Before the Minister speaks will he take notice of this poster?
Committee on Finance. - Vote 48: Health.
The Deputy must not do a thing like that in the House. The Deputy will sit down. This is disorderly.
I move:
That a supplementary sum not exceeding £1,500,000 be granted to defray the charge which will come in course of payment during the year ending on the 31st day of March, 1970, for the salaries and expenses of the Office of the Minister for Health (including Oifig an ArdChláraitheora), and certain services administered by that Office, including grants to Local Authorities, miscellaneous grants and certain grants-in-aid.
The Supplementary Estimate before the House arises from adjustments in the course of the year in levels of remuneration for certain health authority staffs, including general and psychiatric nurses, as a result of arbitration awards and Labour Court recommendations.
These awards had retrospective effect in most cases and the expenditure resulting from them in the current year includes a substantial amount of arrears.
The awards for nurses account for the bulk of the provision mainly by reason of the numbers involved; about 4,500 psychiatric nurses, and 4,300 general and public health nurses benefited from the improved scales.
The total additional expenditure arising in 1969-70 is estimated at £2,830,000, of which the Vote for my Department will meet just under 56 per cent. The additional provision now sought is based on this percentage. The remainder of the additional expenditure, that is approximately 44 per cent of £2,830,000, would, in the normal course, fall to be met from local funds. To a considerable extent, this expenditure would emerge in the form of debit balances in the accounts of health authorities to be carried into the year 1970-71 and to be covered by the rates in that year. As I have already informed the House, however, I am providing in the grants from the Health Vote for next year a sum of about £2½ million which, with the statutory and existing supplementary grants, will enable the health rate in each area to be maintained at not more than 2/-above the rate for the current year.
It will be clear to Deputies that the supplementary funds which I am seeking reflect the upward trend in remuneration generally. In the health services, the remuneration element is of special significance. As working hours are shortened and rates of pay improved and as the services become more highly developed, this feature becomes more marked. The services are, of course, by their nature labour-in-tensive, and they are continually becoming more complex as medical science advances. It must, therefore, be clear that if we are to have the best services that can be provided from our resources the administering authorities must keep them under constant review so as to make the best possible use of manpower and equipment.
In concluding, I should explain that in not giving Deputies a wider review of the health services in a token estimate debate, and in not circulating the customary statement of health statistics and information, I am influenced by the fact that comprehensive debates have taken place in the recent past on the Health Act and also that I will be seeking an early debate in the post-Easter Dáil session on the 1970-71 Estimates of my Department. As Deputies will be aware, expenditure in relation to the new health boards and hospital boards in respect of the period during which they will exist but not be functional is being borne entirely on the Health Vote. The same applies to the initial expenditure involved in the establishment of a system for paying retail chemists for prescriptions dispensed by them for lower income group patients. These will be novel charges on the Vote and will require approval of the Dáil before expenditure can be incurred. Consequently the Estimate will have to be taken very early in the new financial year, and in advance of its introduction a comprehensive statistical statement will be circulated to Deputies.
I want to add in this connection— perhaps I have not made it sufficiently clear—that, as we did have very prolonged debates on health last year and the debate on the Health Bill and as the debate on the Estimate will have to take place literally within the first week of Easter in order that I can engage in fresh expenditure arising from the now signed Health Act, I did not really feel that the Deputies would want prolonged debate this evening. They will have all the information and all the opportunity necessary to debate the health services very shortly after the Easter Recess. I have asked the Parliamentary Secretary to give me time and I think he will give me time in the first week of the session after Easter.
We can sympathise with the Minister in his desire that the debate this evening should not be too prolonged because we have had what might be called a surfeit of discussion on health matters. We did not always reach agreement and I suppose we seldom if ever will. We are unlikely to reach agreement this evening on the few matters we will discuss, although there are some on which we may not find any very large area of disagreement.
There is one thing that needs to be said and the Minister has said it. It is that this Supplementary Estimate is mainly due to increases in pay for the nursing and medical and other staffs of health authorities. The fact that it is £1,500,000 is not something about which we should make any complaint because there is no use expressing sympathy with the nurses unless that sympathy is supported with the hard cash necessary to pay them in accordance with their skills and with the dedication and application which they bring to their very onerous duties.
When I say there is no use in expressing sympathy for nurses without giving the support necessary to translate that sympathy into benefit for nurses I address my remarks not merely to the members of the Government or to all the Members of this House but to the Irish people in general. They will have to accept that if Ireland is to have the nursing service which it has had in the past it will have to pay Irish nurses in accordance with the standards which their skills and duties deserve. That is a humanitarian obligation which we must not hesitate to shoulder any longer.
It is also an economic necessity because if it is not done we will continue to suffer from the considerable drain from this country of qualified nurses and of girls who are about to be qualified as nurses. We seldom thought that we would see the day when nurses would be in short supply in this country. I think it was because of the assumption on the part of administrators down through the years that that would never occur that the levels of remuneration and the conditions of employment generally here were very much below what applied in other progressive countries. That temptation to trim because of the supply of nurses the rewards given to them may have kept down the level of remuneration in the past; but that can no longer be accepted by even the most niggardly administrator or politician because today nurses will simply not stay in the service of Irish hospitals, voluntary or public, unless the remuneration given to them is at an adequate level.
It is not, of course, only a question of remuneration which brings 3,000 nurses walking to the gates of Leinster House today. It is a question of getting reasonable conditions of service, so that they may have some of the enjoyment and the leisure available to people in other walks of life. It is also a demand that recognition be given to nurses for their qualifications and experience and that we end the system whereby what are termed "temporary" nurses—in many cases married nurses—are obliged to accept remuneration well below the rate commensurate with their qualifications and experience.
Some years ago in the Department of Education the Minister had to accept that if married teachers were kept out of the teaching service the necessary standards would not be maintained. There must be a similar and unbegrudging acknowledgment in the Department of Health that all nurses are entitled to remuneration according to their experience and qualifications, irrespective of whether they are classified as temporary or as married. This requires a break with tradition, a departure from the rules and regulations so much beloved by the bureaucrats, but it must be done. To treat nurses any longer as a class apart is a practice which will have to end once and for all.
When all other sections of the community are enjoying shorter working hours it is regrettable that nurses are obliged to work long and arduous hours. The Irish Nurses Organisation have asked that the 40-hour working week be introduced: this is not a revolutionary request but a most reasonable one. At present this House has before it a proposal from the Department of Labour that the maximum number of hours people be asked to work in any occupation should be 42½ hours. That standard is not a generous one. It is regarded as the very maximum beyond which it would be intolerable to ask people to work, but nurses by the very nature of their duties work under constant and unrelenting pressures to which many people in other walks of life are not subjected. They must work also at night and they deserve to have reasonably limited hours of work so that they can give of their best. A tired nurse is unlikely to be a good nurse; she may be giving of her best but when she is tired she cannot be as efficient as she would normally be.
In the structure of our hospitals, where many are run and owned by religious, opportunities for promotion of experienced lay nurses are very limited and this is causing a considerable amount of disquiet, disappointment and frustration among the nursing profession. Some years ago it was strongly recommended to the Department that they establish a new career structure so that there would be deputy or junior ward sisters. This would be of some relief in the present unsatisfactory promotional arrangements but there has been considerable reluctance on the part of the successive Ministers to introduce such a small measure. I hope, therefore, that the orderly and disciplined protest today on the part of the nurses organisation will have its effect in showing the Minister that the nurses are intent upon getting this and other reasonable reforms. It must be some consolation to the Minister to know that the demands of the nurses have, so far as I could ascertain, been acceptable to all Members of the House with whom I discussed the matter and I do not think the Minister would have any difficulty in getting from the House the money necessary to give better conditions of service to the nursing profession.
Another aspect of the nursing profession which the Department overlooked is the considerable benefit which could flow to hospitalisation and nursing activities in general if the necessary work study and research were conducted. Efforts have been made to get the Department to undertake this work but very little has been done, in fact, the Department's main contribution in this field has been to discourage others from engaging in work study and research. Ten years ago the International Labour Office pointed out that systematic measures should be taken by the responsible authorities to apply and extend work study, occupational research and job analysis in the nursing field. This activity has also been strongly recommended by the World Health Organisation. They have stated that research into improvements of nursing care should be promoted as an essential part of the planning of health services and that opportunities should be provided for nurses to be prepared in research methodology through such means as training grants and fellowship studies.
The present Minister is a man who is inclined to this type of activity and he has pursued it in the other Departments for which he was responsible. One hopes that under his jurisdiction the Department of Health will embark upon an intensive course of work study and research. This would bring immense benefit to the people we must primarily consider—the sick and disabled—but it will also have the attraction of making nursing more personally satisfactory. There is nothing more frustrating than to be qualified for a particular professional activity and then find you are unable most of the time to apply the skills and learning because you have to perform duties not pertinent to the qualifications you hold. Many of our nurses have had to pay dearly for learning the skills of their profession and one hopes that the day is not far distant when an Irish hospital will not dare to charge for training pupils nurses. If we continue on this downward slope we will find ourselves perhaps in the position of the Scandinavian countries and the United States and have to supervise our sick people in hospitals by means of television sets and computers rather than with the human and skilled touch that nurses alone can give.
The Minister has emphasised that we shall be having a longer debate when we are dealing with the main Estimates after Easter. Therefore, I do not wish to chase after many other matters that are provoking me but there is a point I recently raised in the House and one I would emphasise again today. It is the problem of dermatitis and skin irritations developing from the use of detergents. The Minister indicated his information was that this was not a considerable problem and he was not inclined to accept my suggestion that there should be very careful tests conducted on all detergents and washing powders before they are made available on the market.
I asked the Minister to invite the general public to notify him if they had experienced dermatitis or any other skin complaints as a result of having used these detergents but the Minister said he was afraid to issue such an invitation because it might produce a wrong result. Apparently, he was not afraid that it might produce a right result. Within the past week or fortnight I, from my inferior position by comparison with the position of the Minister, issued such an invitation and the results have proved worthwhile for me personally and, perhaps, may prove worthwhile for the Minister because I suggested that people might convey their complaints directly to him if they did not wish to convey them to me. I have already forwarded to the Minister any correspondence that I received up to last Sunday but I can tell the Minister now that I have received twice as much since then.
The results which I received give a clear indication of the allergies that can be attributed to the use of detergents and this danger appears to be multiplied with the growth of biological or enzyme detergents. Of course, the Minister gave very good advice to people when he told them to wear gloves or other protective covering on their hands while using these powders but I would urge the Minister to request that this advice be printed on all detergent packets. This advice will not discourage the use of detergents because people will still be as anxious to keep clean in the future as they have been in the past, but it is a precaution.
Perhaps one of the reasons why the Minister and his Department do not know more about this problem is that most people keep it to themselves and hesitate to bring it out into the open. There have been a few cases in the civil courts of people who sought damages against the manufacturers of certain detergents or soap powders but they were unsuccessful because of a point of common law which says that if a manufacturer of a product is able to show reasonable care in the production of the product, he is not responsible if somebody suffers as a consequence of having used it. From my own experience as a solicitor, I can say that many people have consulted their lawyers for the purpose of recovering damages against manufacturers of detergents and soaps but have been advised because of the position of the law that there was no point in taking the case further. The result of this is that most of these cases do not come to the notice of the Minister or his Department but only come to the notice of general practitioners or, perhaps, specialists in allergies and, occasionally, to the notice of the family lawyer.
The incidence recently of more powerful detergents which are whiter than white and which eat dirt has, apparently, aggravated this problem. One of the letters which I have received and which I have passed to the Minister was from a lady who had experienced difficulty in the past. She took the precaution of wearing rubber gloves but latterly she has discovered that the enzymes or biological activity is so powerful that it is causing a disintegration of the protective qualities of the gloves so that her hands are again directly affected. I have no wish to be an alarmist in this respect and I particularly do not wish to make any accusations about one particular product more than another. However, I wish to say that the letters I have received have named a multitude of washing powders, soaps and detergents and were not confined to any particular brand. That should be said in case there might be any general misunderstanding of the position.
May we express our disappointment that legislation to improve arrangements for the control of drugs and poisons was not introduced during this session of the Dáil which is now coming to a close. Last year the Minister promised that we would have such legislation and, therefore, it is very disappointing that it did not come during this session. A fresh promise was made by the Minister on the 5th February when he said that he would introduce the legislation during the next session. We are very anxious that he should do so and I can assure him that if his proposals are reasonable and if they are helpful, we, in Fine Gael, will certainly expedite the passage of any such legislation through the House.
Recently we have had discussion on the considerable shortage of maternity beds on the north side of Dublin city. The Department of Health are moving rather slowly in relation to the provision of maternity beds in the northern region of Dublin. This is something which does not arise so acutely on the south side of the Liffey, although at times it can present its own problems there, but it is presenting a very severe problem on the north side. I would urge the Minister to take all steps possible to ensure that there is ample provision of pre-natal, natal and postnatal beds on the north side of the city because it is in this region that the growth centre is at the present time. If we do not provide the necessary facilities there may be some serious and embarrassing consequences. Any other remarks I wish to make might better be kept until after Easter.
With his short statement, the Minister has, as Deputy Ryan says, determined the kind of debate which we will have here tonight. I have a tremendous amount to say about health in spite of the fact that we had a very recent debate on the subject during the passage of the Health Act, but I accept the Minister's suggestion that on this occasion we should confine ourselves. It is quite obvious that the only fruitful debate one could have would be a debate after one had heard the Minister's views on the various subjects which I proposed to raise on this Estimate. I fully appreciate that the Minister has just taken over the Department and that, probably, he is only now formulating his views on the various subjects which I will certainly raise on the Estimate later. However, in fairness to the Minister perhaps the longer he has to think about the problems facing him in this very important Department, the more valuable will be whatever comments he has to make when he is introducing his main Estimate and the more useful will be our criticims and comments on that Estimate. If I were to continue without first hearing the Minister's views I might find later that I had been taking a line on which the Minister would agree so I shall wait until I hear his speech as I do not wish to unduly waste the time of the House.
The Minister gives me the impression at times that he has become rather impatient of us questioning him in the House on health matters but he has the advantage of having spent all his life in Government whereas I spent virtually all my life in Opposition with the exception of three short years. The Minister must understand that if we are to contribute usefully to his Department's Estimate we must have reliable information on which to act. It is by listening to what he has to say and inquiring through the medium of Parliamentary questions that we can create our own belief in order to deal with the matters the Minister puts before the House. This is something which might be obviated by a better secretariat on the part of the Opposition, or some other method, but, for the time being, I hope the Minister will appreciate that all I am trying to do eventually is to make a helpful contribution to his very difficult task in his Department.
I must say at this very early stage that I am impressed with the apparent energy with which he approached his work and any implied criticism is not a criticism of him—it could not be because he has only taken over—but a criticism of his predecessor who must, I think, have been the most irresponsibly inept Minister for Health we have ever had. It is clear from the answers I get to questions that, in a general way, nothing was done about this very important subject of psychiatric services despite a most comprehensive and valuable report produced as far back as 1966. The advances have been minimal. Here, again, of course, I am not blaming the permanent staff of civil servants—it is not their business to initiate policy: their work is to implement policy—but I am blaming the Minister's predecessor, Deputy Seán Flanagan, for his failure to discharge his responsibilities during his period in office as Minister for Health.
The main subject of debate tonight is the remuneration for certain health authorities' staffs, including general and psychiatric nurses. The Minister said: "...the remuneration element is of special significance. As working hours are shortened and rates of pay improved and as the services become more highly developed, this feature becomes more marked." The Minister is without any doubt facing a crisis in practically every aspect of the health services, not alone in the aspect discussed by Deputy Ryan but in all the medical and para-medical services because of the tremendous shortage of staffs of all kinds, but particularly nursing staff.
I think only those with a real vocation go into nursing. The hours are appalling. The work is very demanding, very responsible and frequently very distasteful, physically and emotionally, making enormous demands. The training is hard. I cannot pretend that this is the first time I have concerned myself about the welfare of the nursing profession. The first ever struggle I engaged in was on behalf of the nurses many, many years ago. As one who has had a fair share of ill-health. I have a particularly high regard for the nursing profession and I sincerely hope the Minister will look into the whole establishment of the nursing services as a matter of grave urgency. The impression I have is that girls are driven out of nursing. They are certainly discouraged from going into nursing. The conditions under which they train are reminiscent of the Victorian presumption that the youngster is a juvenile delinquent and must be treated as such. The discipline is out of date. This is damaging because it discourages girls from going into nursing. The young girl who comes to town and works as a shorthand-typist in the Civil Service, or elsewhere, can live her own life. There is this “in loco parentis” to justify the Victorian discipline in so many of our nursing homes but girls do not have to put up with that kind of thing any more.
Fewer girls are going into nursing and one of the things which will alter even the present poor intake into the nursing profession will be free secondary education. Despite what Deputy Ryan said, there is access to the profession without a fee. If one goes to Britain one can qualify as a nurse reasonably easy. With free secondary education girls in future will go into other forms of employment and there will be a serious shortage of nursing staff. That is already developing. There was a serious shortage in Britain about 20 years ago and now the whole attitude in Britain in the training hospitals is completely different. That was not engendered because the hospitals became more enlightened; it was engendered because they realised that the methods they were using were discouraging girls from going into nursing. Conditions have altered considerably. Today nurses in Britain can lead normal social lives.
There is, too, the attraction of Canada, the United States, New Zealand and Australia. Anywhere in the English speaking world nurses are gladly received and very well paid. The Minister is competing against that. Nurses are going abroad in their hundreds. I do not know how or where the Minister will find the money he will need to improve the living conditions here for our nurses, to shorten their working hours and increase their pay. He will have to compete with the enormous salaries they can command abroad. I do not think nurses in Britain are as well paid as they should be but the recent 20 per cent increase there will be a powerful magnet drawing off nurses from this country, thereby increasing the Minister's many difficulties.
He is in a dilemma because, of course, he, in fact, does not control voluntary hospitals. I do not know what he is going to do about this. It is a problem. He will hear about it on the Estimate. We have got to face this merger of the local authority and the voluntary hospitals. How far will the Minister go? How far will he carry it? The local authority hospital is now in most cases providing just as good service as the voluntary hospital. The old day when the voluntary hospital predominated and provided a magnificent service, and the only magnificent service, has gone. In the last 50 years whatever defects there are in the public health service, there has been a great improvement in many of the country hospitals, the regional hospitals, in the provision of the peripatetic specialists, radiologists, gynaecologists and so on. So, we can now say we are providing just as good a service as the great old private hospitals, St. Vincent's the Mater, Dun's, the Adelaide, and so on.
The voluntary idea is completely gone. The Minister pays their deficits from hospital funds or through taxation or rates. The central authority is now really paying for these services. How far will the Minister go? Will he say: "I am paying for the services. I must now be permitted to lay down certain conditions under which my employees will be employed"? I remember away back coming to that realisation of how little power I had as Minister for Health when I was told that I could not send an inspector into a voluntary hospital, except as a matter of courtesy, in regard to something that had happened and that needed to be investigated.
Is the Minister going to try to impose what he considers are enlightened views where these enlightened views are needed? There are a number of voluntary hospitals which have very good nurses' homes and very good attitudes to their nurses. They are not all the same. Some are better than others. Is the Minister going to attempt to impose any kind of uniformity so that they do not continue with their outmoded practices and in that way discourage young people from coming into the nursing profession? This is a very delicate problem, one with regard to which I got very badly hurt many years ago in my attempt to create the right of the lay nurse to move up the line in a hospital run by a religious order. I was, of course, accused of try-being a communist and accused of trying to drive religious orders out of Ireland, and so on. The Minister will be in much the same dilemma if he attempts to—"interfere" is the word, I suppose—to change this in any way but they are the majority of the training schools. He will have to do something, whether he can do it through An Bord Altranais, whether he sets up a separate college of nursing, whether he gets them in and asks them to face his dilemma in trying to keep the public health services staffed as they expand, as they are expanding continually and will greatly expand under the Act next year, whether he gets them in and asks them to realise that they must provide incentives for youngsters to go into the nursing profession rather than continue the many serious disincentives which exist in many cases.
The only reason a young Irish girl really goes into one of our training schools now is that her mother will not allow her to go to England. It is virtually true to say that. It is understandable. Most parents would prefer that their child could be trained here. Equally, there is the point referred to by Deputy Ryan of the fee-paying, which is abused.
It is a very serious problem. The Minister would be well advised to go into it as rapidly as he can, as soon as he can. On his Estimate I will deal with the other matter of the relationship on the doctors' side —that is another very important question—the whole system of appointments to the voluntary hospitals to carry out services paid for by Local authorities; the need for the Local Appointments Commission rather than a continuation of an appointments system which we believe is not as efficient. With all its defects, and the Local Appointments Commission has many defects, it has the reputation of integrity. It is a system which has been accepted by everybody for a very long time. It can be improved. This is another very difficult problem with which the Minister will have to deal. It would be wrong of him not to face up to it. The voluntary hospitals will have to be told by the Minister: "I have to provide a certain quality of service, whether it is a nursing service, a medical service or a paramedical service. I must be certain that I am getting the quality that I am paying for and I can only be sure of that if I have a system of appointment which I can trust". I shall take that matter up later on in greater detail.
I am very glad to hear today that the Minister is doing something about the question of conciliation and arbitration for local authority employees. He did not have the time. It is some years since this question of changing the structure, remuneration, conditions of service, and so on, was first entered into and the managers had simply done nothing about it until relatively recently when, it appears to me at any rate, the Minister intervened effectively and with his colleagues is now going to provide some sort of central organisation which will facilitate and expedite the activities of this whole machinery of conciliation and arbitration.
Delay in the consideration of salary and pay increase of one kind and another is one of the things which have led to the very serious difficulties the Minister is facing in posts like occupational therapists, psychiatric social workers, psychologists and to this problem that he has in the psychiatric service where has has so many temporary employees, and so on. All of these things stem from this basic problem of conditions of service, hours of work and remuneration and, in the matter with which we are dealing now, he is faced with competition from very wealthy countries who can offer twice and three times as much as anything he is offering at the present time to most of these types of people. Therefore, the Minister should not underestimate the enormous complexity of the job that is facing him if he wants to provide a proper health service and to provide the staff with which to run it.
Has the Minister come to any decision about the demand for a 40-hour week which the girls are making? It seems to me to be a reasonable demand. When I was in the Government I was amused on an occasion when the hours of work of the judiciary were being fixed. They were miniscule. I think two or three hours were the maximum because after that they got tired or felt they were not discharging their functions as efficiently as they should. It certainly was the tiniest output of work or labour one could ever conceive.
This applies very much to the nursing profession. Regard should be had to the fact that the work is so responsible and so demanding, that it requires such a higher and higher level of technical skill and knowledge, and that shorter hours of work will lead to a better nurse and a better nurse will lead, of course, to a better service. The Minister has asked for money for the Central Mental Hospital in Dundrum.
The next Vote to come before the House will deal with that.
We are not taking the two together?
No. They are being taken separately.
We in the Labour Party have absolutely no objection to this Estimate. I hope it will go some way towards meeting the demands of the staff involved in the local authority service. From what I can gather the Minister will be faced with even higher demands for shorter hours and for higher salaries and so on, but that is a matter for the future.
There is very little that I can add to what has already been said by the two previous speakers. I want to join with them in paying tribute to the dedicated service given by nurses over the years. I do not think we have to impress this on the Minister. We do not have to impress on him either that if we are to continue to get this service we will have to pay for it. As Deputy Dr. Browne has just said, if we do not improve conditions and salaries we just will not get the staff required in the hospitals.
At present there is quite an acute shortage of nurses in the various hospitals all over the country. There are some hospitals here and there that feel happy enough about the situation, but there are many hospitals that are very much under-staffed, very much under strength, and this places quite considerable extra strain on the reduced number of nurses. Unfortunately there is nothing much that the people in the hospitals can do about this except to call on the reduced number of nurses to put in that extra effort and do the best they can to look after the patients.
There are one or two small items I should like to draw to the attention of the Minister. Deputy Ryan drew his attention to the unrest in the nursing profession that has been manifested this evening by the large number of nurses who marched from Parnell Square to Leinster House. He described this as a protest. It is not exactly a fair way to describe it. Nurses are not given to protesting in that way because the last thing they want to do at any time is to leave the job, so to speak, or upset the patients or anything like that. They are endeavouring in this way— it is one of the ways nowadays by which attention can be drawn to what can be described as grievances—to draw attention to the fact that for some considerable time they have been making a case for certain improvements and apparently these requests for consideration have not been taken too seriously, or certainly not taken as seriously as they should be.
Mention has been made of a 40-hour week. At present they work a 42½-hour week. There are many hospitals and institutions in which nurses are really being called upon to do much more than this. They feel they cannot walk out in circumstances in which nurses are in short supply. One of the matters raised with me on numerous occassions in that nurses here, like everybody else, should be entitled to be paid overtime for work in excess of the normal working hours. Because of the shortage of nurses there are many occassions on which they would not object to working these extra hours if they were paid for them as they should be, and as people in all other walks of life have to be paid. It is no harm to draw the attention of the Minister to this aspect of the matter.
Deputy Dr. Browne mentioned that something was being done to improve the system of arbitration and conciliation. I take it he was referring to the circular sent out by the Minister for Local Government in which he says he is setting up a secretariat—I think it is best described in this way—to deal with claims coming from the local authorities to the Department, and coming to the various Departments and also going to the Labour Court. It is essential to do this because it is not easy for people on a voluntary basis nowadays to prepare their cases as they should be prepared, and must be prepared if there is to be any hope of success unless this sort of machinery is in existence.
There is a serious flaw in the proposal and that is that the Minister for Local Government will select and appoint the members of this organisation or the staff of this organisation. I do not know which he would like to call it. The Minister will appoint the people who will make the case to fight for better conditions from him. The Minister for Health will see in this something that would give rise to suspicion and, if a claim were not successful or was only partly successful, a feeling that their case was made by the Minister's own friends and they were let down. I would ask the Minister to have a word with his colleague before this is pursued to the point of setting up an unsatisfactory secretariat or machine for the processing of applications for improved pay and conditions.
In connection with the unrest referred to this evening it might be no harm to draw the attention of the Minister to one aspect of it. The present position is—and this is agreed by the Irish Nurses' Organisation— that promotional outlets are filled by open advertisement, so to speak, and all are free to compete. They want that procedure to continue but, at the same time, they want the positions to be advertised for particular hospitals or institutions. That is being done. What they are dissatisfied about is that when a health authority advertise and the interview board is set up, the members of that board are entirely selected from the health authority concerned and there are no outsiders on it. The nursing organisation would be much happier if several members of the board were selected from outside, from the voluntary hospitals perhaps, qualified people but not members of the particular health authority. There is a feeling of possible partiality.
Another thing nurses complain about is the system of marking. Where you have nurses working for a considerable time as geriatric nurses a very strong feeling exists that they are marked down because of this and that where there is promotion in a hospital marking should be weighted in favour of geriatric nursing. In the particular hospital which has given rise to the present unrest the feeling is that this was not done, that there was not sufficient recognition of this fact in this specialised chest hospital.
Small improvements of this kind could lead to much more satisfaction. The whole thing could be smoothed out easily. If only because of the acute nursing shortage, it is essential that the pay and conditions, the promotion system and the career structure of nurses, should get the closest examination at the earliest possible date by the Department and by all the people concerned with ensuring that there will be an adequate supply of nurses in this country.
I thank the Deputies for the constructive character of their remarks. I am glad they co-operated with me, knowing there is to be a longer debate after Easter. I want to say, first of all in relation to the big procession that took place today, that I got information of this only 24 hours ago and therefore I could not possibly have examined all the matters that were referred to. There is normal machinery for negotiation between the managers and the nursing organisation on these matters. At the same time I am always willing to see the Irish Nurses' Organisation if they want to talk about major problems in relation to nurses. I intend to see them later and to study the various proposals they have made. I also intend to examine a report from the Dublin Health Authority. An Bord Altranais are examining the various questions in relation to the vocation of nursing in this country. They have a number of matters under review. I will be talking to them in the next few weeks.
I join with Deputies in praising the splendid vocation of nursing. I am very glad nurses have been able to improve their position in the past few years and I will always be willing to examine sympathetically any claims they may have. The question is: at what rate can progress take place in relation to the total cost of the health services? We always have to bear that in mind.
When I became Minister for Health I was glad to notice that nurses had been able to secure some considerable improvements in their remuneration and conditions during the past few years. Prior to the last British award, the maximum of the nurses' scale in Great Britain was marginally lower than here but in Britain the scale of increments was shorter than here. So until the recent British award the actual pay of nurses there bore some reasonable relationship to the pay of British nurses. In recent years the 90-hour fortnight has been reduced to 85 hours. Nurses in geriatrics get special allowances and TB nurses receive £40 a year additional to the scale. This applies also to theatre nurses.
In relation to remuneration, some considerable progress has been made. The maximum of the general nursing scale, including long-term increments, has been increased in the past two years from £879 to £1,120, an increase of £241 in one year, or 27 per cent, apart from special payments for geriatrics and other special services. Nobody can say that there has not been considerable improvement. Nurses have been able to secure an increase in remuneration which would be greater than average in the community. I agree that the increase at the lower end of the scale was less, but at entrance it was 20 per cent. I am always willing to take sympathetic action towards claims of this kind which I think are worthy of consideration.
Deputy Browne likes to speak very forcefully and I know many of the problems he raised will be with us, but I do not think it is true to say that girls are being discouraged from going into nursing here. Our nursing schools have far more applicants than they can accept. Nursing has been part of our tradition here. It is true to say that conditions of student nurses may not be by any means perfect but neither are they by any means what they were up to a few years ago. Some of the restrictions on student nurses have been relaxed. What more can be done I do not know because I have no control over the voluntary hospitals. However, the attitude towards student nurses is more liberal than it was a few years ago. A great many second and third year student nurses now live out altogether. I cannot agree with Deputy Browne that nurses who train here do so because of their mothers' influence. That is an exaggeration. A great many of them train here because they want to be in this country.
In relation to whatever we can do for professional staff, people engaged in nursing and medicine, quite obviously there must be some comparison between the amounts paid in neighbouring countries such as Great Britain and here, even though we have only half the income per head of the British people; but we never can compete with American salaries and scales. No matter how much we can improve the salaries for the medical and nursing professions, in the end we will have to rely on the hope that with reasonably good conditions there will be a great many Irish people who will want to live in this country, even though perhaps the opportunities for promotion and the rates of pay are not likely to reach the level they have in certain other countries. Industry is growing, The economic growth of the country is continuing. No doubt we shall be able to afford more remuneration as the years go by. I think it is true to say that even at this moment there is a very large number of people who would not for any reason leave this country but who, if they did leave it, would get better opportunities for promotion and higher salaries than they can get here. While we want to go on improving these conditions we must bear these facts in mind.
Deputy Clinton spoke about their being a shortage of nurses. The evidence in my Department is that the shortages of nurses can be found in the hospitals in certain areas but there is no acute shortage of nurses in the generality of hospitals, taking the State as a whole, I am glad to say, although I recognise we have to look at the position very carefully and bear in mind the present position of the nursing profession. Perhaps Deputy Ryan does not know that recently there was sanction for the payment of increments up to five years to married nurses joining the service.
It is not enough.
At least it is an improvement. One cannot do everything at once. I was very glad to see that, because I think married nurses should be able to make the same kind of progress as other nurses when they join hospital staffs.
Deputy Ryan also referred to the necessity for work study. I absolutely agree with him, and I have instructed the secretary to set up a work study unit in my Department. We have to have an officer trained in that work. The object is to try and reduce administration costs and increase the efficiency of work in hospitals. It is not a question of asking people to work in a more exhausting way but of having more work done more effectively without undue effort. That, of course, is the purpose of all good work study.
Deputy Clinton made a number of points in regard to the method of appointment of ward sisters in one of the Dublin Health Authority hospitals. All the matters he mentions can obviously be discussed: the question of whether there should be some outside members on he board; the question of whether the marking for geriatric and chest hospital nursing experience is something which should be revised. I am quite willing to receive the nurses' organisation to hear their point of view. At the same time, I would hope the Dublin Health Authority and the nurses' organisation can engage in fruitful negotiations on this matter.
The Minister for Local Government has not concluded his total examination of the question of the new arbitration and conciliation machinery. I think he is aware of the various points of view of the organisations concerned, but he has not made any final decision about it.
In regard to detergents, I doubt if we have the legal power to compel manufacturers to print a notice on detergent packets advising people to wear rubber gloves. From what I know of many friends of mine, they are already perfectly aware that they must use gloves. Many people are allergic to these detergents, but Deputy Ryan seems to think there should be more publicity about it. The Institute for Industrial Research and Standards indicates that all reputable manufacturers should, in their own interest, test their products adequately before putting them on the market. Otherwise they might find themselves sued for damages in civil actions. Deputy Ryan has mentioned what might happen in that case. Perhaps warning notices should appear on the packet advising users to rinse their hands after use at least or else to use gloves. Modern detergents seem to be effective and the use of gloves seems to prevent dermatitis from taking place.
I do not think there is anything else I need say at this stage. There will be very adequate notes prepared for the House on the Estimate with a great deal of statistical matter which I hope will prove helpful.
In reply to Deputy Browne, I do not really object to questions being asked but they have been enormously numerous. I could not help feeling that some of them perhaps were matters that could have been raised on the Estimate. Nevertheless, it is quite evident that the answers to these questions have given Deputies quite a compendium of information in advance of the Estimate. Therefore, if it enables Deputies to discuss the Estimate more constructively, I am delighted that these questions have been asked. As I say, they have been overwhelming in number and it takes up the time of the staff to a considerable extent. We are very pressed for time in order to see that the Health Bill comes into operation by 1st April, 1971. I am very glad in so far as the answers to a great many questions did reveal in advance of the Estimate a good deal of the policy advocated by myself and by my predecessor for an improvement in the health services. They also revealed a number of the problems we have to face.
Once more may I say I am always willing to examine any problem put before me by any organisation representing the staffs engaged in health services. At the same time, I do believe very strongly that, in the interests of the trade unions and the organisations themselves, the normal means for negotiation should be utilised to the fullest in order that the nurses' organisation and other organisations can work most effectively, in order that they can have meaningful negotiations with the health authorities themselves. A balance must be maintained in relation to this and I think my predecessors have found that it was best to ensure that the normal negotiations continued. On a good number of occasions they have made it clear they would be glad to accept certain proposals that were put forward; in other cases they thought it wiser to wait until the proposals were authorised by the negotiating authorities. There has been a continuous pattern of this kind.
As the House knows, there have been tremendous increases in remuneration over the past three or four years in quite a number of segments of the health services, and we have to think about this in an intelligent way. We must do the best we can for the improvement of services while, at the same time, bearing in mind the effect of such improvements on the cost of living and on the capacity of people to bear the extra taxation involved.
Vote put and agreed to.