asked the Minister for Health if he will make a statement on his final offer to doctors under the fee-per-item of service scheme; and when he expects to introduce the free choice of doctor scheme.
Ceisteanna—Questions. Oral Answers. - Choice of Doctor Scheme.
21.
Following the negative vote last December on the offer made then, I initiated new discussions with the Irish Medical Association and the Medical Union on 8th March. At this meeting and at a subsequent series of meetings between my Department and the organisations, a number of matters which seemed to have affected the voting were discussed and clarified. I found myself in a position to make some changes in the proposals. The main new features of my offer are:
(i) an undertaking to establish an arbitration board with open terms of reference to review fees one year after the full implementation of the scheme;
(ii) the payment of grants for approved renovations to practice premises ranging up to £750 for individual practitioners with higher payments for group practices;
(iii) the provision of a choice of method of remuneration for doctors in specified remote areas;
(iv) the payment of a rural practice allowance of £500 per annum where the doctor lives and practices in a centre with a population of less than 500 and where there is not a town with a population of 1,500 or more within a three mile radius of that centre;
(v) the making of special arrangements to give a temporary district medical officer who finds himself in a non-viable area an opportunity to transfer to a better practice centre;
(vi) the payment of an annual contribution of £100 a year towards the locum and other practice expenses of participating doctors who are not permanent district medical officers;
(vii) the holding of a special limited competition for serving permanent district medical officers to provide an opportunity for change of practice centre before the scheme commences;
(viii) the revision of the proposed scale of fees to improve certain features of it including the fee payable for services given at the doctor's surgery during normal hours.
The revised proposals were recently considered by the Councils of the Irish Medical Association and of the Medical Union and I am glad to say that both councils have recommended acceptance of the revised proposals to their members. The organisations are conducting a ballot and I expect to know the result of this about the end of this month. Assuming that it is favourable, I would hope to phase in the scheme from about March or April next year.
Will the Minister give details of the fees? Is this his final offer?
It is the final offer. It would be impossible for me to give all the details in the House.
Could we have a list of those that are available?
Perhaps it would be better to wait until the ballot is completed.
(Cavan): Would the Minister agree it is highly desirable that the provisions of the Health Act relating to a free choice of doctor should be implemented with the minimum of delay?
I have said it cannot be implemented until 1st April, 1972.
(Cavan): Does the Tánaiste agree that there is an urgent need for its implementation?
I would naturally like to implement it as soon as possible but when I look at the general trend and the improvement in the health services since World War II and when one considers the 1947 Act, the 1953 Act and the 1970 Act, whether the choice of doctor scheme begins in 1971 or 1972 is not of material significance because it will be the ending of the old principle of workhouse medical service——
Hear, hear.
——and it does not worry me that this service is to begin in 1972 when looked at in the total history of the health services in this country and their improvement.
Has the Tánaiste any idea of the increased annual cost?
(Cavan): Would the Tánaiste not agree that it is much more difficult for the sick to get the attendance of a doctor now than it was ten or 15 years ago and that is what counts?
Hear, hear.
In view of the new offer will the Tánaiste now state what the approximate cost to the Exchequer will be?
The Deputy will have to ask a question about that.