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Dáil Éireann debate -
Thursday, 31 May 1923

Vol. 3 No. 20

COMMITTEE ON FINANCE. - HOSPITALS AND INFIRMARIES.

In the absence of the Minister for Finance, I beg to move the next Vote, "That a sum, not exceeding £1,738, be granted to complete the sum necessary to defray charges which will come in course of payment during the year ending on 31st March, 1924, for expenditure in respect to Hospitals and Infirmaries and certain miscellaneous and other allowances, including sundry grants-in-aid." A sum of £15,000 had been voted on account.

I rather expected that we should have had those Deputies who were so eloquent a week or two ago regarding the needs of the hospitals present, to deal with the question of this Vote. It is rather an eloquent testimony to their anxiety for the hospitals and their absence would suggest the unkind thought that they were more interested in sweepstakes than hospitals.

The table appended to this Estimate gives us an indication of the very small amount voted out of National Funds to the work of the hospitals. Apparently it has remained at the figure voted a good many years ago. On this Vote it seems to me that there should be a distinct amendment and improvement, and while I suppose it is not possible for any Deputy to move for an increase in the sum, it is possible for us to urge on the Minister for Home Affairs to consult with the Minister for Finance to see if it would not be possible to devise a method of financing these hospitals to a much greater extent than than they have been financed, and are being financed, without having to resort to sweepstakes or anything in the nature of sweepstakes. One can see how wide an issue is raised when one touches this question at all. We have just been speaking of the County Boards of Health and that brings in the Minister for Local Government. Surely it ought to be part of a general scheme to bring in hospitals that are nominally private institutions, hospitals which are public institutions in the general administration of the medical services under one head and one control, and dealt with by one vote. I would press that upon the Ministers concerned, and urge upon them the desirability of getting together men and women interested in the administration of medical services, to see how far it is possible to bring them under a single national authority, utilising all the voluntary efforts that are at present available. I am not now suggesting anything in the nature of bureaucratic control of hospitals or medical services, but I want to see something in the way of co-ordination of this work, and proper administration in the public interests and in the interests of the sufferers in these institutions. We are asked to vote this small sum of £16,738, and I hope it will be taken to be an earnest of the intention of the Ministry and the Dáil to vote a very much larger sum, and to find that sum by whatever means they may, but to ensure that the hospitals shall be kept going without having recourse to the scheme of financing that has apparently been abandoned — the British Postmaster-General and the British Authorities, I think, have seen to that. I urge that plea upon the Ministers that they should immediately bring that matter into their consideration as to the better method of financing hospitals, and very greatly increasing this amount by a supplementary Vote.

As one who supported the idea of sweepstakes as the only alternative to a Vote of this kind, I think if there is any justification for my doing so in the exceptional circumstances, it is to be found in the very small amounts that are voted under these headings for the upkeep of hospitals. The point I desire to bring home to the responsible Minister is the fact that the scale which has been provided for in Clause C of this Vote was decided in 1854, and I think that the many things that have happened, including the great increase in the cost of living, are some justification for pressing the necessity for increasing the Vote as shown here.

It is an extraordinary thing that the Rotunda Hospital and the Coombe Lying-in Hospital, that provide for the natural requirements of the poorer classes are the hospitals to which the smallest sums are granted. I press on the Minister the necessity for a revision of the grants to the different hospitals. I do not know the grounds on which a distinction was made in 1854. Perhaps in the case of Dr. Steevens Hospital it was because there were so many R.I.C. men and their dependents to he provided for up to a short time ago. If that was the case I think there would be no necessity for that in future. I think there are many reasons, reasons which are not necessary to go into, that could be advanced to impress on the Ministry the necessity for increasing the Vote, particularly in the case of the Rotunda and Coombe Lying-in Hospitals.

I wish to say that I would not agree to do anything that would in any way lessen the anxiety of the State for maintaining these hospitals, but, at the same time, I am of opinion that the centralising of hospitals is a mistake.

I cannot see that there is any justification for the centralisation of hospitals and the bringing of patients in delicate health long distances in order to be treated in hospitals in a central position. I feel that every county, or two counties, should have hospitals equipped with a theatre to deal with cases occurring in these areas. I think it is the duty of the State to see that provision is made in that respect. If we make provision for old age, as we have done, surely we can make provision for cases such as these. The Government should consider the question of making further provision for hospitals, not perhaps on the present lines, but on lines which will give people in the country areas freedom from being carried over large distances to be operated on under conditions which entail great hardship for them. I stand firmly behind those who consider that this is one matter in which we should not consider economies. I have stood against sweepstakes because, I think, it was a terrible thing to put deserving charities under the ordeal of having to have recourse to such a questionable form of raising money.

There is one matter to which, I notice, attention has not been drawn. It points to a certain, perhaps inevitable, neglect in dealing with this important matter. I believe that this is the only estimate, at least it is the only one I have been able to discover, in which all the items for the new financial year contain exactly the same figures as those for the outgoing financial year, coming to a total in each year of £16,738. That would lead one to suppose that these amounts have been taken from the past financial year into the present year without any substantial enquiry such as the circumstances of the time warrant in regard to institutions of this kind.

They are statutory.

I know they are, but they need not remain statutory. The point I am desirous to make is that it is clear that during the past couple of years hospitals of this kind have got into circumstances where they are driven to the necessity of seeking that charitable assistance upon which they depend by a number of public—I hope the word will not be interpreted in any offensive sense —subterfuges by which one is induced to buy a flag of a green colour for sixpence or of a pink colour for a shilling or a much larger flag with a much better design for half-a-crown. There is, to my mind, and I think I am expressing a view very largely held, something not quite pleasant in an appeal of that nature. There is certainly something not quite pleasant in having a youth with a large and ruddy false nose accosting one on behalf of an hospital, say the Cancer Hospital, as occurred recently. These appeals should not be necessary in any well-organised State. I hold that these are primarily a public responsibility, and there should be some enquiry into the present position of all the hospitals. I think the Deputy who last spoke, Deputy McGoldrick, misunderstood the point which Deputy Johnson was making when dealing with the necessity to centralise schemes. Deputy Johnson was not dealing with a centralised scheme of hospitals, but of finance, in order that there should be some central body that would have supervision over the financial position of all hospitals, and that the central body should be in a position to advise the Ministry to make recommendations to this Dáil as to the exact needs of public hospitals — not to dispense entirely with charitable institutions, but to supplement them by adequate State aid in order that the sick poor should have their needs adequately met. I happened, through certain agencies into which I will not go, to have that matter brought before me very forcibly of late, where poor people who had fallen on to a certain public fund, which fund was unable to continue them, had to send them to certain public hospitals. They were there met by the response that in these particular cases the hospitals, however willing, found themselves unable to undertake these cases, because they had not financial support. That should not occur. It is a State responsibility ultimately, and I am urging that these statutory obligations, instead of being taken over automatically from one financial year to another, should be open to revision according to the needs of each financial year, which vary according to the circumstances of the time. Recommendations should be made as to the expenditure required by a body which should be set up as a Commission.

It is obvious from the reports with which we are dealing that a certain number of hospitals in the State receive a grant. This grant varies from £7,600 in the case of one hospital to £100 in the case of another. Now that the Free State is coming into its own it is right that the reasons for these grants should be known. In the past there has been a great deal of heart-burning as to why certain hospitals receive no State aid while others have received it; for instance, why one hospital is receiving £7,600 as an Imperial Grant and others receive nothing. So far as I could gather from the remarks of Deputy Figgis I understand that he was suggesting the formation of a sort of Commission to enquire into these matters, and the general financial condition of the hospitals and see whether the aid should not be distributed more evenly. Now I am not going to say that I wish at present the hospitals to pass under State aid, as if the hospitals are placed under State control the cost will practically be double the cost of hospitals at present run under the voluntary system.

All the physicians and surgeons who are now giving their services in a voluntary way will have to be paid, and the management which is controlled by Boards of philantropic men, who give their time to all the details, will be costly. I say here quite confidently that under no circumstances will a State or Municipally supported hospital be run as economically as a hospital run by voluntary management. But what I do find fault with is this, that in the past it has been possible that any individual for his own aggrandisement or any other reason has been able to start a hospital in the city. At all events, the hospital is run for some purpose. It is run because those individuals want to pose as specialists in a particular line. Those hospitals become from very small ones fairly large institutions, and there is a tremendous amount of appeal for public support made by those hospitals, and they are not under proper supervision or control. I think Deputy Figgis made some allusion to something of this sort. At all events, what I was going to suggest is that the time is coming when we ought to have a commission which will report on the condition and financial position of the hospitals, and set before us the reasons why the nine hospitals on this list receive State grants and others do not.

Is maith liom aontú leis an rud a dubhairt an teachta ata tréis labhairt. Tá a fhios agam go bhfuil na hospidéil ag déanamh go maith ach san am ceudhna níor ceart an t-airgead do thabhairt doibh san caoi a tugtar. Ní'l roinnt cúram déanta ar an slighe na caitheann siad an t-airgead. Ní'lim ag rádh go bhfuil an iomarca airgid aca. Ba cóir go mbéadh níos mó. Deirim gur cóir go mbéadh scrudú ins an caoí na caitheann siad an t-airgead.

There is just one reference I would like to make on the subject. We have had a great deal of discussion on the matter in our constituency, and I would like the Minister to see his way to give the Dáil an assurance that would satisfy public opinion very largely that the system of local hospitals will be extended and developed as time goes on. I do not say it can be done in the present year, but the policy should tend that way. This is being justified by the results of the policy across the water, where small cottage hospitals are very widespread, very successful, not too costly, and undoubtedly meet the needs of the country districts better than the large, and more centralised, hospitals in the towns.

Maidir leis an rud a dubhairt teachta Pádraic Ó Máille, tá bórd ann fé lathair a dheineann scrudú ar an airgead a tugtar dós na h-oispidéalta agus ar an slí 'na caitheann siad é. Níor thuig an teachta é sin. Tá an bórd ann le deich mblíain is trí fichid.

This Vote is accounted for by the Department of Local Government for the first time. The responsibility for the matters with which it deals has just been transferred to the Department for which I am responsible, and I cannot say, as far as they are concerned, that I have had time or opportunity to give them any serious consideration. Heretofore, they were administered quite apart from the Department of Local Government. The Local Government Department had charge of the local Poor Law hospitals and the administration of medical charities. These grants were, I think, administered last year by the Department of Finance. Before that, I think, they were matters that were dealt with by the Lord Lieutenant and not by the old Local Government Board. Then we had the National Health Insurance work dealt with by another body. Without going into that matter in detail now, or anticipating the provisions of the Ministries' Bill, I think it will be obvious to the Dáil that this whole matter can best be considered when all Governmental activity in regard to medical treatment and the provision of hospitals has been concentrated in a single department. I know that the past few years have been very hard on these voluntary hospitals. They made attempts to get increased grants from the British authorities, but any increase was refused, and the ground on which it was refused, I understand, was that hospitals in Great Britain were not getting an, increased grant, and that they were obliged to rely on voluntary contributions. This matter is one that has to be very carefully considered in all its aspects, because we might very easily increase the burden to the State, as Deputy Sir James Craig has suggested in the most serious way, and, perhaps, have no greater efficiency. It is a fact that these grants were fixed in 1854 and in 1855, and since that date the hospitals have managed to carry on. They have managed to do exceedingly good work with only these grants. Certainly this year was not the year to rush into proposals, that might be a very serious charge indeed on the State. I admit that the matter is one that has to be considered, and that these hospitals have had a specially bad time during the past few years, and probably have difficulties that are too great for them heaped up because of the difficulties of the last few years. I think I can promise that the whole matter of the hospitals and of medical assistance and medical relief will be considered very shortly in all its aspects, and not, as it has been in the past, with one Department looking to one section and another department to another.

Tá súil agam go ndeanfhaidh an t-Áire níos mó ar son na n-Oispidéal ná mar atá cúrtha sios ins na meastacháin. Cuireann si í gcuimhne dom an sean-fhocal "mair a chapaill agus geobhaidh tú féar." Má's mar sin atá an sgéul is bocht an sgéul é. Deir sé go ndéunfar sgrudú ar an gceist lá eigin i mbliadhna, bhfeidir nó i gcionn bliadhna nó i gcionn trí mbliadhna nó deich mbliadhna. Ní dhéanfhaidh sin an gnó. Badh ceart don Áireacht rud eigin a dhéanamh anois agus a thuille airgid do thabhairt do na h-ospidéala anois nó gan mhoill. Siné an fáth do chuidig mé leis an mbille a cheap an Teachta S. Ó Maolruaidh — de bhrigh go bhfuil airgead a dhith orra agus nac bhfuil siad ag fághail a n-dothain ó'n Stáit. Thug an t-Aire geallamhaint uaidh agus bhéidir go bhfuil an geallamhaint sin cosamhail le geallamhna eile — geallamna i gcóir an togha mhóir atá ag teacht. Ní geallamhaint atá ag teastail ó na osbidéala ac cuidiú agus airgead.

Would I be in order in asking if the Minister could kindly tell us when he hopes to introduce the Public Health Bill?

Maidir leis an gcheist a chuir Cathal O Seanáin orm nior thugas aon gheallamhaint am ar bith. Níor dhubhairt mé "mair a chapaill agus gheobhair féar." Ni bhfuair na h-ospuidéal puinn féar uainne riamh. Fuaireadar a n-dóthain ón a puiblídheach roimhe seo agus tá súil agam ná teipfidh an puibhlídheacht ortha i m-bliadhna.

The Public Health Bill is being drafted. I could not say at the moment when it is likely to be introduced.

Question put and agreed to.
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