Dáil Éireann debate -
Wednesday, 29 Apr 1925

Vol. 11 No. 5

COMMITTEE ON FINANCE. - VOTE No. 40—HOSPITALS AND CHARITIES.

Mr. BLYTHE

I move:—

40.--Go ndeontar suim ná raghaidh thar £4,728 chun slánuithe na suime is gá chun íoctha an Mhuirir a thiocfidh chun bheith iníoctha i rith na bliana dar críoch an 31adh lá de Mhárta, 1926, chun íoctha Eilithe mar gheall ar Ospidéil agus Otharlanna agus Liúntaisí áirithe Ilghnéitheacha Déirciúla agus eile, maraon le hIldeontaisí i gCabhair.”

40.—That a sum not exceeding £4,728 be granted to complete the sum necessary to defray the Charge which will come in course of payment during the year ending on the 31st day of March, 1926, to pay Charges connected with Hospitals and Infirmaries, and certain Miscellaneous Charitable and other Allowance, including Sundry Grants-in-Aid.

MINISTER for LOCAL GOVERNMENT and PUBLIC HEALTH (Mr. Burke)

There is no change of any importance in this Vote from last year, except the disappearance of the Concordatum Fund. It is a very old fund, and came into existence, I think, in the time of Charles I. It was originally a fund granted for all kinds of miscellaneous purposes, but eventually became exclusively devoted to charities. When the Vote for 1873 and 1874 was under discussion in Committee of Supplies, a strong opinion was expressed by some members that the fund should be gradually extinguished. The complaint was made that it was largely applied to the relief of widows and families of the Irish Church—a practice which, it was alleged, ought not to continue after the disestablishment of that Church. That discussion led to an inquiry on the part of the Treasury, and ultimately to the present arrangement for the extinction of the fund. From that forward there were no new charges on the fund, and it gradually approached extinction. The last person who was receiving any pension under the fund died last year. The fund then automatically disappeared. I do not know if there is anything arising out of the general Vote, but if any Deputy raises any point, I will be prepared to answer him.

Mr. JOHNSON

I want to raise a question as to whether the Minister has any views regarding the continuance in the present form of these allowances to hospitals. The allocations were recommended as far back as 1854 and 1855, and they do not seem to have any clear regard to the needs of the hospitals at the present day. For instance, we see on page 148 that there are certain payments made, according to a fixed scale, to a number of hospitals in Dublin. They are not calculated upon any basis of deficiency of expenditure, of the number of patients, the number of doctors, or even cubic space, and they do not seem to have any relation at all to present-day needs.

I would suggest that it is necessary to have some reconsideration of this whole question of the amount of money which should be provided out of State funds for the aid of hospitals. I do not want to make any suggestion, at the present time, as to whether there should be increases, or how these increases should be allocated. I would like to hear from the Minister if he has any views as to the relation of the State to hospitals, and particularly in regard to the present method of allocation of the sum of £15,850. It does not seem at all sensible to continue paying grants-in-aid, based upon some scheme which probably had a sound basis as far back as 1854 or 1855. That basis has completely altered in 1925. Perhaps the Minister and Deputies generally might have some enlightment on this matter from Deputy Dr. Hennessy.

Mr. WILSON

I would like to support Deputy Johnson's suggestion. I suggest to the Minister that he should place this matter of grants-in-aid to hospitals and charities under the care of that particular Commission which he has mentioned. I am aware that one grant was given, and I mentioned that particular grant to a Deputy who was interested in the medical profession. That Deputy was strongly of opinion that there was one grant which ought not to be continued, and which could be very readily avoided. That grant ought to have come under the aegis of this Commission. I would strongly support Deputy Johnson's suggestion. The Commission which sat in 1854—the time of the Crimean War—could not possibly understand the needs of the present day.

Mr. BURKE

I agree with Deputy Johnson and Deputy Wilson that these charitable funds have been allocated in a very arbitrary way, in a way that it is very difficult to justify when looked at from a modern standpoint. These charities go back very far. For instance, the Foundling Hospital was established in the reign of Queen Anne. This institution eventually became the South Dublin Union, in 1838. Then, the House of Industry, of which at the present time Richmond Hospital is the principal institution, was founded in the reign of George III, and it became the North Dublin Union in 1838. You have all the hospitals receiving grants from these charity funds. They gained a statutory right to that fund at different times and under peculiar conditions. It is a very difficult thing to interfere with those grants. These institutions were carried on in anticipation of the grants recurring from year to year, and it is a very serious matter to cut them off. That should not be done without having a thorough inquiry into all the circumstances of the case. It is a matter either for a Commission or for a consultative council. I hope, at an early stage, we will be able to set up such a Commission or to get the advice of a consultative council on the matter.

With regard to the particular hospital referred to by Deputy Wilson, which, I presume, is the Lock Hospital, there is at present a Commission dealing with venereal disease, and this particular hospital will come within the purview of that Commission. No doubt they will have some recommendations to make with regard to its continuance or non-continuance.

Mr. HEWAT

I think we would be unanimously of opinion that these grants should be revised in some shape or form, not, I hope, with any idea of reducing the amount, but, if possible, rather increasing it. At all events, it requires readjustment. I take exception to the table showing the estimated expenditure and income of certain hospitals in Dublin. If you look at that table, there is a uniform deficit in all the hospitals in Dublin, and the deficit is a very considerable amount. That would seem to indicate that all these hospitals have an annual deficit. I do not know whether that is so or not; but, at all events, from the accountancy point of view, it would seem to indicate they are all rapidly entering into bankruptcy. I do not think that is the case, and, therefore, a table that purports to show that every hospital on the list is suffering a deficit at the end of every year, to the extent indicated, is a very serious matter. That is, if it is accurate; if it is not accurate, then it is misleading.

Mr. GOOD

Is not the object of this table to show that these hospitals to which it is proposed to give this money are in need of funds?

Mr. WILSON

Yes, certainly.

Mr. JOHNSON

I think that is a statutory or customary record which has appeared for many years. Probably it is statutory that the income of the hospital should be recorded and detailed in the Vote or the Estimate.

Mr. HEWAT

If that state of affairs has been going on for years, as is indicated here, I do not know how the hospitals are alive.

Mr. JOHNSON

There is not always a deficiency.

Professor THRIFT

The difference has to be made up by subscriptions.

Mr. HEWAT

That is the explanation, but it is not shown here.

Mr. WILSON

That is the explanation all right.

Dr. HENNESSY

From my knowledge of the hospitals in Dublin, they are in debt; they have ceased to fulfil their main functions—that is, being hospitals for the poor people—simply because of their indebtedness. A hospital now devotes a considerable number of beds to people who can pay for them, and that is mainly due to the fact that they have not sufficient money to go on with. As regards the hospitals, it was the original intention that they were to be utilised, to a large extent, for the very poor; but it can be no longer said that they are for the poor.

Mr. GOOD

That is true, in a sense; but it is not altogether true. In most of the hospitals, particularly some of the older hospitals, while they are compelled to make charges now for a number of the beds, especially in the case of those who can afford to pay for them, there is still a large percentage of what are known as free beds. It is only right that that should be said on behalf of those hospitals. The Deputy is quite right when he says that nearly all of those hospitals are in debt. That is quite true, but in a great many cases that is owing to the number of free beds they provide and the amount of work they do absolutely free for the poor. That ought to be said.

Dr. HENNESSY

By way of explanation, I might add that what I meant was the hospitals would still continue to be the poor man's hospitals only for the want of funds.

Mr. GOOD

They still do an immense amount of work on behalf of the poor free.

Dr. HENNESSY

That goes without saying.

Mr. SEARS

If those amounts were originally intended to aid hospitals for the sake of the poor, it would be interesting to know what relation the amount bears to the number of poor people attended free. If all the hospitals are in the habit of charging now, it may happen that the number of free beds is rather few compared with the amount of money received, and in that case I think there is an added reason why the Commission should be hurried on, and why the whole scheme of hospitals should be based on more scientific principles than in the present haphazard way.

Mr. McCULLOUGH

There is a lack of proportion in the grants for the various hospitals. Some receive nominal sums and some receive quite big sums. It is very interesting to know, as Deputy Sears has pointed out, what services they give to the poor for the moneys they receive. I hope the Minister will take steps to have an examination of this whole question.

Mr. BURKE

It may be taken that the hospitals give very good value for the money received. As I said before, the money has been allocated in a very arbitrary way, in a way that is rather difficult to justify nowadays. Of course, the hospitals are maintained out of public charities. The Lock Hospital exists solely on the Central Government funds, but I do not think that Deputies need worry as to the value given to the poor for the amount of the grant. The grants are not on the whole very large, and they certainly give excellent service for them.

Professor THRIFT

Will the Minister agree that any of the beds that are not free are simply beds for which a small charge is made proportionate to the means of the person?

Mr. JOHNSON

The point I would rather emphasise is this—that I have not any complaint that the State is not getting full value for the expenditure up to now, but that the State's contribution to hospitals is confined to these hospitals. There are other hospitals that are equally in need, and it is a question as to whether we ought to continue the old allocation, and say that out of such moneys as we can spare to hospitals, £16,000 in this case, we ought to apply it only to those hospitals on the basis of the recommendations of 1854 and 1855. I think if this matter is gone into it will be found necessary to increase the amount of money voted, and to re-allocate it according to some basis of present-day needs, and to allocate it to all other hospitals as well as those named in the old list. I would impress upon the Minister the desirability of having some form of inquiry into the needs of the hospitals, and having some declaration of policy on the part of the Ministry as a whole as to the amount of further financial assistance that should be given and the conditions of that assistance.

I would not like it to go forward that in raising the matter I had any thought that the money was not expended satisfactorily and value given for the money. I have no doubt that the money is well spent, and that they would be very glad to spend equally well a great deal more, but I think there are other hospitals that would require assistance. I think the whole question of the relation of the State to the hospitals and charities has to be considered with a view to further grants, and with possibly some conditions as to these grants.

Mr. HEWAT

I think the inquiry that Deputy Johnson suggests would be necessarily a more exhaustive one than he thinks of. That inquiry would need to be an inquiry as to the number of hospitals required for the country as a whole, because the old contention was that there were too many hospitals in Dublin. I think the question as a whole should be considered in relation to this grant and the amount to be given in future.

Mr. MORRISSEY

I just want to make one point with regard to how these hospitals cater for the poor and to the references that have been made to free beds. It should not be lost sight of that the poor people who are sent up from the country to the Dublin hospitals are paid for by the local authorities. It should be also remembered that practically all the members of the trades unions in the City of Dublin pay a sum every year into the different Dublin hospitals. As far as I know, there are comparatively few people who get absolutely free treatment in the hospitals at the present time.

Mr. GOOD

I do not know that that is exactly so. A number of the patients that come up from the country is paid for by the local authorities, but I do not know that that number represents by any means a majority. I am rather inclined to think that it is quite the other way. A very large number comes up from the country, but they contribute a very small sum to the hospitals. I would be also glad if it were true that many of the trades unions had an arrangement with the hospitals, whereby they pay for their members when they are in hospital, because this whole question of the upkeep of the hospitals, from the figures we have before us and from other figures, is becoming a very serious question. The cost of the maintenance of these hospitals is amounting to a very alarming figure. On the other hand, the incomes they are receiving are decreasing for reasons I need not go into. They have lost some very generous supporters, and there are also many people who, by reason of their incomes in the past, were able to contribute towards the hospitals, and who are not able to contribute to-day. The whole question of hospital finance has changed very seriously in the last decade. It is a question, as Deputy Hewat properly pointed out, if we are having an inquiry, that should be included in the terms of reference of that inquiry. Speaking now on behalf of the city, I may say that a question that has confronted some of us who have taken an interest in hospital work, is that very question as to whether there are not too many hospitals and as to whether the work could not be more efficiently and more economically done by a larger hospital rather than in a number of smaller hospitals. These are questions which are of very considerable importance, and which might well engage the attention of any inquiry such as Deputy Johnson suggests.

Dr. HENNESSY

In reference to the statements that patients from the country pay for their maintenance and that members of the trades unions pay, I might point out that they do not pay a weekly economic sum. That is, they do not defray the entire expenses of the bed that they occupy in these hospitals. Perhaps if they had to pay the full contribution to defray the full expenses, the charge would amount to £4 or £5 a week. They pay 30/- or £2, which is a substantial contribution, but it is only a contribution towards the expenses of the hospitals.

Mr. BAXTER

I would like to ask the Minister, or somebody who would answer, whether the functions of the Ministry end when it passes over this money to the hospitals? Is there any superintendence, or in what way is the expenditure of this money regulated or investigated? Are there any arrangements whereby a certain number of patients will be treated in a certain number of hospitals according to the amount contributed?

Mr. BURKE

All these hospitals which receive a State contribution are under the supervision of the Board of Superintendence of the Dublin Hospitals. They do not come under the control of the Local Government Department in any other respect.

Mr. BAXTER

Has the Ministry any right to nominate anybody on that Board?

Mr. BURKE

I could not say. Since I came into office there has been no change in the Board, which was in existence before there was such a thing as a Ministry of Local Government. I can, however, get the Deputy information on that point.

Mr. SEARS

While I have no doubt at all that there are a large number of free beds in all these hospitals, and that the hospitals give a good return for the money, an unfortunate impression remains amongst the poor in Dublin that you cannot get into one of these hospitals as a free patient. It is known that there is £16,000 of State money paid to these hospitals, and, so far as the poor are concerned, it would be much better if there was an hospital set aside for the poor people. I think a large hospital could be maintained for the amount of the grant. That is another aspect of the question which should be inquired into by this suggested Commission.

Mr. JOHNSON

Perhaps I may be allowed to give some information to Deputy Baxter which the Minister has not available at the moment. Evidence was given before the Committee on Public Accounts on the matter which answered this question. It was explained that a Select Committee of the British House of Commons was appointed in 1854, and it allocated grants in the form mentioned in the Estimate, and they have been paid in the same way since 1858 as they are paid at present. As to the point which Deputy Baxter raises, there was a Committee constituted, called the Board of Superintendence, to keep an eye on the work of these hospitals. An Act was passed immediately afterwards creating that Board, and that Board still exists. The person who acts as Secretary is borne on this Vote. The Board of Superintendence is, presumably, the Board of these people managing the hospitals, and there is no supervision of any kind regarding the accounts. The Auditor-General does not check the accounts, because this is a grant-in-aid, and it is thereby excluded from the supervision, and there is no check of any kind respecting the public supervision over the work of the hospitals.

Mr. GOOD

I do not think that the Deputy is quite right in saying that the Board of Superintendence is the Board which governs these particular hospitals.

Mr. JOHNSON

I only suggest that the Board of Superintendence is probably the Board of persons connected with the hospitals.

Mr. GOOD

They may have a certain amount of superintendence, but I think they have very little to do with the Government of the hospitals.

Mr. JOHNSON

It is probably like the Board of Works—no Board at all.

Mr. BAXTER

I do not understand whether this is going to come within the scope of the inquiry, but it seems to me that we are voting a certain sum annually in aid of the hospitals, and if there is a Board of Superintendence, it would not be too much to expect that the Board would exist and function, and I have no doubt that there are very serious functions to discharge. If that Board exists, would it not be right that the Ministry should nominate somebody upon it? It seems to me that it should come within the scope of the work of members of that Board to revise the sums that would be paid to the different hospitals and see whether good value was given. I am quite well aware of the very valuable work which is done by the hospitals. I do not know what the amount of control is, but I am inclined to the view that when these contributions are voted here, the Ministry owes a certain duty to the public, and it should have somebody on the Board who would answer to the Ministry and enable the Minister to answer to this House.

Mr. HEWAT

As Deputy Baxter will realise, the sum of £16,000, which is contributed to these hospitals here, is only a small proportion of the sum expended, which amounts to £113,000.

Mr. BURKE

I have information now bearing on the question raised by Deputy Baxter, but I cannot solve the main inquiry as to whether the Minister appoints anybody on the Board.

Mr. JOHNSON

Who creates the Board?

Mr. BURKE

The Board was created by 19 and 20 Vic., Clause 110. The members are not to exceed 12. They are appointed by the Lord Lieutenant. I presume that now means the Governor-General, and, perhaps, in practice the Minister for Local Government takes his place. Their duties are to inquire into the due performance of the rules and regulations required to be observed by any Act, charter, testamentary bequest, or bye-law existing in 1856 under any proper authority in any hospital in the City of Dublin supported wholly or in part by moneys appropriated by Parliament for such purposes, and to examine into and report on the state of the buildings, the situation of the patients, the government of the hospitals, and the conduct of officials (Sec. 12). The Board, or in their default, the Lord Lieutenant, may make general rules for the government of the hospitals. They make an annual report to the Lord Lieutenant, which is presented to Parliament (Secs. 16-18). The Lord Lieutenant can appoint a secretary with £150 per annum salary, payable from Votes of Parliament (Sec. 14). That is the position as it stands. I have not made any change in the Board of Superintendence since I became Minister, and I do not believe that either of my predecessors did so. I presume that the Board, which was originally appointed by the Lord Lieutenant, is in existence. If a vacancy arises, the filling of it would, I imagine, be a matter for the Ministry of Local Government or the Governor-General.

Mr. JOHNSON

Could the Minister tell us whether that report has been laid before the Oireachtas for the last two or three years, as he is by statute bound to lay it. If it is the duty of this Board of Superintendence to report to us as to the conduct of the hospitals, the state of the buildings, the position of the patients and so on, we could get some enlightenment on the general administration, and it would be well to have that before we pass this Vote. I think that is a very important document that has been read, because, so far, we have not had any notice given of the fact that such a report had been presented to the Oireachtas. It certainly passed my observation, and I would be very much interested in it if I could have access to it. I think we should postpone the decision regarding this Vote until we get those reports.

Mr. WILSON

I take up the position that this is a grant-in-aid, and that, therefore, it is a donation. We have just as much right to inquire into the grant in aid of the University, and to appoint our representative there, as we have on this body, and more so. The grant to the University is a huge one, and the grant to the hospitals is only a small one. For that reason we should let it pass, for it is getting late.

Mr. JOHNSON

So far as the grant-in-aid is concerned, I would have no objection, but I would like to have the report of this Board of Superintendence which the Minister is bound to present to us. I think it would be better if we had that before we pass the vote. We might be induced then to plead with the Minister for Finance to increase the amounts.

Mr. BURKE

The document I have read from is dated 1921-22. There may have been some legislative changes in the interval which may have made this matter unnecessary. I am not aware that it is so, having seen no report from this Board of Superintendence, and I do not know if such exists. The law may have been completely altered with regard to that. I do not think it would be fair to hold up the passing of the estimate in anticipation of getting such a report. If there is such a report I would be quite willing to make it available for Deputy Johnson and the House.

Mr. JOHNSON

I am quite serious about this. There is not a great urgency for passing this vote to-night. It might be left over until later stages of these estimates. If it is a statutory obligation, as appears from the Minister's statement, that such a report should be presented—probably it has been presented to the House before 1921—we should receive it, and should know what is in it. I think it is quite reasonable that we should have some information from this Board, which presumably is in existence, before we decide that this shall be the sum to be granted according to the statute, because I take it that though there is a statute we could refuse to vote this money. I think we might defer this matter until the Minister can give some information as to the position of this Board of Superintendence.

Mr. GOOD

These hospitals have now entered on the current period to which this Vote applies, and if the discussion which has taken place raises some doubts in the minds of the Governors as to the possibility of reduction in income, it may mean that they will have to reconsider the situation. That may react in other directions that might not be desirable, so that however desirable it may be that we should have information with regard to the report, and the appointment of these officials, I certainly would not be in favour of taking any action that might have the result I have indicated. I think we will all agree that for the current year, at all events, there should be no withholding of the money from these particular hospitals.

Mr. JOHNSON

I certainly will not vote for a reduction.

Mr. BURKE

I understand there have been two, or perhaps three, reports from the Board of Superintendence of the Dublin Hospitals presented to the Dáil. I am not in a position to lay my hands on them at the moment. I think, in view of the fact that they have been presented, Deputy Johnson should allow the Vote to pass, having regard to what Deputy Good has said, that the holding up of it might result in a serious hampering of the work of this Board of Superintendence.

Mr. JOHNSON

The mere passing of this Vote to-night will not ensure absolutely that the hospitals will get the money. An Appropriation Act has to be passed, and I think it is desirable we should have the reports, and it might give the impression that we would be failing in our duty, not having read these reports, to pass the Vote without having looked them up.

AN CEANN COMHAIRLE

They can be looked up before the Report Stage.

Vote put and agreed to.