When progress was reported last night, I was referring to employees of health authorities, namely, hospital employees, those referred to as non-nursing personnel. That is not a very apt term because it covers everybody in the hospital, such as ambulance drivers, porters, wardsmen, wardsmaids, cooks and so on, and those people, in the main, are servants of the health authorities as distinct from the officers but there are quite a number of the older people who were, and still are, officers. The status was changed some years ago; perhaps it was more appropriate to have them described as servants coming under Part III of the Local Government (Superannuation) Act but the unfortunate part of it is that the local authorities, the county managers and the Department of Health seem to take that description, "servants," very literally and refer to them as non-nursing personnel.
I do not know whether other Deputies spend as much time in hospital or going to hospitals as I and some of my colleagues do but we find that in the hospitals people who are described as non-nursing personnel in many cases have to do very important nursing work. They are in direct contact all day with the patients. They are the people who feed them, take food to them and attend to them if they require anything in the wards during the day. In some cases, they are asked to do things which I think they should not be asked to do, particularly in wards. It is not unknown that those people have been required to give bed-baths to old people. To describe those who have to do that work as non-nursing personnel is a bit ridiculous.
My main reason for referring to it here is that some years ago when hours were being reduced, the non-nursing personnel did not have their hours reduced to the same extent as the nursing personnel and it took a long fight and numerous applications to the Labour Court before the hours were brought into line. We now have the same thing happening. The Department of Health has given its blessing to an 85-hour fortnight for nursing personnel and we, through the trade unions, have been attempting to get a similar 85-hour fortnight for non-nursing personnel and are finding extreme difficulty in getting county managers to fall into line. Yesterday, Deputy Kitt made an inquiry about having the wages of road workers put on the same level all round. I am quite sure he felt, as I did, that they should all be put up to the Dublin level but the Minister for Local Government might have a little difficulty in swallowing that.
In the case of hospital authorities, the same difficulty does not arise. I see no reason why the Minister for Health should not tell the County Managers' Association that the working week for non-nursing personnel, as for nursing personnel, shall be 42½ hours or an 85-hour fortnight, taking the long week and the short week together. This would avoid much trouble and annoyance. It is amazing how local authority employees are sometimes singled out for particularly bad treatment on the pretext that replacements are not available. If there is a replacement available for a nurse, I am sure there will be a replacement available for a wardsmaid. Such an argument should not be used.
There is another aspect of this matter which I want to bring particularly to the Minister's notice. In quite a number of hospitals, we have matrons who have been there for a long number of years. Many of them are religious; most of them are dedicated to their jobs; and practically all of them believe they have the right of hiring and firing at will. This is something which, unless direct action is taken by the Department, will blow up in everybody's face some day soon. Last week I had a case of a porterambulance driver who had been ill for some time. He had been replaced by a man who is doing the job very well. From last May until Friday last there was no complaint about him but then, probably because somebody else had his eye on the job, that man was sacked at a moment's notice. He was told that he was unsuitable for the job and on Monday morning another man took out the ambulance. I protested to the county manager about the matter and I have not yet received his decision. There has been a request by the fellow workers of this man to take strike action but that is not the way to deal with the matter.
There must be ordinary justice given to these people and I am sure the Minister or his Department would not stand over such action. I am sure they would not agree that even the lowest paid worker should be fired at a moment's notice to make room for somebody else just because somebody did not like the colour of his eyes or the colour of his hair. That is one instance and I could give many others. Most matrons of hospitals are dedicated people who do their work well but some of them still seem to have the idea that they have the right to decide who should or should not work in a hospital. I suggest that this has nothing to do with them. These people are employed by the county manager through his executive officer and he is the person who should make the decision, not somebody who has a thing about somebody else. I do not like to have to raise matters like this in the House but this seems such a blatant attempt to usurp the right of a man to work that it is only right to have it brought up here.
Last year an effort was made by a group of unions to have a joint body set up to deal with wages and conditions in hospitals. That proposal was resisted by the County Managers' Association—why I do not know. We have had appeals from various Ministers for rationalisation in these matters and surely this effort at rationalisation was deserving of support? It is true that when a group of unions come together to negotiate for a group of workers, they speak with one voice. It may be that some of the people who employ these workers feel that they would be in a stronger position if they could operate the old policy of divide and conquer, if they could play off one group against the other. This was an attempt to make arrangements to negotiate for all these workers at the one time. No effort has been made by the managers to meet us and this is a matter of national importance which should have the attention of the Minister.
When other types of nursing personnel did this, the Minister and his predecessors had no doubt about the manner in which it should be dealt. I suggest that a hint from the Minister for Health would go a long way towards solving the problem. There are other matters. Some people who have not had experience and who are not in touch with hospital staffs might find it difficult to understand these matters. In hospitals certain people have to do night duty. Nurses do night duty and they get days off in lieu. This is understandable because night duty for younger people is a very tough assignment but the wardsmaids, who also have to do night duty, will not get the same number of days off in lieu as the nurses.
I am not attacking the nurses or their conditions. They are an excellent group of people doing excellent work and they deserve everything they get but it is time the idea that there are two different classes employed in hospitals was dropped. One of the things that will sooner or later be discovered by the people in authority is that after serving for a few years as a wardsmaid in a hospital here, many of these girls go to England and after a few years become qualified nurses, a chance that they would never get in a hundred years in this country. There should be some regard for these people.
On the question of uniforms, many types of uniforms have been adopted. We occasionally find the matron of a hospital producing a prototype of uniforms which she wants the staff to wear. When the girls try it on, they discover it is something that might be given to them to demonstrate what was worn in the dim and distant days and when they refuse to wear it, something better can be produced. A general uniform should be issued to all the girls and also to the men. A practice is growing up whereby people employed in hospitals are given money in lieu of a uniform issue, in some cases £5. That is supposed to buy an overcoat, a cap and a suit. In some cases the amount has gone up to £12. I know an ambulance driver who got £12. From that he had to pay £3 for a cap which would not have to be replaced every year. But how was he supposed to buy a suit which he could wear on other occasions, and also an overcoat?
Good uniforms should be issued to all hospital staffs. It would give them pride in their appearance and it is a well-known fact that when people are ill, they like to have people who are neat and tidy nursing them and dealing with them.
It is true to say that a great many of our ambulances are nothing more than glorified delivery vans, with a different type of body fitted. I wonder if this matter has received as much attention as it should. A few hospitals have experimented with different types of ambulances and some of them have spent considerable sums in getting a good type, properly sprung, but a number of hospitals still use the old Bedford truck with an ambulance body. While these might be suitable for bringing to a hospital a patient requiring medical treatment, they are most unsuitable for those requiring surgical attention. One doctor told me that he had a patient who had to be brought to hospital for an injury to his back and that the journey in the ambulance did not do him any good. He would not go much further than that but he said it did not do the patient any good. The type of ambulance used should be examined. There should be a standard type of ambulance provided which is suitable so that the local authority just cannot go out and buy any old thing at all.
The stretchers used in the ambulance require immediate attention. Very often, the stretchers in the ambulance are so heavy that it would require two strong men to carry them. What happens? The stretcher is up in the ambulance and must be taken down. It would require two strong men to ensure that it is brought down safely to the level of the ground. There is usually an ambulance driver and, if he is lucky, a nurse with him. How does he get the patient out of and into the ambulance? A number of local authorities have experimented with this kind of thing. They have produced lightweight stretchers which can be moved fairly easily and they have produced stretchers which can be wheeled on to the ground from a type of ramp. To suggest that it is all right to use an ambulance, the floor of which is about three feet from the ground and to send out one man and to tell him that he must bring in a patient who is maybe up to 16 stone in weight, and get him out of the ambulance again, is entirely wrong.
Last night, I referred to the training which it is proposed to give to ambulance drivers. I am all with the Minister there. However, I would point out that about 80 per cent of them have already got most of that training. There is no point in giving them training unless they also get equipment. It is on record that ambulance drivers, arriving on the scene of an accident, have no equipment except a stretcher and a few blankets. They cannot take the place of doctors but they could possibly save a life if the proper type of equipment, which they know how to use, were supplied. One could continue talking on this for a very long time. I have made these points because I believe they are factors of which the Minister may not be aware and, even if he is aware of them, there is no harm in reminding him of them.
Another problem about ambulance drivers is this system of "on call". Those who may not be aware of how the system works may not know that in most hospitals there are a number of ambulance drivers, some of whom are on duty and some of whom are "on call". A man who works during the day and goes home at night but must stay there in case he is needed—"on call"—does not get any payment for that. I have been amused again and again to hear county managers arguing with me that because the man is not actually working, he is not entitled to any payment for being "on call". I do not think there is anybody in this country, anybody else I know of, who would be prepared to agree to stay in his home for the period while he was not working in case he would be needed, and agree that he should do it at night, at weekends, on holidays, or whatever it is, without any extra remuneration. It is stupid to suggest it should be done. I would not do it; the Minister would not do it. I am sure the county managers, who are so definite that people should not be paid for it, would not do it either. If they were asked to stay at home, lest they might be needed for something or other over the weekend, well, we should have a song and dance about it. This matter must be attended to. I leave it to the Minister's good sense to see that it is dealt with in the proper way.
There is a reference here to the hearing-aid service. The Minister says that the service operated by the National Organisation for Rehabilitation on behalf of health authorities continues to function satisfactorily. This is so. However, I think it should be known that very many people who are using hearing aids for many years and who simply replace the batteries in them are entitled to look for replacements. I meet an awful lot of these people. A lot of them tell me that the hearing aid is not as good as it was, that they cannot hear, that their hearing is failing. In fact, what is happening is that the type of device they are using is becoming worn out. I think there is no reason why an effort should not be made, in the national interest, to ensure that people are supplied with the best type of appliance.
With regard to the dental services, I think there is something desperately wrong here. Most health authorities have a free dental service for children. Our own local authority operate it, as far as they can, for adults. I understand that very few local authorities do this. However, the operation of the dental service applies only as far as extractions are concerned. I am informed that there is a two-year waiting list for people who want dentures. I can see no reason why this should be allowed to continue.
I am told it is difficult to get dentists. I am told that the local authorities have difficulty in getting dentists, and that there is some difficulty about the arrangement for the supply of dentures. Would the Minister ask the local authorities to make some arrangement with dentists in the local towns, who do not seem to be overworked, to have extractions done and dentures supplied? I live 24 miles from Navan and six miles from Drogheda. It is quite well known that it would be much easier for somebody who lives in my area to go into Drogheda on the bus, to have the extractions done, to make arrangements for the dentures and to go home again rather than have either an ambulance or a taxi collect him or her at home and bring them there, not once, but maybe half a dozen times at about at least £2 a run before the dentures are supplied. That is an example of something that is happening. I am quite sure the Minister is aware of this and even of worse cases happening all over the country. Would he have this question actively considered—I know he referred to it here— because I believe he can get the service if he wants to do it, and he can get it for at least as low a cost as under the present system?
I come now to the question of people who are insured. This is a different category. It is reasonably well dealt with except for the fact that the cost of dentures is going up as a result of which many people are thinking twice about taking the dental treatment they require. If they have to pay the difference between what the State will pay and what they themselves can afford, there is still a gap. While some local authorities, including my own, do meet fairly the person who requires something extra, at the same time it is not the whole story and perhaps there might be a way out of this.
With regard to the school dental service, I do not know whether it is the same in every county or not but I believe that it is nearly impossible to get more than about one visit of the school dental service to each primary school in the school-life of a child. This is an extraordinary situation and is, in my opinion, a rather stupid arrangement. If we claim to be so interested in the dental care of children, surely they should get at least one or two inspections per year? We have the problem that if they are found to be suffering from dental trouble while the school dental inspection unit is there, they can have treatment free, but if they have not been discovered because the unit did not call, then their parents have to pay for the treatment which the children get and which they are eligible to get free. These are some of the things which are tied up by red tape and green tape which I think should be cut. It would cost very little extra and would make a great difference.
The Minister referred to fluoridation of water supplies. I do not know how far it is intended to go. The Minister said the water supplies of Dublin, Cork, Limerick and Waterford and seven other towns are fluoridated. I am sorry he did not think it necessary to include the names of the towns since there were only seven. He says arrangements have been made to do a further 40 areas within the next 12 months. We may have different views about whether or not fluoridation is a good idea but, the decision having been taken to do it, it should be done as quickly as possible.
We come now to the whole kernel of this debate, that is, the White Paper on the Health Services. One of the things I find fault with in this Government or any Government is that they tend, when the occasion seems to be suitable for them, to make statements about certain things and give the impression that the things they are talking about are about to happen within a matter of months. We had such a situation with the Minister's predecessor when he talked about the improvements in the health services. He promised us particularly the remedy to one of the nagging things in the present health services, free choice of doctor. He also promised to arrange to make an improvement in the supply of drugs and medicines and a number of things like this which so many of us have been finding fault with.
As the House is aware, when the Health Act was introduced the Labour Party supported its introduction on the basis that it was at least an improvement on the old poor law system. We heard a lot about doing away with the red ticket. The Minister must be aware that replacing a red ticket with a blue card or a green card or a white card was not the best thing to do because a person who must go looking for the card must go through an even more searching examination before being issued with the card. Right through the country, no matter what county we go into, we can find the fellow who will tell us he has not got a medical card because his county council have decided he is not entitled to it. He is a married man, with £10 a week and four or five children. He feels aggrieved because he knows his neighbour who may be working with him or working close to him and who has a wife and maybe one child or no children, with £15 a week and maybe some property, has a card. This is one of the things which we hear again and again. Whether or not it is as widespread as we are led to believe I do not know. I have never had it investigated because I feel that we might succeed in having the card taken from the man who had it and we almost certainly would not get a card for the man who had not got one.
We find that the man who has a medical card is entitled to certain treatment and we then find that members of his family are not entitled to it and, in fact, that the members of his family who are working and who may not be giving one penny into the family purse ultimately deprive the parents of the use of a medical card. This is something which should be looked into. This was mentioned in the White Paper and it was stated that in future the incomes of the members of the family would not affect the issue of the medical card. Lots of people immediately reapplied to their local authority to be told: "This is what the Minister has suggested he is going to do. He has not done it yet and it does not appear as if he is going to do it."
With regard to medicines and drugs, I know that most local authorities are generous if a case is made to them that people need drugs or expensive medicine over a long period and they are asked if they will supply those medicines free of charge. This is a great help, but there are so many people who do not know that and, I suppose, at least twice a week I get complaints from people who tell me that they have gone to their dispensary doctor and the dispensary doctor has either sent them to the chemist to buy drugs which he says he has not got or, alternatively, they go to the doctor not having got a medical card, and they have to pay up to £1 or £1 10s a week for medicine out of a very low wage. When the matter is brought to the notice of the local authority, they help that person if the case is good by giving free drugs, for a period anyway. The whole approach to this is wrong and the Minister must set his mind down to having at least those parts of the White Paper put into operation. The person who has a medical card or who applies for a medical card is, in my opinion, in the very same position as if he had the red ticket.
It was the practice before the medical cards were introduced for doctors who knew their districts to give free medical attention to what they called the poorer classes, even if they had not got a ticket. That no longer happens except on very rare occasions. In most cases a doctor will ask for a medical card and if the patient has not got one, he will ask for his money. When a wage-earner falls ill and sends for a doctor, I do not think the question of the money to pay the doctor should be a question he must worry about first but this is true. These things happen.
There is another suggestion of the Minister's to be discussed, that is, the question of choice of doctor. The Minister says that there are areas where this will not be possible, and I agree with him. There must be areas where the amount of remuneration a dispensary doctor would get if he were left on his own would be pretty small. There must be subsidisation from the State in one way or another. There are other areas where it should not be at all difficult to operate the panel system.
One of the troubles that occasionally arise is when a person comes to the doctor who, for one reason or another, has stayed completely outside the Health Act. We have an example of this. This man is a very good doctor and as a result many people go to him. Many maternity cases go to him. They are cases that would normally be paid for by the local authority. They are referred into a hospital. Full expenses are paid and when they return home, they get a bill from this gentleman who has been attending them in the hospital for his services. Further than that he has now adopted the system of having a debt collecting agency attempting to collect his bills. I passed the information about this on to the Minister and I am hoping that the matter will be dealt with.
As I say, he is an excellent doctor but if we have reached the stage where professional etiquette allows a debt collecting agency not alone to collect by way of letter but to pull up a van outside a patient's home with the name of the debt collecting agency in large letters on the van, for the purpose of blackmailing into paying people who were under the impression that they did not owe anything and, in my opinion, did not owe anything, it has gone too far. It is something that 99.9 per cent of doctors would abhor but if one of them does it, he should be stopped. He should not be allowed to do it. As I say, I am waiting with interest to hear what the Minister decides to do about this matter.
We had the question of choice of doctor. When this review was being considered, the whole question of replacement of doctors came up. If somebody applies for a vacancy in a dispensary district—and there are plums, of course—up to now anybody who was qualified could apply. The Minister has included a new qualification, that the applicant must be in an existing dispensary district. This, of course, means one thing. It means that the districts where the dispensary doctor finds he is not doing well, the ones where a dispensary doctor will have to be kept, according to the Minister's suggestion, will be milked dry of those people because they will all go for the plum jobs.
The other day, when the Minister was making a statement here, I referred to the fact that this had been going on for some time but that when I asked questions about it, the Minister denied that it was so. I should like to refer to the Dáil Debates of 17th November, Volume 225. At column 1375, Deputy Treacy asked
the Minister for Health if he is aware of the urgent need which exists for at least two dispensary doctors in Clonmel ....
The Minister replied to that question and I then asked:
Would the Minister say if it is true that the filling of vacancies for dispensary doctors is becoming more complicated and more difficult because of the fact that his Department are insisting that only those at present employed as dispensary doctors are entitled to apply for such vacancies?
The Minister said:
I do not think it is relevant to this question.
I said:
But is it true?
The Minister said:
I will not answer that.
I said:
I will put down a question next week and the Minister can answer that one.
The Minister then said:
Yes, I will be glad to. As a matter of practice, I am not particularly enamoured of answering questions which, by implication, suggest that a situation exists which does not in fact exist——
