asked the Minister for Health if the new health scheme will be introduced on 1st April, 1974.
29.
Ceisteanna—Questions. Oral Answers. - New Health Scheme.
28.
asked the Minister for Health if, consequent on the letter sent by him to the medical organisations on 13th February, 1974, negotiations on the proposed extension of the hospitalisation scheme have now broken down.
30.
asked the Minister for Health if, in view of the proposals he made to the two medical organisations, he now accepts that negotiations on the extension of the free hospitalisation scheme cannot be completed before 1st April, 1974.
31.
asked the Minister for Health if he will give details of the proposals concerning payment to hospitals and consultants contained in his letter of 13th February, 1974, to the medical organisations.
With your permission, a Cheann Comhairle, I propose to take Questions Nos. 28 to 31, inclusive, together.
I will, with your permission, a Cheann Comhairle, have a copy of the letter of 13th February, 1974, included in the Official Report.
Negotiations on the proposed extension of the hospital scheme have not broken down but it has been difficult to reach agreement on the method of remunerating consultants, Accordingly I have told the medical organisations that I would be willing to consider, on certain conditions, a deferment of that part of the scheme specifically related to the payment of doctors. As the conditions of a possible deferment are being discussed this afternoon with the medical organisations. I would not wish to make a more detailed statement on this at the moment.
I would wish however to inform the House that any deferment would relate only to the payment of doctors and that there is no intention to defer beyond 1st April next the implementation of the proposal that maintenance costs in public beds be met in full for all the population and that subsidies from the health boards for maintenance in private and semi-private accommodation will also be available to all. Similarly the scheme for subsidising the purchase of drugs and medicines now available to the middle income group will become available to all.
I will shortly be presenting draft regulations for the approval of the House to give effect to these developments.
Following is the text of the letter:
The Secretary of the Department has reported to me on the present state of the negotiations about the future system of payment for consultants. Very broadly, it seems that the organisations would wish to have for each consultant an option between payment on a schedule of fees (with a guaranteed minimum income) and payment by way of salary (with provision for payments for availability and out-of-hours works). This proposal represents a very fundamental change vis-á-vis the present system of payment for consultants. I do not think I could agree to giving the option requested and it seems clear to me that a considerable further period of negotiations on principles and their application is needed. I understand that this was pointed out by a number of the participants from the organisations during the negotiations up to the present stage. Accordingly, I have been considering the situation which will exist after the 1st April and wish to put some proposals to the organisations. They are designed to continue in so far as is practicable, the present system for payment of consultants pending the completion of the negotiations on the future system of contract. For this purpose, I think I should analyse my proposal to abolish the limits in so far as it will affect consultants. The change will, in the first place, make maintenance at public ward level available free of charge to the entire population. It will also apply to those now outside the eligible classes the system of public subvention where treatment is given privately whether in a hospital or nursing home. Applying this part of my proposal from 1 April next will not affect the position of the consultants.
In so far as the remuneration is concerned, the intention has been that the consultant's public remuneration would cover the treatment of all patients who opt for public treatment in the future, with the retention of his right to private fees from those who opt for private treatment. I am aware that, pending the completion of negotiations, it would be the preference of the organisations that the proposal to abolish the limits should be entirely deferred but I am not willing to do this. However, I think that both your wishes and mine can be met by an arrangement to continue the present system of payment for the time being. In other words, the salary or "pool" payment to the consultant would cover his liability for the group who are new public patients (within an updated income limit) and he would retain his entitlement to fees for those outside this limit. For the purpose of covering the latter group, I would propose to make a special interim arrangement with the Voluntary Health Insurance Board whereby they would be recouped from public funds for the cost of covering the class in question for public ward treatment.
Having studied the movements in rates of pay since 1971 when the present limit of £1,600 a year was determined and the prospective changes in rates of pay during the current year, I am satisfied that, if the corresponding limit were being determined now it would be at the level of about £2,500 a year. Accordingly, I would intend to apply that figure in relation to the proposals which I have mentioned.
In brief, what I propose to do now is—
(i) to proceed with regulations under section 46 of the Health Act 1970 to abolish the income limit for the self-employed and the valuation limit for farmers, thereby making the services now available to the "middle income" group available to all;
(ii) for the cost of maintenance in public hospitals, arrange that the health boards will accept full liability for those at public ward level and make the usual contributions for those opting to be private patients;
(iii) as far as remuneration of consultants is concerned, arrange for a continuance of the present systems to cover liability for the existing eligible classes (but with the income limit raised to £2,500 a year) and for those outside that group, allow for fees to be paid to the consultants. For any eligible person opting for private treatment, there would be no change from the present situation whereby he would himself be liable for consultants' fees (and could insure himself with the Voluntary Health Insurance Board for this if he wished). Any person above the £2,500 a year limit (or the £60 valuation limit for farmers) who opted for public ward care would be covered by the health board arranging through the Voluntary Health Insurance Board for meeting the cost of professional fees at the appropriate number of T units. For the particular category mentioned (i.e., those opting for public treatment) arrangements would be made with the Voluntary Health Insurance Board to cover types of services not normally covered, including normal maternity care and out-patient services.
These are the aspects of the proposal which would affect the consultants. I think, however, that I should also indicate how it would affect other services. The scheme for assistance in the purchase of drugs at present applicable to the middle income group would be extended to the entire population. The maternity and infant care scheme at general practitioner level would also be similarly extended. Representations have been made that the fees payable under this scheme would, in these circumstances, need to be renegotiated. I accept this in principle and will ask the Department to get in touch with the organisations soon about these negotiations.
The above proposals have been evolved to leave us an opportunity for discussions over a reasonable period so as to work out a permanent answer in relation to the system of payment and engagement of consultants in the future. Both the organisations and myself have the wish to evolve a common contract for consultants.
I will be available to meet the organisations at an early date to discuss the contents of this letter.
I should like to ask the Minister if, as the consultants have publicly stated, they do not propose to accept the interim arrangements suggested by the Minister in his letter of 13th February and do not propose to take part in the scheme on 1st April unless the full negotiations are complete, he still intends the scheme to go ahead in these circumstances on 1st April?
As I stated in my reply, I am convinced that the two proposals I made here can be implemented on 1st April, that is free maintenance for all from that date and participation in the present scheme that provides for drugs. As far as the first part of the question is concerned it is correct to state that the consultants did refuse to consider the interim offer I made, an offer I made in order to try to break the logjam and to try to have negotiations with the consultants continue after 1st April.
Could the Minister say whether the partial implementation of this scheme on 1st April would jeopardise the negotiations with the consultants?
I do not believe so. As I have stated, there are talks going on between officers of my Department and the two medical organisations at present.
Is the Minister aware that in the interim offer he made on 13th February, 1974, it was proposed to divide the country into two categories, those above £2,500 per annum and those below it and that the consultants treating a person above it would be paid the full fee for an operation which in a particular case could be £50 while those consultants operating on someone below £2,500 per annum would be paid out of the pools system where the fee might be as low as 50p or £1 for the same operation? Does the Minister seriously suggest that that sort of scheme is a desirable one in this country?
I did not think, nor do I now think, it a desirable scheme. It was not put up as the best scheme. As I explained to the Deputy, it was put up in an effort to break the impasse that arose in February. It is not correct for the Deputy to say that a consultant might be paid for an operation in a public ward an amount of 50p or £1; that is entirely inaccurate. The pools system does not provide for that sort of payment. From what the Deputy has said it would necessarily mean that every single person in a public ward would be undergoing an operation in a particular week. This is not so. There might be one or two operations but the pool would be contributed to in respect of people who would be actually in the ward but not having an operation. There could be 12, 14, or 20 people in the ward.
Is the Minister aware that the profession may have some contingency plans to prevent the scheme coming into effect on 1st April and in the event of such has the Minister some contingency plans to ensure that patients will be treated as and from that date?
If I may say so, that is so much speculation. What I have proposed here would have no real effect on the consultants. What I propose is that people would get free maintenance in a hospital and would be able to participate freely in the drug scheme. From what I have read, the consultants have stated that they would not co-operate. I do not know whether the term "contingency plans" ever arose. In the proposal I have made now, which has no real detrimental effect on the consultants, I cannot see why they should employ any "contingency plans" or why they should not co-operate until there is an agreement on what sort of money they should be paid is reached.
The Minister has stated that patients will receive free maintenance but can I be assured that the patients will get treatment? This is the important thing.
The Chair is calling the next question. Deputies have been allowed a lot of scope on this question which has been under discussion for ten minutes.
I should like a statement on this matter because it is important.
I should like to ask the Minister if it sums it up correctly to say that this is like living in an hotel in which there are no kitchens?
The Deputy has said that.
Does the Minister deny that that is an accurate summary?
It is not an accurate summary. I believe the consultants have more sense of responsibility than the Deputy.