Dáil Éireann debate -
Wednesday, 19 Apr 1967

Vol. 227 No. 12

Adjournment Debate. - Abolition of Dispensary System.

Mr. Treacy

I felt compelled to raise the subject matter of Question 69 in my name on today's Order Paper by reason of the unsatisfactory, disdainful and irresponsible manner in which the Minister dealt with this question today. I have been forced to advert to the scandal of the dispensary system in my constituency on a number of occasions, with particular reference to the appalling condition of many of these dispensaries. The question is of very great interest to a large number of my constituents who are obliged to go to these places many times per week to meet their doctor and have medical attention. They are, of course, in the main, medical card holders who have not the means to avail of private practitioner services.

These dispensaries present an appalling picture of dilapidation and virtual ruin in many instances. Our health officers have condemned as unfit for human habitation very many dwellings far superior to these premises. Many of these dispensaries are in old houses, houses which were condemned a number of years ago. These old houses are small and dingy. They are an eyesore from outside, and are a subject of concern to all those who are interested in the appearance of our towns and villages, especially those engaged in the tidy towns endeavours. The inside of the dispensaries will be found to be completely unsuited to modern requirements. They present an appearance of absolute neglect. These dispensaries have not had a hand's turn done to them for a long number of years: no repairs, no painting, no improvements of any kind have been carried out. They do not provide even the minimum of comfort or privacy to the unfortunate people who are obliged to go there.

These premises are used for many purposes. They are used by our dispensary doctors and local nurses. They are also used as places where people collect their home assistance. Therefore, the matter of privacy is allimportant. There is no privacy for a patient to meet his doctor or for a person facing an interrogation by a home assistance officer. The ordinary decencies of life simply cannot be observed in these circumstances. The privacy between doctor and patient cannot be observed, and it is particularly uncalled for that the very poor and the destitute who have to go to these places to seek home assistance are obliged to bare their hearts and reveal the innermost secrets of their lives within the hearing of all those other people who congregate in these dingy rooms. May I say that home assistance officers are not renowned for their beside manner, and it is often one hears the argument going on between the home assistance officer and the person being interrogated? This is not at all satisfactory.

Many of the premises to which I refer do not have a seat for a patient: others do not even have a hallway where people can stand. In many cases the people are obliged to queue up outside, irrespective of their health condition or the inclemency of the weather prevailing at the time. This is the kind of suffering endured by many of my constituents in South Tipperary and West Waterford. This is the predicament of the people of Ardfinnan, Ballingarry, Kilsheelan, Ahenny and many other places.

The blame for this situation rests solely on the Minister for Health. The blame cannot be attached to the members of the health authority or the manager. The health authority I represent, South Tipperary, had plans made for the erection of a number of new dispensaries, particularly at Kilsheelan, Ballingarry and Ardfinnan. These plans were at the final stage and had been approved by the Minister for Health. In the case of Kilsheelan, the contract for the erection of a new dispensary and doctor's residence had been placed in the hands of a contractor, whom I know personally. Other proposals were well in hand for the renovation and repair of other dispensaries.

All this important work was suspended in mid-air by reason of the implementation of the White Paper on the Health Services. County managers, as much as members of the Fianna Fáil Party and other gullible people, accepted the White Paper on the Health Services, issued in January, 1966, as the Bible and something which was going to be implemented within a reasonable time, having particular regard to the fact that this White Paper adumbrated a choice of doctor for our people, which would involve the abolition of the archaic and outmoded dispensary system as we knew it. The managers and the health authorities are not altogether to be blamed for their action in terminating this important work. They had the strict instructions of the Department of Health in this matter.

The Minister is on record in his reply on his Estimate this year, in reference to my complaint in relation to this matter, that the Department of Health had advised the health authority of the South Tipperary County Council not to proceed with the erection of this new dispensary in the light of what was proposed in the White Paper. It was for that reason this important work stopped. That was some two years ago. One can readily understand the very bad state of these dispensaries when one remembers that they had been condemned for a number of years and that new buildings had been approved. One can easily appreciate the deterioration that has taken place in these buildings in the interval.

The Minister takes credit for the fact that, instead of erecting a new dispensary at Ardfinnan, steps are being taken to provide alternative accommodation. Neither the Minister nor the County Manager can take any credit in this respect. My colleagues and I were obliged to invoke section 4 of the County Management (Amendment) Act, 1955, in order to direct the manager to proceed with the erection of a new dispensary at Ardfinnan. That is how that came about. That motion was passed by a large majority of the members of South Tipperary County Council but the manager stated that, even though the motion had been passed, he could not act on it because money would have to be provided first. Again, I was compelled to invoke section 4 in order that the necessary money would be provided to enable the manager to proceed with the erection of the dispensary at Ardfinnan. The manager informed the chair that the motion was out of order because it was a function of the members to provide money, as if I were putting this motion before some outside body and not before my own local authority. It was hoped the money for this project would be provided in the estimates this year.

It was not provided and could not be provided because of the very high rate burden. It is that situation we have now to contend with and my question today asked for clarification of the whole position. If we are going to have a choice of doctor then, please, let us know when so that those who are afflicted at present may struggle on, with a little more patience and endurance. On the other hand, there is talk as to whether it is feasible and practicable to give a choice of doctor in certain areas, particularly isolated, remote rural areas, such as Ballingarry. Perhaps Ardfinnan might be included in such a scheme and likewise Kilsheelan, Ahenny and these other places to which I have referred. If we cannot provide a choice of doctor in these areas there is a moral obligation on the Minister to see to it that adequate dispensary facilities are provided. It is no wonder we cannot get doctors in our county at the moment. The post in Ballingarry has been vacant since 1955. Where one cannot get even one doctor it is scarcely likely that one will get two, so that there can be no question of a choice.

The Minister and his Department must now make up their minds with regard to the erection of a new dispensary at Ballingarry in the clear knowledge that over the next few years it will certainly be impossible to provide for a choice of doctor. In the case of Kilsheelan it was intended to provide not merely a dispensary but a doctor's residence as well. This is an area in which we find it very difficult to secure a dispensary doctor. There has been, as the Minister and his Department know, a great interchange of doctors there. One of the reasons for that is that doctors cannot find adequate housing accommodation. Indeed, one doctor lived there for some time in a caravan. Because of the proposition adumbrated in the White Paper the people of Kilsheelan have been denied a new dispensary and a proper residence for a doctor. That important area is now being served by a doctor from Clonmel. A similar position obtains in regard to Ballingarry. These doctors are over-burdened because of the number of patients they have to serve.

Mr. O'Hara

Is that a mountain area?

Mr. Treacy

It is. I resent deeply the attitude adopted by the Minister towards my questions on today's Order Paper. These questions were not tabled lightly. It was only after every endeavour had failed that I decided to raise the matter in the House by way of question. No Minister should deal with questions in the disdainful, brash manner in which the Minister deal with my questions. Ministers have a responsibilities and the Minister had a responsibility for these unfortunate people obliged to attend these unsuitable premises every week in order to get medical attention or home assistance. It is not good enough for the Minister to hide behind a White Paper. We want to know when the proposals in the White Paper will be implemented. In the introduction to the White Paper there is an indication of how many years it may take to resolve this problem. It is pertinent to point out that the changes suggested are both complex and costly. That alone rules out any question of their implemention in the near future. That being the case, the Minister must ensure adequate conditions for those involved.

I regret I have been slightly carried away by the unfairness of the position. I had hoped to allow my colleague, Deputy Hogan, to make some observations on the matter, he being a man with high medical degrees and a member of the same authority. I apologise to Deputy Hogan for allowing myself to be carried away.

Minister for Health (Mr. S. Flanagan)

I will give the Deputy a couple of minutes out of my time.

An Ceann Comhairle

How many minutes?

Mr. S. Flanagan

Two.

Mr. P. Hogan

(South Tipperary): The Minister, I understand, has not departed from the principle in the White Paper with regard to free choice of doctor. As I understand it, he will introduce this free choice when economic conditions permit. There is a genuine grievance in having dispensaries left vacant and I would make three suggestions now to the Minister. His predecessor suspended the appointment of dispensary doctors. If there is to be a long interval before the introduction of free choice, then the Minister might introduce a system of short-term appointments; I would suggest three to five years in urban areas, seven years in rural areas, and permanent appointments, even now, in isolated areas in which it is obvious men will have to be paid to go in anyway.

As regards building of dispensaries which has also been suspended by the county managers, I would suggest (a) leasing, where possible and (b) building in isolated areas, again where it is obvious a doctor must always be paid to stay. Repairs have in some cases been deferred. I think this is incorrect. We should carry out essential repairs so as to provide reasonable comfort and privacy for patients attending dispensaries and also to ensure that, as part of our housing property, they will be preserved. Those are my three suggestions to the Minister.

Minister for Health (Mr. S. Flanagan)

I am thankful to Deputy Hogan for his brief and very helpful intervention in this debate. May I say straight out that I did not attempt to deal in any disdainful manner with Deputy Treacy? I do not try to treat Members of this House in that way.

Mr. Treacy

Read the report.

Mr. S. Flanagan

Would the Deputy kindly preserve ordinary good manners? I listened to his painful utterances for 20 minutes; let him listen to my less verbose ones for eight.

Mr. Treacy

Equally painful, I am sure.

Mr. S. Flanagan

The Deputy talks about moral obligation. He also talks about denying people their rights in a dispensary. It seems like a vague memory to me that members of his Party in particular have been crying about the demerits of the dispensary system and saying that it is an imposition on the poor, a relic of longforgotten days of tyranny and that it should be superseded with great rapidity. Therefore, there seems to be some disparity between Deputy Treacy's approach and that of his Party.

I want to make it perfectly clear that my reason for declining to answer Deputy Treacy this afternoon was simply that I regarded his attitude as an abuse of parliamentary procedure and privilege and the parliamentary process.

Mr. Treacy

I resent that.

Mr. S. Flanagan

In the course of his supplementary questions, Deputy Treacy contrived to bring in statements with regard to my intentions which were completely unfounded. It seems to me that in asking a supplementary question a Deputy should confine himself to asking a question and should not broaden the scope of his privilege by trying to make allegations that are entirely unfounded against me, or any other Minister.

With regard to particular dispensaries, Deputy Treacy raised a question not merely today but on other occasions when I certainly did not attempt either to evade my responsibility or to be in any way disdainful. I dealt with the position in Ardfinnan and the other dispensaries but specifically in regard to Ardfinnan in regard to which the Deputy raised his main complaint and in the course of my reply on the Estimate, I said:

I am advised that in an effort to remedy the position there, the local authority have advertised recently for the purpose of acquiring alternative premises for use as a dispensary, pending the implementation of the choice of doctor scheme. They have also undertaken to examine the position in regard to the other dispensaries I have mentioned, with a view to effecting any essential improvements required at any of these centres.

Since I made that statement, I am glad to be able to report that, in fact, alternative premises have been acquired in Ardfinnan in the old school through the agreement of the manager. These premises are, I am told, in good condition. The doctor is seemingly satisfied with them and they will be put into operation in a very short time.

With regard to Kilsheelan, I understand this has been serviced by a doctor from Clonmel and that no complaint whatsoever has been made with regard to the services being provided by the doctor in question. It seems from the map, and indeed from one's general knowledge of the area, that when choice of doctor is implemented, several doctors in Clonmel will be practising in that area and it would not be one that would require any special attention.

With regard to Ballingarry, the House may be interested to know that only last week I was asking somebody who came to see me if he would be interested in going to Ballingarry to practise there. My difficulty in regard to Ballingarry is simply this: as the House knows, the Local Appointments Commission is at present dealing with candidates in connection with a number of dispensary areas which were advertised in a confined competition among permanent DMOs and Ballingarry was one of those. Until the situation is clarified in regard to Ballingarry, and that, of course will be only a matter of weeks, I cannot take any interim action. This also applies to other areas, for instance, Nobber in County Meath which has been in the news. I cannot take any effective action until I know the result of the examinations now being held by the Local Appointments Commission. The moment I do, I will proceed to take action, in consultation with the representatives of the medical profession because then the situation will have clarified itself.

With regard to Kilpatrick, as the House, and Deputy Treacy in particular, know, a dispensary has been erected in this particular case.

I am somewhat concerned to hear what Deputy Treacy has to say about the privacy of people going to seek home assistance. This is something which I was aware of for the first time only in the past few days because in my part of the country, it is not the practice of the home assistance officer to attend at dispensary premises such as this. In fact in most cases, the home assistance officer calls on the applicant or the recipient in the case of re-investigation. I am very concerned to hear that the use of these premises by home assistance officers in regard to these people is the cause of ill complaint. I shall certainly take steps to remedy that situation, if necessary by asking the health authority to see to it that home assistance officers visit people in their homes and desist fror using these premises altogether.

I want to make one specific repudiation, that is, that the situation here is entirely the responsibility of the Minister for Health. This is not so and this applies to my predecessor as well as to me. Indeed, the fact that Tipperary has a health authority and that the word "authority" appears in it is in itself a repudiation of the allegation that the situation there is entirely and exclusively due to the direct action of the Minister for Health. Indeed, the correspondence from the health authority made it clear that they themselves were not anxious to go ahead with any expenditure on these dispensaries and it is because of that fact that Deputy Treacy had to attempt to invoke the provisions of the City and County Managers Act, 1955. If the health authority had taken a different attitude as they were entitled to do in pursuance of the terms of the 1966 circular, it would have obviated the Deputy taking the action he mentioned.

I am very grateful to Deputy Hogan for the practical and sensible suggestions he has made and I would like to tell him that I am giving serious thought to any practical suggestion I can get and in particular to these, which in many ways summarise my own tentative thinking but again this is an area in which decisions can be made only when the result of the competition is announced in a few weeks' time. We will then have a clear picture of the situation in regard to the posts advertised and the consequent effect the filling or non-filling of posts in that competition will have on the country as a whole. I will give serious thought to the suggestions the Deputy has made and any other serious, well-meant suggestions that are made to me in an attempt to help me to discharge my responsibilities as Minister for Health, something that I intend to do despite the disruption of individual Deputies.

The Dáil adjourned at 11 p.m. until 10.30 a.m. on Thursday, 20th April, 1967.