Last night, I was referring to a service which came into operation under the Health Act and for which there was a long-experienced want. That was to help people who had been touched by the hand of God and for whom apparently, under our health services, there was not any relief forthcoming in the way of improved health. The community would have felt an obligation on them to do what they could to relieve the circumstances of people in such an unfortunate position. The burden of my complaint in the matter is that the intention of the Oireachtas and the spirit of the Act in respect of this provision have been outraged and I do not think that is too strong a word to describe the administration of this provision, as it has come to my notice.
I have before my mind a certain number of cases and I think I am entitled to express the opinion which I have formed on the administration of the scheme in so far as these cases showed it. It might have been a better arrangement to have taken this type of service from the Health Department entirely and to have put it under the Social Welfare Department which would seem to me to be more appropriate for the idea which animated most of us in relation to it, when it was being enacted. In cases of people who have been invalids for long periods —some of them all their lives—and who have been unable to do anything to contribute to their own incomes, and some of them have been so ill from birth as not to be able to receive education, one would have thought they would not be ruled out on some narrow technical medical decision. It seems to me, unless one of the official doctors in a county is prepared to say that an applicant is suffering from organic trouble which is likely to cause his death within a reasonably short time, he does not qualify for benefit under the disablement benefit regulations.
I have gone to the trouble to argue out the question with one of the official doctors. I stated more or less what I have stated now with regard to the intentions of the Oireachtas and the spirit of the legislation and he disagreed flatly and fundamentally with me in the matter of interpretation. People who, to all intents and purposes, were not disabled but who were found, as a result of his minute examination, to suffer from what he thought was a dangerous complaint have in fact qualified for these benefits; people who have never been able to earn a livelihood, or any part of it, and who are in the general opinion fully entitled to these benefits, people for whom the legislators intended these benefits, have been refused.
I think that situation is a mockery of Parliament and its intentions. If there is within the wording of the sections any justification for the operations of the official doctors in the various counties, then I think the Minister ought to take serious notice of that situation, and, if necessary, have a conference or any other consultation which may be within his power to have this position examined.
Another matter which has caused a good deal of misconception and disappointment is the question of entitlement to domiciliary attention. I admit it is not a matter easy of solution. Very often in the past, those least able to pay have been least able to get out of paying, while those who were most vociferous and possibly not quite so deserving got free treatment, in relation to which there might be a doubt as to their entitlement. What the solution of the problem is I cannot say; I cannot put my finger on any method by which it can be solved. It does seem to me, however, that the administration of old age pensions is a possible pointer to a solution. There is there a mixture of local representatives, plus an official, to deal with old age pension and blind pension applications. These two elements in local administration do not always see eye to eye and do not always agree. Usually, there is a conflict, but, if there is, there is also an official arbitrator. That particular type of administration has worked well and satisfactorily on the whole. The amount of injustice done under it has been very small. As a matter of fact. I think it is true to say that the balance would be in favour of the applicants.
Whether or not a somewhat similar scheme could be worked out in relation to free domiciliary treatment is a matter to which I should like the Minister to pay some attention. Domiciliary treatment is every bit as important as hospital and specialist treatment. We know a great many people do not require hospital treatment. We know that in many cases, if the people get treatment at the earliest possible moment at home, it is a reasonable assumption that fewer people will require to go into hospital than is now the case, because the possibility is that hitherto they have left treatment too late; and the reason they left it too late was that they did not wish to involve themselves and their families in the cost of treatment.
I have come across—not in recent years—some very extreme cases. They were maternity cases in which deaths resulted, because of the inability of the people to pay the recognised fee for the treatment required and because of their unwillingness, too, to accept the red ticket. Whether a red ticket would have been accepted by the doctor in that matter is something about which I am not quite sure. Those were extreme cases, but they demonstrate to me the importance of getting a satisfactory solution for the problem of domiciliary treatment.
I shall pass from that now. In my constituency, they are certainly important problems and I hope the Minister will give all the attention he can to solving them. There is just one other point. When we were amending the managerial legislation here, a good deal of credit was claimed for the fact that additional powers were being given under that amendment to local authorities. On a reading of the Bill, it was not very clear as to where these additional powers would lie and I myself tested the position out in an amendment in relation to certain appointments. I found that the Government and the Parties supporting it had their tongues in their cheeks as far as these extra powers were concerned, and they turned down my amendment which would have given a little bit of real power in the matter of temporary appointments. The note struck by Government speakers was that, now the powers of local authorities were being enlarged, there would be some real inducement to people of merit and capacity to offer themselves for representation on local bodies.
I should like at this point to draw the Minister's attention to a recent action of his. I have as yet no official confirmation of the information to which I am about to refer, but, if I am wrong, and the Minister says I am wrong, I will accept his correction and sit down. I understand that within the past week the Minister sent a sealed Order to Galway County Council in connection with the appointment of staff to the Central Hospital in Galway, which has now become the Galway Regional Hospital. There are two schools of thought as to the method of appointing the staff to that hospital. The respective appointments are: a wholetime surgeon, a wholetime obstetrician and gynaecologist, and a part-time ear, nose and throat specialist.
There was a conference on this matter, participated in by the Galway County Council as the principal party, representatives of the Department of Health, representatives of University College, Galway, and representatives of the Irish Medical Association. I understand there was a two days' sitting to consider the best basis of appointment of these persons. The issue was whether the appointments should be part-time, with the right to full private practice, or wholetime, with a very limited right to private practice. I understand, with regard to the surgeon, that he would have the right to be consulted, but that he might not operate. What exactly the purpose of tying a man like that was I could not see, because the man could very easily charge 100 guineas for a consultation and not give the patient the benefit of a manual operation. In any event, it did seem strange to those of us who had been listening to the principles enunciated—if principles they were—and the viewpoints expressed by the Minister and by Fine Gael spokesmen generally and by the Irish Medical Association on this question of the right of citizens to have what private consultation they were able to pay for to have these persons in an important place like Galway, a university town, cribbed and confined in the way proposed by those who have been backing wholetime appointments.
In my remarks on this Estimate, I am not so much concerned about the merits of these proposals as with criticising the Minister if he has taken this action—if he has not done so, I hope he will stop me in my tracks—and has sent down a sealed Order to Galway County Council compelling them to make wholetime appointments. The Galway County Council, as I said, participated in a two-day discussion with people of great importance, knowledge and experience in the matter, and, having heard all the viewpoints, decided by a two to one majority that these appointments should be on a part-time basis.
Heretofore, that was the basis on which these appointments were made, and in the view of Galway County Council, that had given general satisfaction, and, in fact, had given more satisfaction than their limited experience of full-time appointments led them to expect of such full-time appointments. If the local authorities—as has been claimed in the amendment of the Managerial Act—have been given these greater powers and fuller discretion than was formerly the case, it does seem a very striking and strange commentary on that amendment of the Managerial Act that the Minister should now send down a sealed Order directing the Galway County Council to adopt a course which they had very definitely turned down by a two to one majority.
I do think that the Minister would have contradicted me, if my information was incorrect and, therefore, I take it that the information which is the subject of current rumour in Galway—that is the only authority I have for referring to it here—is correct. If I were wrong and the Minister had not made this Order, I think he would have corrected me. I take it, therefore, that this Order has in fact gone out and that the people in close association with the service in Galway, who believe it has gone out and who informed me it was received, were speaking the truth.
I am not going to delay much longer on the point, but I do wish to castigate very definitely the high-handed and dictatorial attitude of the Minister for Health in dictating to the Galway County Council in a matter which had been fully examined by experts at a conference to which they as a council entirely, and not merely by way of delegation, were a party and were fully informed. After getting the fullest information on the matter, they take a decision by a two to one majority in favour of part-time appointments, with the full right of private practice, and the Minister, by his sealed Order, has upset that decision and directed them to make these appointments on a full-time basis. I would like to hear the Minister, when he is concluding, justifying his action in this respect, if, in fact, he has taken it.