Léim ar aghaidh chuig an bpríomhábhar

Dáil Éireann díospóireacht -
Tuesday, 23 Nov 1965

Vol. 219 No. 1

Private Members' Business. - Health Services (Resumed).

Debate resumed on the following motion:
Dáil Éireann is of opinion that the present health service is inadequate to the needs of the people, and that in particular many injustices arise in the administration of the medical card system, and calls on the Government without further delay to establish a comprehensive no means test health service with a free choice of doctor for all sections of the community. —(Deputy Kyne.)

Having listened carefully to all that the Minister had to say on this motion, it is safe to say that his approach is undoubtedly a reasonable approach. It has indeed been most conciliatory, but while that is so, we are still left wondering what is his intention in regard to the White Paper. Every speaker in this debate had something to say in favour of the motion and the Minister himself made statements which contribute to the motion. If nothing else this motion has evoked from all those who spoke a positive indication that there is a need for an improvement in the health services. I noticed that the Minister, speaking at the Árd Fheis last week, said that one of his main objections to a free, comprehensive medical service is that the people would be treated like cattle. I am sure the Minister will agree with me that under the present system people are being treated like cattle. I am very pleased to know that he realises that there is a need for a change. I know that when I was on the Select Committee with him, he recognised the need then but unfortunately his predecessor did not think the same way. The same can be said for the advisers in the Department. I hope the Minister will keep pushing towards this objective of bringing satisfactory services to our people.

In that connection, I am satisfied that the people who plan health services are too far removed from the people's needs to know exactly what they do need. This is the cause of all our trouble and it is quite true to say that the university of adversity is the best type of university for this exercise. One has only to spend a little time in any of our local dispensaries to see our people being treated like cattle herded together, waiting and watching for assistance, assistance which they should be given as an entitlement. This is something which has caused people to cry out for a free choice of doctor. We believe that every Party has adopted the view that there should be a free choice of doctor. There is no real trouble about that. If we have a free choice of doctor, perhaps it will result in the elimination of the antiquated pauper houses which are described as dispensaries.

If nothing else, we have got to get this system away from this hand-out treatment. I know from my experience of looking after my constituents what it would mean to have a free choice of doctor. It would mean an awful lot because I have known people who had medical cards but who did not avail of the benefits which they could have had because of the absence of a choice of doctor, because of the rude way in which they were treated and because of the obvious lack of interest in them when they went to avail of the existing system.

Mention has been made of the expenses borne by people who come within the ambit of the present scheme in regard to medicines and drugs. I have known some such cases. I have known, for example, the case of a man who had £10 16s. a week, whose wife was in a mental home, and who had a son working and who was required to pay consistently for his wife's upkeep in the mental home. The reason he was required to pay for her upkeep was that his son had an income. We have all grown up sufficiently to realise now that unfortunately the majority of boys and girls who are working do not contribute in the way we would imagine they would, or the way a civil servant imagines they should contribute, to the upkeep of their homes. These are things that have to be taken into consideration.

There is of course an appeal but this is something that requires a lot of doing. No matter whether they have £8, £9 or £10 a week, you find people not wishing to appeal, as if they were begging, for entitlement. That consistently happens. You also have the situation in which a number of people do not know what they are entitled to. In some cases they apply for a medical card, do not get it and do not pursue the matter further. No matter what happens, even if this motion is not passed, it will certainly inspire a movement and whatever is done must be an improvement. If nothing more, I appeal to the Minister to take steps to ensure that the administration of health services is taken out of the hands of the local authority in the person of the county or city manager. It should not be left to the whim of an individual, or the people who work for him and who must carry out his instructions, to determine whether a person should or should not have something to keep them well. This matter cries out for attention.

The Minister said he had not quite made up his mind on what was to be done about the health services but this is something that must be done. This is one of the reasons why we in the Labour Party advocate free, comprehensive medical services. A number of people are described as ratepayers, people who could be described as tenants of small dwellings, and each one of them could safely be described as a member of the working classes. A considerable number of these just eke out an existence but they are denied medical cards and medical services because of what appear to be their possessions. If a real investigation were made it would be found that object poverty exists in a number of homes occupied by the tenants of small dwellings. This also cries out for attention. Such people are very often left to the mercy of a manager or his employees who are conditioned by the whim of the manager who feels obliged to keep down the rates.

I had an experience in connection with the choice of doctor in my own constituency—indeed, more than one. I had a group of people signing a petition to have something done about a doctor who was supposed to be attending to their needs. Nothing was done. In his good time the doctor went but in the case of one woman that he attended—she was expecting a baby—he promised to come back. In the meantime he was transferred. The baby died and there was a suggestion that this was as a result of the doctor's bad handling of the case. The father decided to take it up with the medical officer but needless to say the city medical officer took the stand of his profession and did nothing about it. These things are very hard to prove but they indicate the need for a choice of doctor.

Before the promised White Paper comes out—I hope it will not be too long—the Minister should take serious notice of the present position in the Six Counties and here. By now I am sure it is common knowledge that one of the main planks in the Unionist platform in the present election is the social welfare and health services. They have actually issued a brochure showing the services existing in what they describe as Northern Ireland and in the Republic of Ireland. This is a revelation to anybody making comparisons. It should urge us, if we are sincere about desiring unification of the country, to do something about our own services.

When Deputy Kyne spoke on this motion, he indicated that we were prepared to assist the Minister and the Government in finding money for this project. It is easy to ask: "Where will the money come from?" The situation calls for a close examination but I think it reasonable to ask the Minister to consider seriously the priorities of the matter. Far more money has been spent over a number of years in the maintenance of animal health than on the health of human beings. I got this information recently in reply to parliamentary questions I addressed to the Minister for Agriculture and the Minister for Health. The replies showed clearly that we had not been looking after human beings as we should. It was about time to consider the human beings because if we fail to look after them our cattle will not be much use to us.

It would not be a bad thing, as regards the matter of payments, if the Minister for Social Welfare and the Minister for Health got together. I and my colleagues have had occasion to try to ascertain if certain things could be done through the health services and we have had the Minister for Health saying—not the present Minister but his predecessor—that he is waiting for the Minister for Social Welfare. Similarly, we were told the Minister for Social Welfare was waiting for the Minister for Health. Before the White Paper comes out there should be consultations between these Ministers with a view to ensuring proper health and social services.

At the moment we are paying directly or indirectly for services which are absolutely unsatisfactory. I am sure the Minister has taken notice of the fact that whenever there is an increase in the social welfare contribution from the worker there is never a complaint despite the fact that there are continual complaints about the benefits. From my knowledge and experience of the working people I am satisfied that they are quite prepared to pay for proper services and the only way in which we can obtain proper services is by having free, comprehensive services. The idea of discrimination is bad and discrimination will come about even if we have a Minister as well intentioned as we have now.

The Minister indicated that he had in mind the choice of doctor but he also said that where people did not obtain benefit they would be entitled to appeal. This right of appeal will prevent proper health services from operating. We must stop thinking in terms of appeal and have more regard to entitlement. A person is either entitled to something or he is not. You make application for something to which you are entitled, but if somebody judges you are not entitled to it, you have to go through the exercise of arm-twisting, cajoling or string-pulling to get that to which you feel you are entitled.

Under the present system, medical appeals are dragged out and, in the meantime, the applicant is left without the service to which he is entitled. In view of what has already happened, I do not believe an appeal meets the case. For example, I know of a case of a woman who required surgical boots for two of her children. Her husband had £10 5s. a week. She was denied a medical card because her daughter, who was saving up to get married, was working. There was an appeal, but it took four months to reach a decision. In the meantime, the surgical boots had to be provided. It is all very well to say that, if there is an appeal, it means something will be done in the case of a person not being rightly treated; but you cannot make an appeal when somebody urgently requires medical service. I am asking the Minister to get away from that. Comparisons have been made with the "Black North", and comparisons can be made with other parts of Europe. There has been a lot of talk about free trade and the Common Market, but we will have to improve our social and health services if we are not to continue to be described as an underdeveloped country. We keep on preaching that we are not underdeveloped. Let us put more value on our people's health than on anything else. Let us put first things first, and the health of our people is undoubtedly our first priority.

At the beginning of this century, a commission of inquiry was set up to inquire into the workhouse hospitals. Shortly after the conclusion of that inquiry, a dispensary doctor from Cavan wrote an article in a journal called The Irish Monthly in which he summarised his evidence before this commission of inquiry into the provision of medical services for the poor of this country. He emphasised in this document that, just as important as the hands of a surgeon, just as important as the knowledge of the medical man, was the maintenance of the dignity and self-respect of the sick poor. He said then that the poorhouse system—the system of medical charity such as we had in operation in Ireland then and now—could not maintain the dignity and self-respect of the sick poor. This man said then— and this was 61 years ago—that he wanted to see that the sick poor had the same right as the rich people, and that was freedom to choose their own doctor.

We in Fine Gael have been advocating this for many years. The Labour Party have likewise being advocating it. Within the last week, we had the Minister for Health throwing out his predecessor with all his works and pomps and saying that he, too, believed in the free choice of doctor. It is only recently I came across this article of 1904. I was not a little proud of the fact that the man who wrote it was my grandfather. It was 61 years ago that a dispensary doctor working in rural Ireland said that the poor of this country had the right to a free choice of doctor. We have not yet given it to them after 40 years of freedom, and are we going to give it so long as we have in office a Government who have no conception of the necessity to have a proper health service? I pity the present Minister. I accept his bona fides and his anxiety to have such a service. But he is a member of a Government which for years had as their deputy leader a man totally, morally and psychologically opposed to giving poor persons a free choice of doctor. We know from their published programmes that they rejected it as not having any contributory or beneficial influence on economic expansion, health, education and what they call social investment. We reject this idea. We believe a proper social programme and a proper health service are just as essential to our economic growth and welfare as any other service the Government can provide. Until such time as we have an adequate health service, there is no prospect of seeing a just society in operation here.

We, in Fine Gael, are only too happy to lend our support to this motion in the name of some members of the Labour Party. We are in favour of a comprehensive health service which will give a free choice of doctor. We believe the way to bring about that health service is to ask for a reasonable contribution from every person who has an income. Those who have not got an income would receive the same health benefits without having to go through the present undignified and demoralising system of applying for medical cards, which in practice under our legislation are a badge of poverty and are accepted as such. At present the main weakness of our health service is that a person of limited means has no choice of doctor but must go to a particular State official. In the course of the last general election campaign, a dispensary doctor declared he was not going to vote for Fine Gael any more because he was a dispensary doctor and he did not agree with the Fine Gael health scheme because it gave the poor a free choice of doctor. He was queried as to why he adopted this attitude and he said: "They are not paying for it, so why should they have a free choice of doctor?" As far as Fine Gael are concerned, we are glad not to have the support of people who think that way. We think it is appalling that that attitude of mind should exist in the twentieth century.

Another weakness of the present health service is that the provision of a medical card to preserve life or to kill pain is in competition with roads, bins, public lighting, vocational education, rates and all the multitude of services a local authority provides.

That should not be so. It should be a prior charge on our resources, be they national or local. Until you have that approach to the relief of human suffering, the present miserable system will continue. We reject as trite the kind of tripe we used to get from the Minister's predecessor. His figure of £15 million as the cost of a decent medical service is complete and utter cod. With the Minister throwing out Deputy MacEntee's works and pomps, as he has been busily doing ever since he succeeded him, he should also throw out that figure of £15 million. In that figure there is no allowance for the reduction in our hospitalisation rate, which at present is the highest in Europe. Why? Because we are not treating the sick poor in their own homes. We are not treating people in a limited way in their own homes. We expect dispensary doctors, because of the thousands of people they have to serve, to send sick people into hospital so that they may get some kind of treatment there which the dispensary doctors themselves, because of the thousands of demands on them, are unable to provide.

The real cost of a proper health service will only be about £3 million or £4 million extra on the total health bill. That is an extremely small sum compared with the frightening figure the Minister, like his predecessor, is using now. I am quite certain that when the Minister argues his case before the Cabinet he never advances a figure of £15 million as the additional cost of providing a decent health service here. If you try to graft on to the Medical Charities Act of the nineteenth century twentieth century health services, I am quite certain the bill will come to another £15 million. But that is not the way to go about providing a proper health service. We in Fine Gael have been saying that now for several years past and that is why we endorse this motion tabled by the Labour Party. We do not use glib phrases like "free for all". We know that everything must be paid for and I have yet to find any working man or woman who would jib at paying a few shillings every week in return for being relieved of the colossal worry and expense of medical treatment. We will continue to argue for a comprehensive insurance health service, free to those with no incomes and paid for by those with incomes through the medium of a reasonable contribution. We do not mind what Government or what Party brings that health service into operation. All we want to ensure is that in our time we will achieve what a country medical doctor said at the turn of the century, namely, freedom of choice of doctor for the poorest of the poor.

I am sure every Deputy here wishes to see a proper health service.

May I remind the Deputy that he has only five minutes?

We all want a comprehensive health service designed to ensure that no one in need of medical attention will be denied that attention because of lack of means. The present health services have very often been the target of ill-informed criticism. That criticism does not help those who need help. I have heard Deputies criticise the method by which medical cards are issued. I do not think the system is one that should be maintained very much longer, but it is not nearly so bad as some people make out. It should be our aim to minimise suffering. It has been said that in the area administered by the Dublin Health Authority cards are issued, or refused, by people who are not qualified to make a decision. First of all, when a person applies for a medical card the inquiry officer goes out and finds out what the circumstances are. The case is examined in the office. The inquiry officer makes a report. He can issue a card but, before a card is refused, I understand it is the executive officer who must make the decision. It very often happens that an applicant for a card is rejected. His income is too high, or something like that. Later, he may apply again through a member of this House or a member of the City Council and a card is issued to him. What happens very often is that the illness has become much more serious or the income has fallen. That puts the applicant into the category for a medical card immediately. The Dublin Health Authority administers the system very, very fairly indeed. Their whole ambition is to help those who need the card. One speaker said here this evening that he applied two or three times and his application was rejected. Then he became a member of this House and he had no difficulty getting a card. Any active member of a local authority or of this House knows that these things are done by the health authority examining each case on its merits and giving a fair decision.

How fair?

As fair as is humanly possible. The people in the health authority are the same as the Deputy and the same as me. They are concerned about the health of the person.

Home assistance officers.

(Cavan): The Minister says it is a joke.

We call them inquiry officers. They administer the system to the best of their ability.

I am sorry I must interrupt the Deputy. Deputy Coughlan has 15 minutes in which to conclude.

In the time at my disposal, I want to bring to the Minister the irregularities and anomalies in the present Health Act. Some of us may have the good fortune to sit on a health authority with managers who are human. Others may have to contend with managers who are cold and inhuman and who take very odd decisions with regard to the people entitled to health services. I can make a comparison between the health authority of which I am a member and a neighbouring health authority in County Clare.

There was an elderly woman living a mile outside the Limerick border. She was dying alone in her home. A good neighbour came to me and asked me to have her transferred to our hospital in Limerick. I tried to do that, but unsuccessfully. It seemed more desirable to transfer her to Limerick, a short distance away, rather than impose a journey of 26 miles on her to the county hospital in Clare. Our resident medical officer in Limerick told me admission was refused. The unfortunate woman died. I instituted inquiries and the answer I got was that there was no co-operation and no understanding between the health authority in Clare and the health authority in Limerick. I could recount other instances for the Minister but I am sure he is well aware of them. Because of the interpretation of the Act as between one manager and another and because of their divergent views as to how these services should be used, unfortunate people are deprived of that to which they are justly entitled. We in the Labour Party believe that a manager, whether human or inhuman, should not be the deciding factor in these matters.

There is no co-operation between one health authority and another. Drugs prescribed by professional men in the medical services are being withheld and put on one side by an order of the Minister to all managers of health authorities. Who is the deciding factor in this?

Mr. O'Malley

That is not correct.

It has happened in Cork and was questioned by Deputy Casey at the last meeting of the Cork Health Authority. It was stated at the last meeting of the Limerick Health Authority and will be questioned at their next meeting by me. If a medical practitioner prescribes treatment for a patient it is the responsibility of the health authority to see that that treatment is carried out.

I have mentioned some of the anomalies in the Health Act and the administration of the Health Act. The Minister is as well aware of them as I am. We welcomed the statements the Minister made shortly after taking office as to the radical changes that we might expect in the health services. We are still awaiting these radical changes, particularly those changes we envisaged as a result of statements made by the Minister with regard to the nursing profession and psychiatric treatment. There were statements made by the Minister which suggested that 30 per cent of the people of Ireland are mad or half mad and that the institutions in which these mental cases are housed are archaic and have been handed over from an old régime. Grandiose statements were made by the Minister but we await action and await it anxiously.

We are now presented with an effort at stalling in the introduction of a White Paper. The White Paper will contain many promises, particularly having regard to the fact that local elections will take place in June next. I do not know what we will be facing after that.

The Labour Party are not satisfied and the Minister in his heart and soul is not satisfied. He has stated that the issue of a medical card was treated as a joke. We have no time for joking about the health of the nation and do not treat these matters jocosely. The Minister's humour and our humour do not coincide. Every health authority must contribute 50 per cent of the health charges. I do not know of any health authority that has agreed to this 50-50 basis. At the last meeting of Limerick Health Authority, a recommendation was sent to the Minister. At the previous meeting, a recommendation was sent to the Minister. The first proposal sent to the Minister for the introduction of a fairer basis of contribution came from the Minister's own Party in the Limerick Health Authority. Nothing has been done since then.

When a request was made that the State contribution should be increased and the burden on local ratepayers correspondingly decreased the reply received from the Minister's predecessor was that that would involve sending down civil servants to run the authority and that he was loth to hand over further authority to civil servants. If the Department of Local Government can relieve rates through the Road Fund, there is no reason why the Minister for Health should not be in the same position in regard to the health services.

We are looking forward to the introduction of the White Paper. I know it will contain the Santa Claus promises that we have been getting from the Minister. We are sick and tired of listening to statements made at dances, dinners and all kinds of functions ridiculing the services. We all know of the anomalies that exist. We want them rectified. We want to see action being taken. Since the Minister took office, nothing has been done to satisfy the Labour Party.

My time is very brief, which is a matter for regret because this subject is very dear to the heart of the Labour Party. We have introduced the motion with a view to arousing public opinion and to bring out the delinquent Fine Gael Party and to make them see that we are the spearhead of the movement for a free for all health service for the people of Ireland. We offer no apology to any other Party for introducing this motion, which we will press by way of division.

I want to bring to the Minister's attention the fact that the powers of health authorities are limited in respect of visits to institutions. Members of Limerick City Health Authority are in a singular position in regard to visits to a certain institution. As public representatives and members of a health authority we are entitled to visit, in reason, any of our health institutions or hospitals on reasonable demand. Unfortunately, we in Limerick are not entitled to do that because of the whim of a certain individual. We do not ask for anything unreasonable. If a patient in an institution demands or requests a visit from a member of a health authority or any other public representative that should be sufficient reason for allowing the visit, within reason.

I shall now give a personal opinion as to how the services should be run generally. The Minister would be well advised to consider regionalising the services. In that way there would be a broader and more humane approach as between one manager and another. If the services were regionalised there would be a more reasonable approach and a levelling out of the discrepancies and anomalies that exist at the present time.

While we welcome the introduction of the White Paper, I want to warn the Minister that as far as the Labour Party are concerned, this is to be no stalling gimmick. We will insist on a final decision being made one way or another in regard to this matter.

I am afraid I must ask the Deputy to conclude.

I am sorry. I bow to your ruling, Sir.

(Cavan): If you will permit me to say it, Sir, we believe in a comprehensive scheme based on insurance and, on that basis, we vote for the motion.

The debate is closed.

Question put.
The Dáil divided: Tá, 35; Níl, 51.

  • Belton, Luke.
  • Belton, Paddy.
  • Burke, Joan T.
  • Cluskey, Frank.
  • Corish, Brendan.
  • Cosgrave, Liam.
  • Coughlan, Stephen.
  • Creed, Donal.
  • Crotty, Patrick J.
  • Desmond, Eileen.
  • Dockrell, Henry P.
  • Everrett, James.
  • Farrelly, Denis.
  • Fitzpatrick, Thomas J. (Cavan).
  • Harte, Patrick D.
  • Jones, Denis F.
  • Kyne, Thomas A.
  • Larkin, Denis.
  • L'Estrange, Gerald.
  • Lindsay, Patrick J.
  • Lyons, Michael D.
  • McAuliffe, Patrick.
  • Mullen, Michael.
  • Norton, Patrick.
  • O'Connell, John F.
  • O'Donnell, Tom.
  • O'Higgins, Michael J.
  • O'Leary, Michael.
  • Pattison, Séamus.
  • Ryan, Richie.
  • Spring, Dan.
  • Sweetman, Gerard.
  • Tierney, Patrick.
  • Treacy, Séan.
  • Tully, James.


  • Allen, Lorcan.
  • Andrews, David.
  • Blaney, Neil T.
  • Boland, Kevin.
  • Booth, Lionel.
  • Boylan, Terence.
  • Brady, Philip.
  • Brennan, Joseph.
  • Brennan, Paudge.
  • Breslin, Cormac.
  • Carter, Frank.
  • Carty, Michael.
  • Childers, Erskine.
  • Clohessy, Patrick.
  • Colley, George.
  • Collins, James J.
  • Cotter, Edward.
  • Crinion, Brendan.
  • Cronin, Jerry.
  • Crowley, Flor.
  • Crowley, Honor M.
  • Davern, Don.
  • de Valera, Vivion.
  • Dowling, Joe.
  • Egan, Nicholas.
  • Fahey, John.
  • Fanning, John.
  • Fitzpatrick, Thomas J.
  • (Dublin South-Central).
  • Foley, Desmond.
  • Geoghegan, John.
  • Gibbons, James M.
  • Gilbride, Eugene.
  • Gogan, Richard P.
  • Hillery, Patrick J.
  • Kenneally, William.
  • Kennedy, James J.
  • Lalor, Patrick J.
  • Lemass, Noel T.
  • Lenihan, Brian.
  • Lynch, Celia.
  • McEllistrim, Thomas.
  • MacEntee, Seán.
  • Meaney, Tom.
  • Mooney, Patrick.
  • Moore, Seán.
  • Moran, Michael.
  • Nolan, Thomas.
  • Ó Briain, Donnchadh.
  • O'Connor, Timothy.
  • O'Malley, Donogh.
  • Smith, Patrick.
Tellers:—Tá, Deputies James Tully and Pattison; Níl, Deputies Carty and Geoghegan.
Question declared lost.
Business suspended at 7 p.m. and resumed at 7.30 p.m.