Dáil Éireann debate -
Wednesday, 22 Jun 1994

Vol. 444 No. 2

Adjournment Debate. - Community Care Director's Dispute.

Mr. Durkan

I thank you for affording me the opportunity to raise this matter on the Adjournment. I am sure the Minister is fully aware of this matter. He is not responsible, but he inherited the causes of this problem. Unfortunately the situation is getting more serious as time passes because of the number of directors of community care who are either acting, acting temporarily, part-time or whatever, on a variety of scales of appointment that is obviously unsatisfactory. They are unsatisfactory from the point of view of those attempting to fulfil their role and obligation to the health boards and there is a concern that the dispute is likely to be ongoing in such a fashion as to disrupt services. The problem is that the ongoing needs of the handicapped, the disabled and the elderly in the normal course of events, require the attention of the directors of community care on a daily and hourly basis. These services are administered by the directors of community care in each health board area. I accept that it does not apply to the same extent in all cases. Those of us who operate in the Eastern Health Board know there are some variations.

The problem was brought to my attention in the past few weeks in a way which gave a graphic description of what is happening. An unfortunate person awaiting a decision on a disabled person's grant could not get a decision, because of the particular problem that exists. The Minister may say that should not cause a problem, but unfortunately these problems have a habit of turning up at the most inopportune times, causing serious difficulties for the people at the receiving end.

I strongly urge the Minister, without interfering in the negotiations in which he has to become involved, to use all his powers and influence to bring about an early resolution of the dispute with a view to ensuring the maximum delivery of the broadest possible range of services is made available to the general public unimpeded. Failure to do so could cause serious hardship, considerable stress and strain of both a financial and physical nature. Failure to respond now could have much more serious consequences for the morale of the people involved and the services generally. We should take whatever steps are necessary immediately to resolve the difficulties. This would be in the interests of staff in the health services and of those who expect services to be delivered through the health boards. As an emergency measure the Minister should ensure that the delivery of services to the most vulnerable in society is not impeded.

Minister for Health (Mr. Howlin)

I thank the Deputy for raising this important matter. I regret that this dispute has been in progress for almost five weeks despite the best efforts of the management side to find an equitable solution. There are 33 posts of director of community care in the health board service. Seven of the post holders are employed in a permanent capacity and continue to carry out their duties. The remaining 26 are involved in the dispute and have reverted to their substantive senior area medical officer posts. The Deputy will understand the reason the posts were not made permanent — total restructuring of public health medicine was envisaged and there was an ambitious plan to achieve this.

My Department is in constant contact with the health boards to monitor the effects of the dispute. In particular I have been anxious to ensure that interruptions of service that could give cause for concern should a medical input be withheld are closely watched so that alternative coping mechanisms can be put in place at short notice in the event of an emergency.

The Irish Medical Organisation agreed from the beginning of the dispute to provide cover for emergencies. However, I took the precaution last week to write to the IMO formally requesting a continuation of the emergency cover provision in the continuing absence of a resolution of the dispute.

The emergencies which, on both the public health and humanitarian grounds, demand medical involvement would be cases of child abuse or neglect, outbreaks of infectious disease or serious pollution incidents. To date, there have been no emergency-level incidents of either infectious disease or pollution and occurrences relating to child welfare have been successfully dealt with under the agreed emergency provisions.

A public health medical service continues to be provided. The normal duties of public health doctors not affected by the dispute continue to be carried out. These are permanent senior area medical officers and both permanent and temporary area medical officers. I have sought an assurance from the IMO that these doctors will continue to work normally.

The management side in this dispute has made strenuous efforts to being about a successful resolution but so far to no avail. Proposals for settlement which I regard as both reasonable and equitable have been put to the Irish Medical Organisation in negotiations and subsequently in writing and clarifications have been provided on request. The management side have formally proposed to the IMO that, should it not be possible to reach agreement, the matter should be put to a third party. To date, the IMO has been unable to agree to this.

While I am satisfied that no hardship has been caused to any member of the public arising from this dispute——

Mr. Durkan

Not true.

Mr. Howlin

If the Deputy wishes to provide details I will ensure to the best of my ability that any cases are dealt with speedily and effectively. I am nevertheless concerned at the length of the dispute. I hope that a resolution can be found in the not too distant future. I urge the members of the Irish Medical Organisation to carefully re-examine their position.