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Dáil Éireann debate -
Thursday, 12 Nov 1959

Vol. 177 No. 8

Adjournment Debate. - Discussions with Irish Medical Association.

Last Thursday, I asked the Minister for Health whether, in accordance with the public undertakings he had given, he had yet had discussions with representatives of the Irish Medical Association. In the course of his reply, the Minister referred to a letter of his of 13th March of this year in which he had expressed his willingness to meet the Irish Medical Association, provided they removed what he termed a ban on certain hospital appointments. The Minister went on to say that, on 23rd May last, the Association, far from withdrawing this ban, published a notice seeking to extend the ban to other medical posts. The Minister said that on 13th June the Medical Association issued a statement disclaiming the existence of any ban and said that shortly afterwards he was invited by the Irish Medical Association to be their guest at their annual dinner in Killarney and that on this occasion he again expressed his readiness to meet the Association, provided this ban was removed.

The Minister went on to say that subsequently he had further evidence of a continuance of what he termed a ban and accordingly the conditions were not such as to permit him meeting a deputation from the Irish Medical Association. It transpired, in reply to supplementary questions directed to the Minister, that what he described as a ban was a notice published in the newspapers advising doctors who intended to apply for certain posts to discuss the matter with the Irish Medical Association. The Minister has called that a ban and since the Minister is in charge of his own terminology, the absurd position now appears to be that the Minister for Health in Ireland is not prepared to discuss with the representatives of a great profession matters which should be matters of common concern in relation to health. I assert that that situation is intolerable and that whether the Minister wishes it or not, it will have to be changed and changed forthwith.

I do not think it is possible to have a continuance of any cold warfare between the Minister for Health and the Irish Medical Association. If that is to continue, then the only result will be a stultifying of efforts which were being made to improve the standard of health services. The Irish Medical Association is a lawful association; a coming together of members of a common profession in accordance with their rights under our Constitution. I would remind the Minister that under our Constitution the right to co-operate lawfully is preserved and guaranteed. The Irish Medical Association are such a body and as such a body, are entitled to advise their members on terms and conditions applicable to different medical posts.

I doubt if the Minister would deny them that right. I doubt if any person interested in democratic principles would deny them that right. I doubt if any member of this House, which is a House freely elected to preserve the rights of the people, would deny any lawful association the right to look after the interests of their members. I suggest to the Minister that he should recognise that this lawful association is exercising a constitutional right which it has and that he, and only he, can cut the Gordian knot which he himself has created.

The Minister must be aware that at the moment—I do not intend to make a bad situation any worse—in the operation of the country's health services there are grave problems to be faced. I shall only instance the fact that in our local authority hospitals there are at present first-rate men, carefully appointed through the Appointments Commission machinery, to carry out various operations and do the surgical work required. These men are expected to be 24 hours on duty; under the conditions now obtaining they are expected to be available to give of their best to help the patients every hour of every day.

I know of my own knowledge—not from the I.M.A.—that some of these highly-trained, highly-qualified county surgeons are on the verge of a nervous breakdown. They have no assistance and cannot get it. It is impossible at present to provide any relief for them. That is one of the problems that urgently requires discussions between the Minister and the I.M.A. There are other problems of which the Minister is aware and which I do not intend to detail, problems affecting other medical practitioners whose services are necessary for the proper functioning of the health services here and these things urgently require the Minister's attention. I suggest that in the interests of the country itself he should forget his own dignity in this matter and realise that someone has to take the first step.

I feel this is a situation which the Minister seems to have permitted to arise. Certainly, when the Minister resumed his present office, conditions as between his Department and the I.M.A. were not as they are now. While all the problems had not been overcome and all the difficulties had not been cleared, at least there was a feeling that those difficulties might gradually be surmounted.

I should like to remind the Minister that in 1956 when it was possible by agreement to ensure that the health services would operate under the Health Act, not merely on paper but in fact, that should have been the beginning of a new era so far as the Minister's Department and the Association outside were concerned. I regret very much that we are now faced with a situation in which the Minister is isolating himself in the Custom House, issuing bulletins and statements wrapped around with his own dignity, and he is not prepared to discuss matters of public importance with representatives of the medical profession. Such a situation is likely to lead to anything by frustration and lowering of health standards.

I am raising this, not as a spokesman of anyone except those who elected me. I raise it as a person concerned to improve the standards of health services and I have no other reason. I have had no discussions whatever with the I.M.A. or anybody concerned with them and I have no way of raising it other than this and I do so with the plea that the Minister would be—as I am sure he is— big enough to realise that this situation if not attended to and relieved now will only lead to much trouble and great harm in the future.

I think nothing is further from the facts than the impression that Deputy O'Higgins has given us. His speech has been just a rehash of what he said on the last two occasions when this matter was discussed. I should like to point out that we had all this out before the Summer recess and the Minister at that time pointed out that, even if he wished to meet the I.M.A., the law as framed at present would not permit him to discuss certain matters with them. If they have complaints, as evidently they have, on certain matters governing the conditions of appointment and salary in regard to specific posts, it is mandatory on them to meet first the County Managers' Association. On the 12th June, 1958, they met the County Managers' Association and the agreement then made was that the meeting would be adjourned, that they would report back with certain recommendations, and that each manager would go to his respective council and put his proposals before them. The only function of the Minister was to sanction those increases or turn them down. Therefore, in regard to these functions, this is not a matter for the Minister.

However, I think the Minister overstepped the mark in that he certainly displayed great latitude and tolerance. We should go back to the matter mentioned by Deputy O'Higgins, the I.M.A. function in Killarney on the 1st July last. "The man who came to dinner" was the Minister for Health; he travelled to Killarney to the I.M.A. annual dinner. Surely the House will agree that a Minister so fully occupied in a Department such as that of Health and Social welfare displayed feelings of co-operation by travelling to Killarney? Surely he displayed an anxiety that relations between his Department and the I.M.A. should be more harmonious? Evidently, as he said at the time in his speech in Killarney as reported in the Press, he was most anxious to come to an understanding with them. I shall quote from his speech at the I.M.A. dinner:

The Minister referred to his agreement to meet a deputation from the I.M.A. on the following terms:

Speaking as the guest of honour of the Irish Medical Association at their annual dinner in Killarney, the Minister indicated his readiness to participate in a discussion far removed from trivial. Afterwards, we saw a letter in the public Press signed by one Dr. Noel Reilly, medical secretary to the Irish Medical Association, which was a copy of an open letter sent to the Taoiseach saying they were compelled to write to him, due to the failure of the Minister to meet them on certain matters. It was not bad enough to insult the deputy Prime Minister of this country. It was not bad enough to insult the Minister for Health and Social Welfare, but nowadays if one writes to the Taoiseach, on the same day as you drop the letter into the post, you write a letter to the three daily newspapers.

If that is not lack of courtesy by these gentlemen, I do not know what is. It would certainly arouse bitterness on my part, but, notwithstanding that, the most disquieting part was the spate of abuse of the Minister by the Irish Medical Medical Association. Despite that, the Minister publicly announced his intention to meet them but their reaction could be summed up by Jeremiah: "The fathers have eaten sour grapes and the children's teeth are set on edge." That is about the height of it.

The time has come when I would ask the Minister to set up a judicial inquiry. Before the summer recess, he might well have been driven to do so. Deputy T.F. O'Higgins thinks there is nothing to do but ring up the secretary of the I.M.A., that he will attend, and then all will be well. He says that someone must take the first step. Did the Minister not take the first step at the dinner in Killarney?

Deputy T.F. O'Higgins also says that the word "ban" is a piece of imagination in the Minister's mind, yet the Association themselves agreed at one time to suspend their disapproval of certain key positions. Was that a ban or not? Deputy O'Higgins also suggests that the Association notice in the public press, asking members not to accept certain posts without prior consultation, was purely for the purpose of discussing these posts with the Irish Medical Association. The I.M.A. themselves expressed their disapproval of these posts and, therefore, they were going to inform the individuals who would approach them of their disapproval.

Back on 2nd June last, Deputy O'Higgins to show his inconsistency, when Surgeon Hurley was removed from his post in Mallow said: "I do not wish to express any view on the inquiry which the Minister has conducted because I do not know the facts." Yet, for the past 10 minutes, not knowing the facts, he went into detailed discussion.

I should like to be clear. Is the Deputy replying for the Minister? I understood this was a half-hour debate.

It is a half-hour debate and only ten minutes are left. I was about to remind Deputy O'Malley of that.

I was just concluding. I was reminding Deputy O'Higgins of his inconsistency when this matter was previously introduced. I would ask the Minister to set up a judicial inquiry. This body known as the Irish Medical Association does not, in fact, represent the vast majority of its members and does not carry out their wishes. Its letters in the public Press and general conduct are not in accordance with the wishes of the vast majority of the members of that Association. The great body of doctors throughout the country are respected and highly honoured members of the community, and I know several country members of the Irish Medical Association who are appalled by the conduct of this small clique. They are a small politically-biassed clique and they have selected the Minister for Health as their target.

In conclusion, I think the best summary of their action was given in a leading article in the Irish Times, a paper I do not always agree with, when it said of the boycott: “It will deserve and receive just as much sympathy as complacency and arrogance usually command.”

Deputy T.F. O'Higgins in his opening remarks said that the I.M.A. has the constitutional right to advise its members on the terms and conditions of appointments. I am not denying the right of any body to advise its members as to their conduct but there rests upon the Minister, the person who occupies the position of a Minister responsible for any Department, the responsibility to ensure that the position which he holds on behalf of the people, and which has also its constitutional rights and its duties, is fully maintained. I have the right and also the responsibility to see that no organisation in this country will succeed in its endeavour to prevent the proper functioning of any Act of the Oireachtas. I am convinced, by my knowledge of what has happened in this regard since the middle of 1958, that the purpose of certain members of the I.M.A. is to bring the administration of the Health Acts into disrepute with the general public and to prevent them from functioning properly.

The Deputy referred to public undertakings which I have given. I am prepared to stand over them. They were not unconditional undertakings. There was a condition attached to my offer to receive a deputation from the I.M.A. and it was that the ban which they had imposed, the proscription which they had imposed upon applications for certain posts, should be withdrawn, because that ban was imposed without due reason, without any justification and without prior notice.

The Deputy has also suggested that it is merely a question of nomenclature, so far as I am concerned. He has referred to the act of the I.M.A. as "what I have termed a ban." The designation of the action which the I.M.A. has taken did not, of course, originate with me. I have here the official report of the proceedings of the Central Council of the Association held on 23rd April, 1959, and published in the June issue of the Journal of the Association. It refers to "the proscribed posts" and to "proscription of posts." The official report of the proceedings of the annual general meeting on 30th June, reported and quoted in the August issue of the Journal, referred to a resolution from a branch as follows: "This branch is of opinion the time is opportune for revising the Association's policy concerning (a) the ban on medical appointments."

So there is a ban. I have further evidence here, but I do not wish to utilise the time left to me to go into it, showing that, in fact, there was and is a ban. I informed the Association that so long as that ban was persisted in, I would not meet them. They published a letter disclaiming that there was any ban. Acting on that, I indicated that, since there was no ban, I was prepared to meet them but evidence came to me later, and continues to come, to indicate quite clearly that there was a ban and that it remains.

I went down to the function to which Deputy O'Malley has just referred; but I went down there under conditions and as a result of assurances which I had received from prominent members of the Association. Here it is necessary for me to read an extract from a letter which I wrote to one of these gentlemen, one of the gentlemen who was responsible for the insulting reference to myself which was published recently.

Let me say this. I am not dealing with this as a personal matter. I am dealing with this issue as a Minister of State charged to protect the prerogatives of a Minister on behalf of the public. Here is what I did write to one of the gentlemen who has had the audacity to refer in the newspapers to my attendance at this dinner. One thing I have learned as a result is to beware of dining officially with doctors in future. I said this:

Dear So-and-So: Further to our conversation at the Reception in honour of the President on Thursday night last regarding my acceptance of the invitation of the Irish Medical Association to their Annual Dinner at Killarney on the night of Wednesday next, 1st proximo...

my letter was dated the 26th June—

However, as I was unable to attend the similar function last year, but mainly as an earnest of my desire for good relations between the profession and the Department of Health in the interests of the general good, I would like very much to attend this year.

The position, however, is not without difficulty.

The Association has assured me and the general public that there is no ban or boycott on medical posts in local authority hospitals. On the basis of that declaration and accepting it as unequivocally and definitively expressing the considered view of the Irish Medical Association, I agreed to meet a deputation from the Association in an effort to arrive at a solution of certain matters at issue between us. Recent events at Mallow, however, seem to belie the statement that there is no boycott. An effort is being made to clear up the situation there and if a satisfactory settlement can be arrived at in the next day or two, I shall ask the Taoiseach to make arrangements for my absence and will have pleasure in accepting the invitation to the dinner.

A day or two before I was due to depart for this function, the issue of the Journal of the Irish Medical Association appeared and in that issue, instead of the usual editorial, they had cribbed an editorial which had appeared, I think, a fortnight before in one of the provincial newspapers and published it as their own editorial. I immediately indicated that in those circumstances I was proposing not to attend the dinner of the Irish Medical Association. I received certain reassurances, however, and in consequence I wrote again to my correspondent and said:

Thanks for your note and for the assurances which it gives. I confess that, were it not for these and those which the Association's President Elect, Dr. Dolan, also gave me on Saturday evening, I should have been slow to make the long journey to Killarney and back this week in view of the Editorial in the July issue of your Journal.

I was the more annoyed by the ill-timed reprint of The Nationalist editorial in the Journal, as in the spirit of my letter of the 15th June to the I.M.A. I had with some restraint refrained from replying to it. However, Mr. Murray has told me of the discussion which he had with Dr. Reilly and your good self, from which I gather that, being gravel'd for lack of matter, the Editor of the Journal had to find something to fill the page. Accordingly, as I am a good-natured man, I am looking forward to being with you and your colleagues on Wednesday. My wife is coming also—she feels that her presence will safeguard me from the lancets and scalpels of the brotherhood.

Those are the conditions upon which I went to this dinner at Killarney. Notwithstanding the letter to which Deputy O'Malley has referred, I am still prepared to meet the members of the Irish Medical Association, but only because I put the public interest above my own private and personal position. Indeed, if that letter had referred to me in my ordinary capacity as a private citizen in this State, I should refuse ever again to speak to any person responsible for it. In spite of all this, I am still prepared to meet a deputation from the Irish Medical Association, provided that they honour their word, that they make good their disclaimers and withdraw the ban upon these posts.

What is going to happen meanwhile?

Meanwhile, if this is going on, we may have to have recourse to a public investigation into the reasons why this ban was imposed and what is behind it.

I think that would be an excellent idea.

The Dáil adjourned at 5 p.m. until 3 p.m. on Wednesday, 18th November, 1959.

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