Irish Medical Association, which, in the main, is, unfortunately, tainted with political prejudice against the Government Party.
Is the Chair going to allow Deputy O'Malley to slander the medical profession in this fashion? It is nothing short of pure slander.
I do not see that the Deputy is slandering anybody.
The Chair must not be listening.
Is the Deputy making a charge against the Chair?
With respect to your ruling, Sir, I hold that Deputy O'Malley is carrying on a line which, in accordance with proper order and procedure, should not be allowed.
The Deputy and I differ on many matters and that is one of them.
When the poacher turns gamekeeper again, I shall give notice of it. The dispensary doctors of this country particularly are doing tremendous work, but I cannot agree with the Minister yesterday when he just gave us this information. When I pushed him to have a judicial inquiry or bring the boycott to an end by some means, there was no reply from the Minister. I think the Minister for Health has a duty to perform to the country. He is charged with the administration of the Department of Health. We now find out from a reply to Deputy Brennan today that this Association is not even authorised to negotiate on behalf of the members of the Association because it is illegal for them to do so.
What authority had the Managers Association? Are they registered?
That does not arise. It is quite obvious that Deputy Corish is not conversant with the Trade Union Act of 1945 because a further section of that Act says that it shall not be illegal for any person or persons to act as mediator. Here we have the City and County Managers Association acting as a mediating body between the local authority and the members of the Irish Medical Association. If they had come back, as they were told to do, and if the Managers Association said: "All right; we agree with you; you have a justification for an increase in salary and conditions generally; we will recommend it to our Council," then every local authority in Ireland would decide: "Yes or no; we will agree or disagree with the managers' recommendation". If they did agree, the next step would be that the recommendation would be sent to the Minister for Health whose only statutory obligation was to say either: "Yes; I sanction this decision of the local authority in question" or "I refuse it." He has absolutely nothing else to do with it.
Deputy Dillon is barking up the wrong tree. I have not doubt that Deputy Dillon's attitude that this thing should be brought to an end and that red tape should be cut out is the feeling of many of the members on both sides of the House, but even if the Minister wished to-morrow morning to get his secretary to ring up the secretary of the I.M.A. to come to see him, he could not do so. First of all, he would be transgressing the law as it stands at the present time; secondly, he would be committing a breach of the law himself in so far as he would be exceeding his power; and, thirdly, he has no authority, good, bad or indifferent, to tell them: "Yes, I agree with your case." That is not a matter for the Minister for Health. It has to come to him after due consideration by the local authority in question.
My main reason for bringing this question up on the Adjournment is to see whether there is a way out of this deadlock. I think it was Bernard Shaw in The Doctor's Dilemma who described these associations as glorified trade unions. The I.M.A. considers it is a trade union. Then the sine qua non of trade unionism is not to call an unofficial strike. A sine qua non is to take a poll of its members.
Everyone in this House knows and everyone in the local authorities knows that the members who pay their two guineas or three guineas every year to the Medical Association were not consulted on this at all. They were not asked to voice their opinion on the ordinary democratic principle. Under the previous Minister for Health, Deputy O'Higgins, we had not this outcry but when this Government was appointed, a short five weeks after we came into office, the trouble started with the I.M.A. It is very interesting to note the dates.
May, 1957, is the relevant date. There is another date which is too much of a coincidence, in my opinion —the 12th December, 1958, which should be noted from the Minister's reply as to the means they took upto themselves to force their members not to accept or apply for certain posts.
There is another important date. There is one case on record of a doctor who has broken this boycott. He pitched the I.M.A. to hell and said he was getting out. They not alone sent him to Coventry, so to speak, but he has been threatened with well-nigh physical violence. He has been ostracised by what I would call the local shop steward of the I.M.A.
The Deputy is travelling beyond the terms of the question.
The House is not meeting next week and the thing that upsets me most, and other Deputies also, is that the in-patient services and out-patient specialist, surgical, medical, obstetrical, radiological and ophthalmic services are all under this boycott. As I say, this House is not meeting next week and, within the next 48 hours, could not fatal consequences arise? It is all right to lock the stable door when the horse has gone, but, if we could get the Minister to tell the House, before it adjourns for a week, what action he intends to take, it would be a help.
Deputy Dillon is forcing the issue over on the Minister, saying the gesture should come from him. I have no doubt the Minister is quite prepared to make any magnanimous or other type of gesture required to bring this position to an end, but, as I see it, it is not in his power. If Deputy Dillon and Deputy Norton directed their pleas to the I.M.A. could the boycott not be called off and, the boycott having been called off, they can then go back to the County and City Managers' Association. In fact, the Minister has said that once they are prepared to lift the boycott, that action can be taken and he can meet them about their grievances. Could he do any more? Apart from the public altogether, the 40,000 qualifying for health services, these people are suffering great hardship and will suffer greater hardship as time goes on. We have the case of one doctor, not necessarily a member of the I.M.A.——
I have allowed the Deputy to travel far because the matter is of such importance. I would suggest that he should come to the terms of the question.
I gave the Chair a hint in that direction.
The Chair does not usually take a hint from the Deputy.
I have nothing further to add. I think I have made the position abundantly clear and I sincerely trust that the Minister will bear in mind the point I stressed. The vast majority of doctors in this country are of a highly responsible disposition, and they are totally against this boycott in the main. As the Minister is now aware, the Irish Medical Association in fact appears to consist of a biassed political clique.
The Minister told you to say that.
Order!
I always say what I wish to say in this House.
I am calling on the Minister for Health.
I suppose, in the serious situation in which we are, I should try to make my position very clear. The difficulty has not arisen because of any action or inaction on my part. I have not proclaimed a lock-out. The Local Appointments Commission, acting upon the request of the local authorities concerned, advertised a great number of responsible posts and asked that qualified persons should apply for them. I do not know why the Irish Medical Association have taken the action which they have, in asking intending applicants for those posts to communicate with the headquarters of the Association before sending in their applications, and in requesting members of the medical profession generally to refuse to sit upon the selection boards which the Local Appointments Commission sets up to determine which of these applicants is best qualified.
I say I do not know why the Irish Medical Association have taken the action they have because they never requested myself, as Minister, to receive a deputation at any time, to hear the representations which they had to make in relation to any matter, until the date upon which they sought to boycott these posts. The first communication I had from the Irish Medical Association was on 10th May, 1957. I am not going to read the whole of these communications but I am going to read the significant phrases in them. This one is addressed to the Secretary of the Department of Health and it reads:
Dear Sir,
I have been directed to request a discussion at official level concerning the following matters——
the matters being a review of the terms of service of county surgeons. It went on to request that representatives of the county managers be invited to the proposed discussion. That letter was replied to on 19th June and, in the course of the reply, it was stated it would be more appropriate that the matter should be discussed, in the first instance, between the Irish Medical Association and the City and County Managers Association.
The suggestion that the matter should be first discussed with the county managers association arose from the fact that in 1955, the City and County Managers Act was amended to provide that no county manager could submit any proposal to fix increased or reduced rates of remuneration, applicable to any class or description of employee, for the sanction of the appropriate Minister, save with the consent, by resolution, of the local authorities. Whatever private individuals may or may not do, the one thing members of the Government and the staffs of their Departments are bound to do is to observe the law and, in asking the representatives of the Irish Medical Association to meet the county managers association, as representing their local authorities, we were complying with the letter and spirit of the law.
After a further exchange of letters, the following letter was received in the Department. Again, it was addressed to the Secretary of the Department of Health and not to myself personally as Minister. It indicated that the Secretary of the Irish Medical Association had been directed by his Council to write to the Secretary of the City and County Managers Association and request they should receive the representatives of the county surgeon group to discuss the position of these officers. It went on to say:—
In taking that step my Council is keeping in mind the Minister's desire that the matter be discussed at this level in the first instance,
and that was underlined. That meeting took place a long time afterwards. I do not know why it should have been delayed, but the meeting of the representatives of the I.M.A. and the county managers did not take place until 12th June, 1958. I received no indication from the I.M.A. that those discussions had been unfruitful or that the Association wished the Minister for Health to take some further action. I may say at this stage that I could not have taken further action because, as I stated, whatever the Council of the I.M.A. may dare to do, at least I have to observe the law.
I heard nothing further on this matter until bans were imposed quite arbitrarily on the county surgeon posts in November and on county physician posts in December. Then I heard nothing further.
Might I ask the Minister a question? Was there any account at all of the meeting between the managers and the I.M.A. on 12th June? Did they report back to the managers?
I do not know. I did ascertain afterwards from the county managers that the matter had been discussed. The concluding words of the communication from the county managers read: "It was agreed to adjourn the meeting to enable the surgeons' group to prepare a statement setting out their claim and that facts and figures will be given." I heard nothing further and neither did the county managers until the beginning of this year or the end of last year. Then, on 14th February, this letter was received and this time it was addressed to the Minister for Health. It began:
"Mr. Minister — At a special meeting of the Central Council of the above Association"
—that is the Irish Medical Association—
"held on the 12th February, the following resolution was passed:
That the I.M.A. enter into negotiations with the Minister and others to procure conditions of work and remuneration under the various Health Acts satisfactory to all its members.
In view of this resolution I am instructed to respectfully request you to receive a deputation from the I.M.A. at your earliest convenience on the subject-matter of the resolution."
I do not wish to dot the i's and cross the t's of that communication, but the House will see there is a plain indication there that they proposed to enter into negotiations, which was on their part quite an unlawful proceeding.
The Secretary of the Department replied informing the Association that the Minister would be prepared to receive a deputation, but that by reason of previous engagements and pressure of public business, it would not be possible for him to do so until after Easter. In the meantime, he would be obliged if a statement detailing the various matters which it was desired to discuss was forwarded to him. The letter continued:—
I am also to state, in view of the request for a discussion and in order that the discussion may be without prejudice, that the Minister will expect that steps would be taken by your Association to withdraw the proscription which has been placed on the recruitment to several important posts connected with the provision of health services to the community and to restore the status quo to these posts.
When an intimation has been received to the effect that action on these lines has been taken the necessary arrangements for the fixing of a meeting can be completed.
The I.M.A. refused to take these necessary steps. Naturally, having regard to the manner in which the executive of the Association had acted I refused to meet them and that is the position at the moment. Deputies should bear in mind that I did not lock out any person. There is no question of a lock-out in this matter, but, without any intimation of their reasons for doing so, the Council of the I.M.A. have taken certain action.
Deputy O'Malley asked me whether I would ask the Dáil—I suppose I should have to ask the Dáil—to set up a judicial tribunal to investigate the actions of the I.M.A. in respect of their actions in this matter. Nobody can foresee the future, but if this boycott continues, it may possibly come to that. I do hope that it will not come to that. I am well aware that just as in many other organisations the vast body of the members of the I.M.A. do not engage in the day to day administration or activities of that Association, that they are content to allow the people who are energetic enough or, perhaps—shall we say— public-spirited enough to take charge of their affairs and administer them according to the best of their ability, but I feel in relation to this matter much more than the interests of the medical profession are being brought into it by the Council of the I.M.A.
I do not know whether it is that the members of the Central Council have taken umbrage at the fact that I pointed out in my first address to the association that the principles of the Health Act had been twice endorsed by the Irish people at general elections and that whether we were for or against the Health Act originally, the job of both of us was to co-operate and make it work. I do not know whether that has anything to do with the attitude that has been taken up by a comparatively small, a very small and insignificant fraction of the I.M.A. Unfortunately, this fraction does purport to speak for the general body of the profession throughout the country. I wish to say, however, that I make a very clear distinction between those who have been responsible for creating the present situation and the great body of medical practitioners throughout the country. I think that very few of them would endorse the attitude which the I.M.A. has taken up in relation to the unfortunate Mallow incident.
I think that perhaps the great majority of them are now learning for the first time the true background of the situation which has now developed. I would hope that good sense and the traditional concern of the Irish doctors for those who are sick and are in need of their care and services will bring such pressure to bear upon the Central Council of the I.M.A. that this ban may be lifted and that the position which existed before it was imposed will be restored; so that I shall be able to meet representatives of the profession and discuss with them whatever grievances they may have.
Unfortunately, I cannot meet them as a negotiating body for two reasons: first of all, I must have regard to the requirements of the Trade Union Act of 1941 and secondly, the only body that would be competent to negotiate with the I.M.A. in relation to conditions of employment in the local authority health service is the County Managers Association, as representing the local authorities. Even the County Managers Association—and I want to make this quite clear—are not free agents in this matter and can act, as Deputy O'Malley rightly pointed out, only as intermediaries. They can discuss the position of the county surgeons and the county physicians with the representatives of the I.M.A. and then, having arrived at what they would think would be a reasonable and acceptable basis for a settlement —to put it that way—can go back to the local authorities—I am talking now of the county managers—and secure the consent of the local authorities —which is essential—to putting the proposals before the Minister for Health. When they come to the Minister for Health, the only thing I can do in relation to them is either to sanction them or refuse to sanction them. The Minister has no other function than that and certainly he has not got the function of negotiating rates of remuneration or conditions of employment with any organisation representative of those engaged in the health services of this country. That is a power which rests, and rests only, with those who represent the local authorities.
The whole of this agitation has been completely misdirected from the beginning. Whether or not that was due to a hasty desire to "have at" the Minister for Health, I do not know, but it is quite clear that those who have been directing the affairs of the association have misled themselves, and of course they are misleading those whom they are purporting to represent.
In conclusion, I just want to make it quite clear that I have a high regard for the medical practitioners of this country. I only hope that their spirit of comradeship will not allow them to be involved in a dispute which can end only to the disadvantage and detriment, not only of the profession but of every person in this country.
The Dáil adjourned at 3.55 p.m. until 3 p.m. on Tuesday, 23rd June, 1959.