I listened carefully to what Deputy Carter said. I believe he was trying to allay certain anxiety on our part in respect of what is contained in the Fitzgerald Report about the regionalisation of the hospital services by saying it would be phased over a relatively long number of years, 15 or 20. This is to take the sting out of a proposal which is so radical in its implications as to close down and wipe out altogether most of the hospitals in this country. Certainly it will close down, and render redundant, and run down, all the hospitals in my county of Tipperary. Not one hospital will remain, county or district, if and when the Fitzgerald Report is implemented.
This Bill is an improvement on our health services in all it contains to implement the White Paper on the Health Services. But the Bill also contains an outline of our future health system as recommended in the Fitzgerald Report which has been accepted in principle by the Minister. This report, which, as yet, has got little publicity, when implemented, will have the most widespread repercussions on the lives of our people because it calls for radical changes in our hospital system. It calls for the establishment of a relatively small number of regional and general hospitals based, at a minimum, some sixty miles apart. It recommends that all hospitals in between, general or district, as the case might be, be abolished.
I appreciate that the eighteen gentlemen who drafted this report are very eminent specialists in the field of medicine, but what they are recommending here is the cold clinical approach to health and hospitalisation with little regard for the human considerations involved. This is a report based on economy and efficiency of the clinical kind that one associates particularly with specialists in the field of health. It may be economically wise to adopt it, but to my mind it is socially imprudent to embark upon a measure which will result in the closure of so many of our hospitals, thereby obliging people to travel considerable distances in order to receive medical attention.
The mind boggles at the thought of a patient, critically ill, having to be transported some sixty miles to receive medical attention at a district, regional or general hospital as contained in these new proposals. There is also the problem of the inability of relatives and friends to visit patients hospitalised so far away from home.
In view of the sacrifices made to build up our hospital services within the various county council areas, it seems a tragedy that such a proposal should be contemplated. When I consider the amount of money expended on these old workhouses, so to speak, these old buildings which we inherited from the British, and the transformation which has taken place as a result of the courage and devotion of county managers, medical men and county councillors and the modern facilities now provided for our people in the hospitals in our counties, the thought of their being closed up, the thought of the crows flying through the windows of these institutions, appals me.
We appreciate fully the need for some form of regionalisation and specialisation. We understand fully the need for economy and efficiency. But this report is too far removed from the real needs of our people; and when our people realise what is contained in this report in regard to our future hospital system, I believe there will be consternation. I do not think it has dawned on our people yet what is contained in this report. It is a wise and astute tactic on the part of a Fianna Fáil Deputy here tonight to say: "Do not worry unduly about this. It will be implemented gradually, phased over a long period of time. This is for the 1970's and 1980's. Do not worry about it in the meantime".
We are being asked to legislate here for the implementation of this report. The Minister and his Government will have the authority to implement it as soon as this Bill is enacted. If and when the Minister gets a mandate for the implementation of the Fitzgerald Report I fear very much—and I would welcome sincerely an indication about this from the Minister when he is replying—that the Minister will commit himself too much to this report and that it will result also in his Department refusing sanction to the necessary monies for the maintenance of our present hospitals, and that we shall see a deliberate policy of the gradual running down of those wonderful hospitals of ours for which we now have responsibility. That is the sinister way in which our health authorities, as we know them, will be compelled to accept this radical change.
I am naturally concerned about what will happen in my own constituency. My primary purpose in speaking here tonight is to indicate to the Minister the outright opposition and hostility of all public representatives of all Parties who have become aware of this report in so far as it affects the hospital services in Tipperary. I want to place on record what this report states in reference to Tipperary hospitals. I will quote now from page 110:
At present there are county hospitals in Nenagh, Cashel and Clonmel. The hospital in Nenagh provides a general medical, surgical and maternity service for North Tipperary while the two hospitals in Cashel and Clonmel combine to provide a similar service for South Tipperary. Our recommendation is that the role of these three hospitals should be changed to that of community health centres. We realise that this recommendation involves leaving County Tipperary without its own hospital service. It has been fundamental to our approach, however, that county boundaries have little or no relevance in the proper organisation of the hospital service and, in fact, many areas can more conveniently be served from centres in other counties. Nenagh is less than 25 miles from Limerick on a fast, main road and we could not justify the development there of a hospital which would duplicate many of the services already available at Limerick General Hospital. Cashel is about 36 miles from Limerick while Clonmel is less than 30 miles from Waterford. We are satisfied that the areas now served by these hospitals can be fully catered for from the hospital centres in Cork, Limerick and Waterford. In spite of the absence of a hospital within the county no potential patient will be at a greater distance than 60 miles from a well-equipped and staffed regional or general hospital (Vide Map 3). There will, of course, be available locally the out-patient facilities provided by the consultant staffs of the main hospitals at the community health centres.
This means, as the Fitzgerald Report so clearly states, the closure of all the hospitals in the vast county of Tipperary. Not only does it mean the closure of the hospitals stipulated here—the surgical hospital at Cashel, the maternity hospital in Clonmel and the county hospital in Nenagh—but it also quite obviously recommends the closure of the other district hospitals as well: the hospital in Tipperary town, the hospital in Clogheen and the hospital in Carrick-on-Suir.
The prospect is an appalling one for my constituents and we cannot be expected to lend our support to such a radical and far-reaching measure as this Bill which places one of the biggest counties in Ireland at the will and pleasure of other districts or regions. As I have said, without boasting, the members of our county council down through the years, irrespective of politics, have been a very dedicated group, particularly in respect of health. As the Minister well knows, we have made vast strides in building up our institutions at Cashel, Clonmel, Tipperary, Carrick and Clogheen. We have not skimped on the monies required for improvements, extensions and maintenance. All our hospitals are fitted with the most modern equipment and we have been blessed with an exceptional staff of doctors, sisters and nurses.
It is difficult to contemplate the closure of a hospital in places like Clogheen or Carrick-on-Suir. Clogheen has no industry of any kind. It has a very high incidence of unemployment and it is noted for its abnormally high emigration. The lovely hospital there is its status symbol. It is the place of greatest social activity in the town. There is an excellent service for the patients. It serves a vast hinterland and anyone who visits it cannot but be impressed by the welcome extended and the happy relationship that exists between patients and staff. Everyone knows everyone else. The doctor knows all his patients personally. There is a wonderful spirit of cordiality and goodwill. That is bound to be conducive to speedy recovery. Yet, here we have a proposal that these people must in future go to Cork, Limerick or Waterford, at the very nearest, for hospital treatment, to become digits in a large institution, numbers in a book, patients in an alien atmosphere, faced with an impersonal approach, to say the least of it. It is a pity that the more human aspect of this problem has not been examined.
It is not good enough to say that this will be a gradual transformation. We challenge this policy in its entirety. We want to nip this proposed transformation in the bud. It is significant that all the people who compiled this report on the future hospital system are all medical men. Surely the layman's point of view ought to be considered? We are the representatives of the people and I believe that I am tonight voicing the sentiments of my constituents in Tipperary and West Waterford. I believe I know their needs, their hopes and their fears in regard to the implementation of a policy of this kind. I lend my voice to the opposition to this measure. I set my face against it. I do not think it is good enough that specialists in any field should impose this kind of policy on our people. I do not think it is good enough that a Government should lend itself to the implementation of this kind of policy without grave and compelling reasons.
I am concerned at the indecent haste with which the Minister adopted this Fitzgerald Report. It is not very long off the printing press. Other reports have been published for years, reports the Government have been loath to implement. On the other hand, they are more than anxious to accept this radical document. We were not unduly worried when we heard the Minister had accepted the report in principle but we are gravely concerned that he should ask us to give it the force of legislation with such speed. I hope I shall never see the day when this is implemented. I would appeal to the Minister to consult with the members of the health authorities on every phase of its implementation and to change this policy wherever the needs of local communities dictate it.
There are other aspects of this matter about which we are concerned. There is the setting up of the health boards, the membership of which will be comprised of not more than half members of local authorities and half members nominated at the instance of the Minister. I understand the Minister has taken to himself the right to appoint the chairman of these boards and the vice-chairman as well. Clearly, the Minister is seeing to it in the structure of these boards that he will have an overall majority for the implementation of his policy at any given time.
I would look with disfavour upon a health policy which was implemented at the behest of the medical men, at the behest of the bureaucrats or even at the behest of the Minister. Our feeling is that whatever health policy we conceive and implement should, in the main, be implemented at the behest of and with the approval of all the people and not of one clique—be it the medical profession or an overbearing group of bureaucrats. Undue Government interference or overbearing control should not be tolerated in respect of the implementation or administration of our health services. The voice of the common people must be heard. It is the people that we are concerned with. We are not concerned, in this Party at any rate, with placating any clique or professional interest. We are not concerned about conceding to any Government undue control over the affairs of our health services. It is appreciated that the more the State subscribes to the maintenance of our health services, the more they will be entitled to have a say and control in the health services. At the present time, the contribution would be approximately 50 per cent. Let us have an equal say but let us not have domination by any one section. We are concerned lest a Minister would bow to the dictates of vested interests in matters of this kind. We would hope, as a Party which has consistently cried out in this House and in the country for a free health scheme embracing all our people, that the community's health requirements would be met without regard to money and that need would be the sole criteria which would apply.
We welcome the improvements in this Bill. We welcome the intention to implement the good things in the White Paper on the Health Services. It is long overdue. We welcome as important the liberalisation of the means tests for medical cards, making clear the eligibility for medical cards and clearing away the ambiguity and doubt which existed as to who was and who was not entitled to a medical card.
Deputy Carter seemed to infer that there was nothing fundamentally wrong with our present health services. He re-echoed the sentiment of the ex-Minister for Health, Deputy MacEntee, who always consistently maintained that our health service— the present health service: it has not changed an iota since his time—was adequate for the needs of our people. That was one of the last sentiments he expressed here before he resigned as a Cabinet Minister. Nothing could be further from the truth. Anyone who tries to maintain that point of view is completely out of touch with the people. It will be denied by anyone who understands the frustration and fear of not being able to afford doctor's fees or to pay for costly drugs or medicines, by anyone who understands the ingrained fear and worry of individuals and families about the prospect of going to hospital and not being able to pay the bill there.
There are countless thousands in this country who have been putting off receiving badly-needed medical attention because of inability to pay the doctor or the specialist. There are others who, having started treatment, are unable to continue the course of medicine prescribed because of the inordinate cost involved. We know these things to be a fact. We know the concern felt about the odious means test involved in granting medical cards. We know how humiliating it is for our working class people to be exposed to rigorous investigation by a home assistance officer—the interrogation, the searching inquiry into their innermost private lives, the compilation of a report on the income of all the members of the household, whether or not they be members of the family. All of that was taken into account and, instead of being granted the medical card, you were told you were virtually a millionaire and should not be looking for a medical card.
Deputy Corish reflected the views of the Labour Party when he said that we regard the means test as utterly contemptible. The people of the lower income group and the working classes generally are the only people to whom these means tests are applied. As he pointed out, in respect of grants for new houses, grants for house repairs, grants for farm enterprises and the like, there are no means tests of this rigorous kind. These grants are given on merit and on merit alone. We wonder why we have held on for so long to this degrading system. Too many people have suffered under this degrading system for far too long.
We welcome the change. We welcome the proposal for a choice of doctor and we hope the Minister will find it possible to have this choice in every area. We appreciate his difficulty in outlying areas and in sparsely populated areas but wherever it is feasible or practicable let us have a choice of doctor. Let us not forget that this was a most demoralising piece of legislation which condemned medical card holders, the mass of our people, to one doctor but if you had money you had all the choice in the world. The medical card holder was tied to the dispensary doctor and the doctor was tied to that patient. Was it any wonder that with this natural ingrained desire for a choice of doctor thousands of medical card holders were exercising a choice and going to a doctor other than the dispensary doctor and paying him?
The lack of a choice of doctor was particularly unjust. It condemned the doctor to continuing to provide treatment for a patient whom he may not have liked and it condemned the patient to continuing to accept treatment from a doctor whom he did not like. Obviously this was not conducive to good relations or good health. The proposal to have a choice of doctor is long overdue. I also hope that something will be done to end the long queues we find at our dispensaries. Of course, the Minister proposes to abolish the dispensaries in certain areas. He has not said precisely how the people will be provided with their drugs and medicines but presumably the doctor will issue prescriptions and the people will be entitled to go to the chemist of their choice.
