As the House is aware, the Government decided last August to extend the present "limited eligibility" health services to the entire population from April 1st next. This decision is intended to provide a free hospitalisation scheme for all. Every member of the community, irrespective of income or type of employment would be entitled under the Government's scheme to the following health services:
1. Free hospital in-patient services
2. Free hospital out-patient services
3. Free maternity services
4. Free infant welfare services
5. Assistance towards the costs of drugs and medicines, so that from the commencement of the scheme no family would be required to pay more than £4 per month for drugs and medicines.
I belive that this scheme represents a significant step forward in the creation of a socially just Ireland and is in fulfilment of the Government's commitment in their statement of intent to introduce a comprehensive system of social services in this country.
This scheme of free hospitalisation for all members of our community was widely welcomed as a major social advance and as an important social innovation. Among other things I was pleased to receive a statement from the Catholic Hierarchy's Council for Social Welfare to the effect that
The Tanaiste's initiative in this area is welcomed by the Council and is in harmony with the recommendations of the Council's "Statement on Social Policy" which was released last November.
It was welcomed for what it was— a significant re-ordering of the existing system of patchwork legislation where the quality of the medicine depended on the money in your pocket.
It is the policy of this Government to provide free hospital services for all in public wards. The policy is fully supported by the parties constituting the National Coalition and that policy will be implemented.
I want to assure this House that it is my express determination as Minister for Health to help create an Ireland where the cost of being sick is not for anybody a cause of illness. I want to assure this House that I will not be deflected from my decision— and the Government's decision—to bring in the new scheme.
The House will recall that at present only insured manual workers, non-manual workers earning less than £1,600 per year and farmers with a valuation of £60 or less, are entitled to free hospital and maternity services. By extending these services in accordance with the Government's decision to the entire population, I estimate that over 300,000 extra persons will become eligible for these services for the first time.
There were, and still are, those who did not approve of our scheme. In fact Deputy O'Malley, the Opposition spokesman on Health, was quick off the mark the day the Government announced the scheme, to voice his party's opposition. He evidently believes in a system of different standards for different income groups, although fortunately for the children of this country a distinguished member of his family did not believe that in respect of secondary education and I do not believe it in respect of medicine.
I want to emphasise that in introducing free hospital and maternity services for all members of the community the Government were not eliminating private practice for consultants or forbidding patients to enter private or semi-private wards in a hospital but were giving every member of the community, without distinction, the option of free treatment and maintenance in a public ward, if so desired.
I also want to emphasise that from the very beginning I wanted to implement my scheme with the co-operation and involvement of the consultants upon whom the hospital system ultimately depends. I extended to them my trust and I asked for their help in bringing in the new services by April 1st. My only desire was to improve the social conditions in our country by extending the hospital services.
To my intense regret I have received neither the understanding nor the co-operation which I could have expected as Minister for Health charged with the responsibility of implementing a policy decided upon by the Government elected by this Parliament.
Instead representatives of the medical consultants opposed the introduction of my scheme until such time as they decided the population should have free hospital and medical services. To some extent the fears of the consultants were understandable since a large proportion of their incomes comes from those to whom I intend to extend the benefits of my scheme. They said they were concerned about where and how they were going to recoup themselves for a falling off of this source of income.
I believed when the negotiations started with the consultants that they would be prepared to accept remuneration based on salary because they had indicated, in the context of existing services, that they favoured a contract system based on a salary with pension and other rights.
It seemed to me that our negotiations on the new scheme would go on from there and would be concerned primarily with determining the compensation they were entitled to because of any losses in their private practice arising out of the Government's proposals.
Unfortunately since negotiations began the consultants moved from the salary form of remuneration and introduced the idea of a system of payment for each item of service.
They now wish to secure an option for every consultant, between a salary, on the one hand, and a fee per item on the other. What the consultants are talking about is so much for one type of operation, so much for another and so on. This fee per item option constituted a new and unexpected element in the negotiations.
We have tried to persuade the consultants to drop this idea, because this type of payment could lead to bad medical organisation and it is very difficult to cost. But the issue of the fee per item payment presents great difficulties and at a certain stage appeared to me that it could lead to prolonged and protracted negotiations.
Since I could not resolve that matter quickly, I made an interim proposal to the consultants, which would protect their incomes, permit negotiations to continue and allow me to bring in the scheme on schedule.
The proposal was that consultants would be paid on the present basis for patients who have an income under £2,500 per year and at voluntary health insurance rates for public patients earning in excess of this amount. The terms of this interim proposal were to have applied until final agreement was reached with the consultants.
The consultants rejected this proposal.
I had, therefore, to consider other alternatives. Clearly no new scheme can be worked if the consultants refuse to take part in it. They have the freedom to refuse to work any scheme which they do not like, no matter how much the scheme might benefit the public at large.
I wrote to the medical organisations representing the consultants and said that in view of their attitude I intended to introduce only those parts of the scheme which did not involve their participation or affect their incomes Those portions of the scheme which I referred to were: (a) free maintenance in public wards and (b) the drug subsidy scheme. I also proposed to revise upwards the income limit for free hospitalisation so that the existing free services could be in part extended to some of those over the present limit of £1,600 per year.
The consultants have also rejected this compromise reiterating that final agreement on rates and methods of remuneration for them must be made before any part of the scheme can come into effect.
I am, therefore, faced with a very difficult choice. I can either postpone the entire scheme for free hospitalisation until final agreement is reached with the consultants, or I can seek to implement those parts of the scheme which do not rely for their implementation on the co-operation of the consultants.
In relation to the latter, I have to tell you that the consultants have, as indicated already, rejected any introduction of any part of the scheme, even those parts whose practical working does not depend on them, until their pay position, on a fee per item or salary option has been satisfactorily concluded from their point of view.
I had to consider what would happen if I were to introduce on schedule even the modified scheme to which I have referred.
As I have indicated to the House the consultants had said they would refuse to co-operate in implementing the scheme unless final agreement on salary and conditions were reached with them. They repeatedly refused to spell out what they meant by non-co-operation but to me this implied serious disruption of the existing services.
Any Member of this House or of the public could read a report in Monday's Irish Independent to the effect that “the doctors' negotiating body will refuse to co-operate, and that vital services, except for emergency cases, will be withdrawn in protest”.
If this is what the consultants have in mind, or if they propose to restrict admissions to hospitals, then human health and even life could be placed at risk. I am not prepared to take such a risk.
Deputies must all recall the very serious prospect that faced us when the junior hospital doctors were involved in a work to rule and I cannot allow the risk of a similar situation developing and, perhaps, actually occurring.
For the public good I have decided to postpone the introduction of the free hospital scheme for a limited period in order to avoid any danger to human life and to avoid confrontation with the consultants on this occasion in the hope that they will reconsider their general attitude.
In order to effect a settlement so that the free hospital scheme can come into operation as soon as possible, I propose to establish a body to look into the present systems and rates of payment and incomes of consultants and to make recommendations on the system or systems which should operate when the limits are abolished. The findings of this independent body should help towards finally reaching a settlement which will allow the full implementation of the Government's scheme.
Accordingly, it is not the Government's intention to move the motion dealing with the Health Services (Limited Eligibility) Regulations, 1974.
There are some points arising in relation to liability from the 15p health contribution, voluntary health insurance cover and the scheme for drug subsidies which I have to consider following on this decision and I intend to make a statement on these when introducing my Estimate tomorrow morning.
