asked the Minister for Health the immediate steps he proposes to take to alleviate distress and prevent danger to patients as a result of the partial withdrawal of services by junior hospital doctors.
107.
Private Notice Question: - Junior Hospital Doctors' Dispute.
106.
asked the Minister for Health the extent to which hospital admissions will be curbed by the dispute with junior doctors.
asked the Minister for Health if, in the light of the present serious breakdown in the hospital services and the consequent danger to patients' lives, he will initiate immediate discussions with the involved parties to resolve the present impasse.
With your permission, a Cheann Comhairle, I propose to take the Private Notice Question and Questions Nos. 106 and 107 together.
I have already taken all reasonable steps open to me, firstly, to prevent the situation from developing to the stage it has now reached and, secondly, to minimise the effects of the action taken by junior hospital doctors against the advice of the Irish Medical Association and the Medical Union.
The present dispute relates to new claims for improvements in remuneration and conditions of employment made by the Medical Union dated 3rd October, by the Irish Medical Association dated 11th October and by the Medical Union dated 18th October. I met representatives of those two organisations on 10th October. Representatives of my Department and of the employing authorities conducted negotiations with representatives of the two organisations, including some junior hospital doctors, at meetings on the 15th, 19th, 23rd, 25th and 30th October. At the meeting on 30th October, an offer was made. The two organisations involved are at present conducting a ballot on the offer and, pending the result of it, they have requested the junior hospital doctors to continue working normal hours. In accordance with the usual practice, I must await notification of the outcome of the ballot. I should make it clear that the claim rejected, following arbitration, at the end of September had been made on a totally different basis to the new claims made during October.
The offer made to the doctors on 30th October, was a responsible and reasonable one to meet the immediate financial aspects of the claims made. The increase in the case of interns was from £1,959 to £2,237 a year. For house officers the existing salary range of £2,143 to £3,213 would go to a range of £2,487 to £3,710 and for registrars the existing range of £2,855 to £3,742 would go to a range of £3,315 to £4,294 a year. The claims also related to other things including living out allowances and provision of telephone and I have conceded these.
Perhaps most important in the long-term was a claim that there should be a better career structure for junior hospital doctors. This, too, I have accepted in principle and I would see to it that the necessary studies to establish this career structure should be completed within a fixed timetable.
My earnest desire to have this dispute resolved can best be judged by reference to the speed with which I dealt with the claims. Complex claims were made between the 3rd and the 18th October; a realistic offer was made on the 30th October.
On the 24th October, as a matter of prudence, I had a letter sent to all hospital authorities giving them the full facts of the position to date. The authorities were requested to assess the situation which might arise after the 1st November as a matter of urgency with a view to their taking whatever steps they considered necessary to maintain essential and emergency services in their hospitals.
I have been keeping in close touch with the situation in Dublin and throughout the country since Thursday last and medical officers of my Department have visited several of the major hospitals in Dublin to obtain information on the spot.
As Deputies will be aware, hospital authorities have made arrangements with the consultants attached to the hospitals to provide services and cover in the light of the situation which had developed. The facilities being provided inevitably involve some curtailment of normal services such as the deferment of the admission of non-urgent cases and the cutting down of out-patient activity. The arrangements made will impose some considerable strain on those concerned and on the overall situation in the hospitals. In the circumstances, I would appeal to the public not to seek attention at the out-patient departments of hospitals where it is not essential to do so but rather to avail of the services of general practitioners. I would like to make a special appeal to general practitioners to do all in their power to ensure that the minimum demand is made on the hospitals at this time.
As regards the question of further discussion with the involved parties, I am willing to meet them just as soon as the situation regarding the offer already made has been clarified.
Could I ask the Minister to state whether, following investigation by officers of his Department at various hospitals, he is satisfied that the lives of patients are not being endangered by the present dispute? May I also ask if, in his capacity as Minister for Social Welfare, he is aware that many hospitalised patients are not being granted their social welfare certificates and will, in consequence suffer serious financial hardship and what action he proposes to take to remedy this matter?
That matter has been brought by the Deputy to the attention of the Department of Social Welfare and satisfactory arrangements are being made to ensure that these people will not be deprived of their social welfare benefits. In regard to the other general question, I do not think the responsibility is entirely on me as to whether the patients are treated in the normal way. There are two sides to this dispute, and I think I have done everything possible within a very limited period in order to satisfy, as I said in the reply, the financial claims by the doctors, career structure and all the other things that are involved. I said I would set up the necessary machinery in order to ensure that there would be a proper career structure and within a given period. I do not think it is unreasonable for me to ask, as it is not unreasonable for the two medical associations to ask, the junior hospital doctors not to take this precipitate action but to wait until the ballot is completed. When the ballot is completed, whatever the result is, there may then be the necessity for further talks, negotiations or conciliation. I am prepared to go, as I have gone in the last four weeks, to the utmost extent in order to see that sick people in this country are properly protected.
Is the Minister aware that hospitals at the moment are only barely ticking over, that they are enabled to do this by the fact that the consultants are working enormously long hours, many of them in fact, working all night long, that the consultants say, quite reasonably, that they are not going to be able to continue this for more than a few days more? Does the Minister realise what the situation will then be, and can he do anything at all, irrespective of the merits or demerits of this dispute, to ensure that people will not die, because that is what is facing us this week?
Whilst I regard the position as a serious one. I do not think it is as serious as that suggested by Deputy O'Malley. I do not say either that the hospitals are ticking over as normally as they would be in normal circumstances. There is an emergency in the hospitals and the consultants have agreed to service the various hospitals by way of roster. As far as what I can do is concerned, I have been dealing with trade union problems all my life and, as I said in reply to Deputy Dr. O'Connell, I do not think it is unreasonable to ensure that precipitate action will not be taken until the members of the two medical organisations, the IMA and the Medical Union of Ireland, have given their decision. Only then can I come in.
Is it not a well-known fact that the junior hospital doctors have voted already by a majority of about 100 to 1 approximately, something over 700 to 7, against acceptance? Is it not also a fact that a great many of these junior hospital doctors are not members of either organisation and the strong likelihood is that the vote at the end of the week will be against acceptance? Even if one or other of the organisations' members were to vote for acceptance the great majority of the junior hospital doctors would still withdraw their labour. In those circumstances, and in view of the fact that the consultants have reached the end of their tether, would the Minister not do something, whether or not it is in accordance with usual trade union practice, to ensure that the suffering which is now starting and the deaths which, I am afraid, will inevitably follow will be avoided?
All the negotiations were conducted under the auspices of the Irish Medical Association and the Medical Union and in these discussions the junior hospital doctors participated. The two medical associations, the IMA and the MU, have advised on several occasions the junior hospital doctors to remain at work until the result of the ballot is known. Maybe Deputy O'Malley knows more than I do about the result of the ballot. I do not know officially yet. As a matter of fact, I do not know unofficially what the situation is. As far as the meeting in the Mater Hospital is concerned, I have had no communication from those who organised that meeting. It is a fact, as reported in the newspapers, that the offer was rejected by 770 votes to 6. The only comment I would like to make in that respect— I do not want to aggravate a serious situation—is to say that what I could not understand in respect of that meeting was the fact that the offer was made at six o'clock on Tuesday afternoon, this day last week, and there was rejection within 27 hours. Whether or not sufficient consideration was given to the offer I do not know. The Deputy asked me if there is anything I can do. What can I do? I might ask him what would he do in the same situation.
A Deputy
You are the Minister.
I take the responsibility. As far as meetings are concerned, I was approached by the junior hospital doctors' action committee on Saturday night asking me to meet them. I said I would be prepared to meet them any time, even before the result of the ballot was known, provided that that meeting was arranged under the auspices of the two medical associations.
Could I ask the Minister now, as an emergency measure, to call the members of this action committee into his office with members of the medical union and the IMA in virtue of the fact that many of them are not represented by either body and to do it now—today or tomorrow, ask them to come in and see him to discuss the matter and refer contentious clauses to the Labour Court? This is the answer to the problem.
I do not know whether or not it is a complete answer because one of the parties may not want to take that course, but I have stated here today, as I stated to the junior hospital doctors, and the majority of them are in the two medical associations—there are some who are not— that I do not think it is unreasonable for me to say: "Yes, I will meet you provided you come under the auspices of the people who conducted the negotiations on your behalf."
Would the Minister——
I have allowed a great deal of latitude.
Yes, but would the Minister not meet them as a group representing the junior hospital doctors and try to come to a settlement that way? I do not think this is the time to stick to what may be commendable in normal circumstances. This is a very unusual situation in that a great many of these men are not apparently members of either group and, because they are not, they should not hold up a possible settlement which might come about if the Minister would meet them.
Deputies will agree that we cannot discuss this matter all evening.
The offer I made is still open. I will be prepared to meet them provided I meet them under the auspices of those who negotiated for them and with them.
The Minister indicated that he did not quite accept that the consultants were as fatigued as was being made out.
I did not say that.
I interpreted it as part of the Minister's reply.
Then the Deputy interpreted it wrongly.
I will not say they are very fatigued.
A question, Deputy, please.
Is the Minister aware that an error of judgement can occur when a man is in a fatigued condition and would he bear that fact in mind? The lives of people are involved.