asked the Minister for Health if he will give an up-to-date report on the dispute between his Department and the consultants concerning his proposals for free hospitalisation for the wealthier sections of the community.
Ceisteanna—Questions. Oral Answers. - General Medical Services.
11.
I would draw the attention of the Deputy to the reference to this in my speech of 28th November, 1974, when introducing the debate on the Health Estimate, at columns 474-475, Volume 276 of the Official Report. The present position is that I am awaiting the report of the review body referred to in my speech.
In the light of the answers the Minister has given in response to questions about various inadequacies in different centres throughout the country, would he not agree that the time has now come for him to announce the dropping of the proposal for free hospitalisation for those who can afford to pay?
No.
That is a separate matter.
In view of the very considerable number of people in our community to whom the general medical service should be extended, and who are vitally in need of an extension of that service, would the Minister not agree that that should take priority over extending free hospitalisation to the wealthy?
This question concerns the dispute.
The Government have made their decision.
Can the Minister answer my question? To which would he give priority, an extension of the general medical service to those who need it and cannot afford to pay for their fundmental medical requirements, or extending free hospitalisation to the wealthy?
The Deputy is raising extraneous matters
There are other people on whom hospital bills are heavy charges.
Would the Minister state the number of meetings held by the review body to consider the methods of payment to consultants under a free hospitalisation scheme, how long they were sitting, and has a time limit been set for the length they will deliberate on this problem?
No, a time limit has not been set. I do not know how many times they met or for how long. These men are doing a voluntary job and I do not propose to push them beyond their capacity.
Have they given the Minister any indication if it will be this year?
No, they have not.
Would the Minister confirm that it is the clear policy of the Department to provide free hospitalisation for all sections of the community——
The Deputy may not raise extraneous matters of this kind.
——irrespective of a means test?
Question No. 12.
Would the Minister agree that the special exemption for the wealthy sought by the Opposition spokesman is one of rank class discrimination?
We are straying from the subject matter of the question.
If the Minister wishes to extend free hospitalisation to the wealthy sections of the community——
This is not in order, Deputy Haughey.
The question deals with the proposal for free hospitalisation for all sections of the community. Is the Minister satisfied that the existing structure of services would be able to cope with this extension even if he could bring it about?
Yes.
Despite all the answers the Minister has given to Deputies today to their queries in relation to inadequacies in relation to different hospitals?
If Fianna Fáil had been doing their job over the last ten or 11 years we would not have this problem.
It happens that it is the Minister's job now.
Deputy Haughey seems to assume that the rich get sick more often than the poor.
It is the poor I am concerned about.
Medical cards for the poor and private patients to consultants.
I want the Minister to give priority to the poor and not to the wealthy.
The Deputy could be accused of discrimination.
12.
asked the Minister for Health if he will give an up-to-date report on the dispute between his Department and the pharmacy profession regarding their participation in the general medical service.
I indicated in my reply of 12th February that I intended to meet the Pharmaceutical Union. I did so on 20th February and we had a frank and, I think, useful discussion. Essentially I proposed to them that we should come to an agreement on an interim increase in their fee, to have regard to changes in other salaries and fees since the pharmacists' fee was fixed. I suggested that we should set up, at the same time, an impartial arbitration board or review body to which we could refer the fundamental issue of the level of fee appropriate under the scheme. I made it clear that any such body and its terms of reference would be established only with their agreement. I envisaged that it would undertake factual studies and that, while these studies were going on it would be possible to consider matters which did not require such study. I also asked that, to enable discussions to proceed, they should consider deferring the operative date of their resignations.
The pharmacists' representatives indicated that they would be prepared to give further consideration to these proposals and they were discussed in detail at a meeting with the Department on Saturday, 22nd February, and set out in full in a letter of 25th February to the union. Following a meeting of the full negotiating committee of the Pharmaceutical Union on 26th February I was informed on 4th March that the union had accepted that a completely independent review body should be set up forthwith. The union asked for an early meeting with the Department on this. This is being arranged. In the meantime, the union have decided that the notices already served on health boards for withdrawal from the scheme on 21st April should continue in operation, but this decision will be reviewed in mid-March in the light of developments in relation to the review body. The union have not accepted my proposal for an interim increase.
Is the Minister satisfied that the provision of services in the context of the general medical service by the pharmacy profession is essential to the whole general medical service structure? If the Minister is so satisfied, will he use his best endeavours to bring this dispute to an end so that the people who need these vital medicines will not be in danger of being deprived of them?
I should like to assure the Deputy that I will do, and have done since I replied to a similar question put down by him some time ago, all in my power to make sure that these services will continue. In fairness, the Deputy, as Opposition spokesman on Health, should address the same admonition to the other side.
The Minister might not be aware of the fact that I have spoken to the pharmacy profession. I had a very informative discussion with them. I should like to ask the Minister if he will pursue these negotiations until this dispute is brought to a satisfactory conclusion because he and I agree that the pharmacists are excellent, responsible professional people and that they are anxious to continue this service and bring the dispute to an end.
Both sides are anxious to bring this dispute to an end but differences will have to be ironed out. I met these people and had a discussion lasting a few hours with them. We did iron out some of the difficulties and there are still some remaining.
Will the Minister give the House an affirmation that he will attend to this matter himself and not leave it to the ordinary Departmental negotiations?
It is not fair to say that these negotiations are confined entirely to the officials of my Department. Not alone have I met these people but, needless to remark, I consulted them before and after any official meetings held between them and the Pharmaceutical Union.
13.
asked the Minister for Health if he will give an up-to-date report on the dispute between himself and the medical profession regarding their participation in the general medical service.
The Deputy will be aware that on 12th February I set out, at considerable length, the background to and the position at that date in relation to the disputes which had arisen with pharmacists and doctors participating in the general medical services.
As indicated in that reply, I had made it clear that, with the arbitrator's award, I could not, without grave consequences, offer more than an increase based on the national wage rounds since November, 1974. However, developments which occurred recently in relation to the pay of salaried medical officers, including medical officers participating in the choice of doctor scheme on a salaried basis, created what appeared to be an anomaly within the scheme as between the salaried doctors participating in it and those remunerated on a fee basis. Having been satisfied that an anomaly did exist, I indicated I was willing to rectify it in respect of the period after the arbitrator's award but if it was desired to go back further, the matter would have to be referred to the Arbitration Board. The medical organisations asked that this be done and I arranged for the reconstitution of the board.
This board met on 25th February and decided that the effective date of the anomaly award of 10 per cent should be 1st January, 1973. I accept this finding. I have, therefore, sent a revised offer to the medical organisations which I have asked them to put to their members.
Under this new offer, the surgery fee would go up to £1.18p for services in normal hours, to £1.69p for such services outside normal hours and to £3.36p for these services between midnight and 8 a.m. There would be corresponding increases in the other fees. The fees for domiciliary visits would range from £1.76p to £9. Revised increases have also been offered in specific allowances. The rural practice allowance would now go up by £270 to £770 a year and the allowance towards locum and other practice expenses would be raised by £50 to £150 a year.
There are two other issues which have been the subject of discussion with the doctors in recent months. One is the question of the right of entry to the scheme of certain doctors not currently engaged in it; the other relates to a question of guarantees for a limited category of doctors operating within the scheme which, under the original agreement, would terminate on 1st April next. We have now effectively reached agreement on the right of entry issue and I have, in response to representations, arranged with health boards to continue these guarantees until September.
I hope that this further initiative will leave the way open for a settlement of this dispute and I have expressed to the profession my hope for a continued development of this scheme by mutual co-operation.
As in the case of pharmacists, could the House have in the case of the medical profession an assurance from the Minister that he will devote his personal efforts to bringing this dispute to an end and to ensuring that the general medical service is not seriously disrupted by the dispute? In that connection would the Minister recognise that the reply which he gave me some weeks ago in which he quoted gross income of doctors in the general medical services has caused serious resentment and has completely misrepresented the position because what matters to the doctor in the general medical service is his net income after he has paid all his expenses? Would the Minister give me an undertaking to refrain from such exacerbating statements in the future?
I do not know whether I know the medical profession better than the Deputy or not but I deliberately said "gross" so as to emphasise the fact that it was gross income and that it did include their expenses. As far as the assurance is concerned I do not think I need to repeat that I will do all I can to resolve this dispute.
Will the Minister agree that the publication of gross figures can be very misleading? In this case it was very misleading. The gross figure in the case of many doctors has no relation whatever to the net income that the practitioner derives. To that extent it was very unfair of the Minister and exacerbating on his part to give gross figures in this way without at the same time attempting to give some average of net income.
Will the Minister tell the House what the cost to the State will be of the increases and retrospective payments?
With the revised offer I could not give it at this stage. The figure I gave on the last occasion for the joint claim—it is irrelevant now— was about £13.75 million.
Would I be correct in saying that the cost to the State will be about £1.9 million for the increase under this new scheme and retrospective payments?
I am not able to put a figure on it.
£1.9 million?
Plus the original offer.
In view of the considerable public disquiet in relation to this protracted dispute will the Minister agree it is now fair to assume that a settlement is imminent?
A settlement?
That a settlement is almost imminent in relation to this dispute?
The Deputy must not have been accurately primed.
Would the Minister say whether the Department has agreed to the retrospective payments that will arise under this new offer from the arbitrator?
I do not think I should disclose any more here today. There is a further meeting being held today and I think it would be better to confine the figures to those who are in discussions about them.