When I reported progress, I was pointing out that one of the biggest bones of contention as far as the present Health Act is concerned is the administration of the domiciliary services. The trouble arises for a number of reasons. First of all, we have quite a number of doctors who are doing a really excellent job, devoted to the service of the people, and with whom no quarrel can be picked. I am glad to say that the majority of the dispensary doctors fall within that category. However, there are some very excellent doctors who still do not realise that they are not forced to accept posts as dispensary doctor, but that is the impression they try to give the general public. If someone phones the doctor's house after hours and that someone turns out to be a medical card patient, he is told he must send in his complaint in some other way.
It is on record that people who have sought medical attention, which they considered they required urgently, after normal dispensary hours, have had a lecture on the necessity of notifying the doctor in time, if they are dispensary patients, and before a certain hour, with the advice that they should not seek medical attention after certain hours and, above all, medical attention at the residence of the doctor. If a person falls ill, particularly a person who is not used to being ill, it is not at all unusual to find that person thinking himself very much worse than he actually is. While the doctor, who has probably met hundreds or thousands of cases like this, may feel the case is a very simple one and one that can be dealt with quite easily, he should also appreciate that the patient cannot be blamed for seeking immediate attention in the circumstances. The very few doctors who behave in this way are doing no credit to the service. I hate having to mention this matter again, but it is on record here and there throughout the country and so I consider it necessary to mention it once more.
On the question as to whether or not someone is entitled to attention without a medical card, if he is not prepared to pay, then he should be dealt with in the way laid down by the Act. The first duty of the doctor called to attend a patient is to attend the patient. If the patient produces a medical card, it is not for the doctor to decide whether or not he is entitled to the card. The Department of Health and this House have laid down certain regulations and these regulations should be carried out. An argument as to the rights or wrongs of a patient to free treatment is scarcely conducive to early recovery.
It is also, unfortunately, a fact that there are some doctors who, for one reason or another, have been on bad terms, to put it mildly, with certain families in a district over many years. When this happens it is usually found that the patient, either because he feels he will not get the treatment which he would get from another doctor, or because the doctor and he are likely to have an arguing match before the treatment is given, will usually seek treatment from another doctor for himself and his family. The Minister will agree that this is quite understandable, that it is quite a human way of behaving. Therefore, it is rather unfortunate that a dispensary patient, a medical card patient, is limited to one doctor. This is a matter which will have to be dealt with very quickly.
I would suggest to the Minister that one way which would help to break down these prejudices would be to adopt a rota system in fairly thickly populated districts, not only in towns and cities, but in the country; that a particular doctor is not the person available but a doctor. That system is being introduced in Drogheda in the very near future to cover Sundays for both Meath and Louth.
I am one of those who believe that doctors are as much, if not more, entitled to free time as everybody else. It would be most unreasonable to suggest that they should always be on call. There are many people who believe that they should be and that there is no reason why a doctor should not be sitting there waiting for a call. The rota system seems to be the answer. It is being introduced with the co-operation of the Meath and Louth County Councils, only for Sundays, but it should be extended to as many districts as possible. If patients got into the habit of meeting different doctors it would be all for the good of the patients as well as for the good of the doctors.
The question of medicines comes up again. Occasionally, somebody who falls ill goes to the local dispensary doctor or to some other local doctor and, as a result, is sent to a hospital, perhaps the local hospital or, perhaps, a hospital in the city of Dublin. Then he may return home with a prescription for pretty expensive drugs. Everybody does not know how the Health Act works. Everybody does not know that in October, 1959, the Minister for Health issued a circular recommending the manner in which people who could not afford to pay for drugs, even though they had not a medical card, should have their cases dealt with.
The natural thing to do is to go to the local chemist to get the drugs and, as far as their finances allow, to pay for them and when they find that the money is running out, they go to a county councillor or Deputy and say: "This is the position. Can you do anything about it?" When something like that happens I do not think it is right that the local authority should say that this person has got this prescription from somebody who is not employed by the county council and did not make application through the county council and, therefore, to use the words of the Minister for Local Government referring to housing last night, "they can stew in their own juice".
I do not think that is the way it should be dealt with. The simplest way to deal with it is for the local authority to send out the home assistance officer, even though these people have paid out money which they can ill afford and which they will require before they are fully recovered, to make arrangements to give a refund of the money actually paid.
I honestly believe that when the circular was issued by the Minister and up to the present time it was the intention of the Minister that that was the interpretation which should be given but, unfortunately, it is far easier for an official of a local authority to dictate a snappy letter saying: "You have paid for those things. We did not tell you to get them there. Therefore, you must pay for them yourself." These are some of the irritations which cause people to say that the Health Act is useless. I do not agree at all that it is useless. I believe there are quite good sections in it and that up to a certain point it can be very well used.
To return to dispensary doctors for a minute, I have one serious complaint, that is, that when a doctor retires or dies or for any reason leaves a dispensary, despite the fact that there appears to be quite a big number of doctors anxious to apply for the position, there is inordinate delay in filling the vacancy even where, as in one case in my constituency, there is quite a decent house and grounds and a very good district available for the new doctor. I do not think it helps the new doctor if the vacancy is left for months until doctors over a wide area have succeeded in taking up the patients who normally were served by the doctor who was the dispensary doctor for the area. It is rather unfair that that situation should result.
In the particular case that I am talking about, that of the dispensary officer of Stamullen, Meath, the position has been vacant for quite a long time. There is no reason in the world for that, as far as I know. I understand that there is quite a number of applicants and that the position is regarded as rather a plum. Yet, a doctor has not been appointed. I have raised the matter at local authority level and the reply is that they are waiting, that they can do nothing about it. Perhaps the Minister can do something. That is one instance that I can give. I know there are others. Such delays do not help.
There is another situation which has arisen from time to time, particularly when temporary doctors are doing duty. You can find a doctor who is a private doctor in an area doing locum for a dispensary doctor and occasionally attending patients who were previously private patients of his. They may have fallen on evil times or for some other reason are no longer able to pay the doctor's fees. It causes embarrassment when that happens because the doctor doing locum usually expects that they should continue to pay the fees they formerly paid and which they had to stop paying. This is something which possibly could be avoided and, if at all possible, should be avoided. The question of whether or not persons are entitled to free medical services is not a matter for the doctor but for the local authority concerned.
Having said that, I want to emphasise that as far as the local authority of which I am a member are concerned, as far as they can go they are a model in this country. They do attempt to give as good a service as they possibly can and usually they bend over on the side of the patient, which is a good thing.
The question of sending patients to the local hospital rather than to a hospital outside the area, which may be more convenient, has been got over by Meath County Council who agree that it is the right thing to do, that it is the interest of the patient which is important, what is best for the patient and not what is best for the County Manager or some of his officials. There are other councils who do not agree with that. We have the example of councils who from a sizeable town in which there is more than one hospital will send patients 20 to 30 miles to the county hospital, no matter how ill they may be, because of the fact that they are medical card patients. The plea has been made that the hospital is new and that they must ensure that the right number of patients go there in order to ensure that it is paid for.
I do not think it is right that that should be done but it is still being done in this country. It is just too bad that somebody who is seriously ill should be driven so many miles simply because he has not got the necessary money to pay for his treatment in the local hospital. It was never the intention that the Health Act should be administered in that way and I do not think the Minister or his Department should allow it to continue to be administered in that way.
That brings me to the question of how people are brought from their homes to hospital or from one hospital to another. There are in this country a group of people for whom there is the blanket description "ambulance drivers". They are employees of the local authorities in most cases. I find that from county to county there is a very wide variation in the rates of pay and conditions of employment of these people. The Minister for Health would be doing a very good job if he had an investigation carried out into the manner in which ambulances are being serviced in the country.
It is not right that one county should pay a rate of £10, £11 or £12 a week for a 45 hour week with overtime, while the next county should pay only £8 10s. with no overtime, and that the ambulance men in that county should be asked to spend the whole day from early morning to late at night going around the countryside and that no meal allowance is given to them. It is generally expected by practically everybody that because of the type of work they are doing nobody can write down what their rates of wages and conditions should be and whether they should have a meal allowance. These must be dedicated men because otherwise they would not remain in the job.
They are excellent people. They have a knowledge of the districts in which they operate which nobody else has. I gave an instance before of a man who got a sick call to go from Navan to a tinkers' camp in the wilds of the countryside and within half an hour the ambulance driver had found the camp and taken the sick person from it. Nobody else could do that. The Minister should take a greater interest in this matter and there should be a standard laid down because at present the position is anything but satisfactory.
Then we have the other type of hospital employees most of whom are represented by trade unions but conditions are not always as good as they might be. In many hospitals there is grave dissatisfaction regarding rates of pay. The ninth round of increases did bring the rates up somewhat but, generally speaking, the rates are pretty low for the type of work they do. It must be remembered that these employees work on Sundays, Church holidays and bank holidays. There is no question of any of them being able to work a five day week or taking their Sunday off or availing of Church holidays or bank holidays. They do not get adequate compensation for this state of affairs and, in addition, they have to do a lot of night work. They are people who are dealing with those who are very ill.
While the nursing staffs do an excellent job and get the respect due to professional people, a lot of work is still done by the domestic staffs. They do a considerable amount of the nursing work and they must do certain things with regard to the patients but they do not get as much respect as they are entitled to. When the 96 hour fortnight was introduced for the nursing staffs many years ago the local authorities did not include in that concession the domestic staffs. In some hospitals we find people working well over 50 hours a week.
People working in hospitals, porters, ambulance drivers, wardsmaids and all the others are doing a very good job and should be entitled to appropriate pay and to the reduction in hours given to the nursing staffs. I remember the Minister stating, I think it was last year, that if a proposal came from any local authority to reduce the hours of the nursing staff to an 80-hour fortnight he would sanction it.
The county homes have improved tremendously. I have been through quite a number of them and I must say that many of them have become a home from home. Something happened in Drogheda recently which caused a certain amount of unrest. It was decided that an old building should be vacated and that the group in it should be broken up. That was a necessity because nobody had decided that another building should be erected there and it can be argued that it would not be a good idea to erect such a building because of the cost. I do not agree with that argument. A town like Drogheda could have done with such a building. It would have saved the patients from having to travel to Dundalk for treatment and it would have saved the friends and relatives of these patients the trouble of having to travel long distances to see them.
Part of the treatment of a patient is a visit from the relatives. If a patient is left on his own, his health does not improve, and it would be much better if he could be visited frequently.
A matter which I have already taken up with the Minister is that of dentists in local authority employment and the system under which they operate. I know it is the belief in the Department that if they are able to look after the teeth of the children of the present generation they are going most of the way towards ensuring that the people of the next generation will have no dental trouble. That is poor consolation to the working man who is suffering from bad teeth, who is in need of teeth extraction and dentures perhaps with aid from the local authority. It is no consolation at all to his wife who may also be suffering and who gets no such assistance.
In most counties there is a long waiting list of adults requiring dental treatment. Up to 12 months ago we had a long waiting list in County Meath but that has been wiped out now. It should be possible to have additional dentists employed by local authorities until such time as they could clear up the waiting list and so prevent pain and suffering to the people concerned.
I mentioned the matter of cancer research last year and I know the Minister is taking an active interest in it. The people doing voluntary work in this connection are doing an excellent job but it is our opinion that this is a matter for the State. The problem of cancer should be tackled just as the problem of tuberculosis was tackled. The voluntary organisations can only work on the fringe of the subject. If we are really serious about tackling the cancer problem the State should tackle it now. I am casting no slur whatever on the people who are attempting to do such excellent work on a voluntary basis. This is one of the things that should be dealt with as quickly as possible.
I am aware of the figures published earlier that heart disease is the biggest killer in this and many other countries. Whether or not anything can be done to detect the incidence of heart disease at a stage early enough to enable it to be treated with any hope of success is something I am not competent to judge. If it is possible, the State should do something about it. If they are able to arrange for chest X-rays for the purpose of checking on possible TB sufferers, is there any reason why they should not be able to have heart X-rays for the purpose of detecting heart disease? A killer of the proportions of heart disease presents a shocking danger which must be tackled immediately.
I should like to refer also to the question of ambulance services. I have been listening to some people talking about accident ambulance services. Usually, they are theorists who comment from an office somewhere in Dublin. One of them had the idea that every Garda station should have attached to it an ambulance with a full complement of trained personnel. We need not dwell too much on that sort of comment. I do not believe it is possible or practical to have an ambulance even in each county, whose only function would be to look after the victims of accidents. The proportion of people dealt with would not warrant the heavy extra expenditure.
For some extraordinary reason, more road accidents occur in Meath than in any other county. Let me add, however, that they are nearly always drivers from outside the county. Despite that, I believe it is foolish to suggest there should be an ambulance with trained personnel waiting for some fool to run into somebody else. If we can build up our ambulance service, we should do so. If within the amount of money available we can have extra ambulances, we should have them. Indeed, it would prevent unfortunate drivers having to stay out from 7 o'clock in the morning until 3 o'clock the next morning. Whatever our approach, this question of setting up ambulances in country districts mainly for the purpose of dealing with road accidents is not feasible and there is no point in pursuing it.
I am very glad to see from the Minister's opening statement that it is proposed to increase the disabled person's allowance by 5/- a week. That is a step in the right direction and I congratulate the Minister on it. However, I should like him to go a bit further. Would he consider contacting the local authorities and telling them they should not adopt the system alleged to have been adopted by the people who examined the applications for non-contributory old age pensions in the early years following the introduction of these pensions? They should not go to houses and count the number of apples on the trees and the number of hens around the yard to find out if they can give a reduced amount to the unfortunate disabled person.
The Minister can take my word for it that it is the usual thing that those who apply for a disabled person's allowance are paid less than the amount they might be paid. The amount laid down is 32/6. I am satisfied that in many cases the people, who according to the Minister's speech should be getting 32/6, are at present getting 15/-, 16/- and 17/-. The amount saved is very small. I grant you there is a means test, but the Minister can be assured that those people in their own right have nothing at all. It is tragic that they should be cut the few shillings which mean so much to them and very little to the general rate at the end of the year. As far as my constituency is concerned, it would not make a difference of a farthing in the pound if all the applicants received the full allowance. I would be glad if the Minister would consider pointing out to local authorities that this is one case in which people should not be cut down to the very last degree.
Whenever a decision is reached by the Select Committee the Minister should endeavour to have introduced a health scheme which will ensure that people will be able to get, as of right, the services they require and that the old history of people being given the impression that they are getting charity will be done away with. One thing which the ordinary people, particularly the old people, resent is the suggestion made—and maybe it is not meant unkindly—that they are getting something out of charity, that they are getting this because they are poor and all the rest. Particularly in the case of those who have worked for a living and have paid insurance all their lives, it would be much better if they could be given this treatment, without being put under a compliment to anybody. If they are going to get such treatment, they should not be confined to the one doctor. He may be an excellent doctor but, for one reason or another, he may not have been seeing eye-to-eye with them over the years with the result that the treatment does not have the effect it should have.
