I think the Minister is to be congratulated on the fact that he has succeeded in making fairly substantial reductions in the salaries, wages, and allowances of the staff in his Department. He has also effected reasonable reductions in the travelling expenses of his inspectors throughout the country. That is a fact that has not been commented upon by any Deputy, and I think it should not be allowed to pass without comment, in view of the very general desire that appears to be expressed throughout the country for economy.
I consider the amount of attention paid to the preventive side of health services as compared with the amount of attention paid to the curative side, is far too little. In this country the public health machinery is elaborate, and there does not appear to be a very good return for the money expended on public health services. For example, take executive sanitary officers, sanitary sub-officers, and medical officers of health. In many rural districts, more especially such of them as belong to the congested areas, the administration of public health services appears to be a dead letter; no progress is evident.
It is true, however, that the appointment of a county medical officer of health, as provided for in the Local Government Act of 1925, may effect more progress in the matter of public health. Having the dispensary doctors acting as medical officers of health should be an advantage. Such an arrangement is convincing proof that the Minister realises the necessity for some change. The relations between the county medical officer of health and the district medical officer of health are not defined, nor does it become apparent whether, when the county medical officer of health is appointed, the position of the district medical officer of health will continue.
The relations between the county medical officer of health and the county tuberculosis officer are not defined. I assume it will be open to the county council or the county borough council to combine the positions and appoint one man to act as tuberculosis officer and county medical officer of health; otherwise there would be two expensive public officials attending to the same kind of work.
It cannot be seriously argued that the prevention of the spread of tuberculosis does not pertain to the public health code. If two highly-paid officials, with substantial travelling allowances, are to be appointed in each county health district, it would be monstrous, simply scandalous. It would, in short, mean officialdom gone mad to have two such officers.
I would like to know from the Minister what is his policy with regard to the treatment of tuberculosis. I would like also to know if he can supply any information to show whether the working of tuberculosis schemes has resulted in the cure of any cases of pulmonary or surgical tuberculosis, and if the operation of the schemes has checked the spread of the disease or lessened the number of sufferers. Local rates are taxed to breaking point for such services. I consider any further development of those schemes should be borne either by the State or, to some extent at least, by the individuals.
Recently a circular was issued by the Department making it almost obligatory on county councils to establish tuberculosis hospitals under threat that the grants will be withheld from them. I think the setting up of separate establishments in each county, either sanatoria or tuberculosis hospitals, would, under the present system of rating throw an undue burden on small counties. I consider it should be the duty of the Minister to see that two, three or four counties should combine for the purpose of setting up some central institution for the treatment of their tuberculosis patients. It is certainly unnecessary in the smaller counties to have separate tuberculosis hospitals.
In the matter of public health there appear to be two main items. The first relates to the provision of an adequate water supply and the second to the installation of modern sewerage systems. Many places throughout the country, small towns particularly, suffer through the want of both. It is certainly fortunate there have not been widespread epidemics. The initial cost of these schemes is in many cases prohibitive. Under the present law the cost must be made a charge over the whole county health district. I consider that is altogether inequitable and I am of opinion that cost should be borne by the benefiting area.
The Minister should, I think, point out to the Minister for Finance that it is a matter of absolute necessity to renew the facilities which local authorities had up to some years ago with regard to borrowing money from the Board of Works on easy terms for long periods. I agree that at the moment it may not be easy for the Minister for Finance to give the same facilities as the local authorities enjoyed three and four years ago; but I think that when the report of the Banking Commission has been submitted it should be possible for the Minister to renew the conditions upon which public bodies were able to get loans for these purposes prior to 1922.
Quite a number of Deputies have criticised rather severely the scheme for the amalgamation of unions. I happen to be intimately connected with one particular scheme of amalgamation and I must confess from the experience I have had of the working of that scheme that it was undoubtedly a great success; not merely has it been a success from the ratepayers' point of view, but from the point of view of public health as well. In Sligo the ratepayers are gaining something like £20,000 a year as a result of the putting into operation of the amalgamation scheme. There is no doubt that the patients in the county hospitals are treated very much better than in the old days. I admit that in quite a number of counties they seem to have difficulty in regard to these schemes. The cost does not seem to have decreased, and, so far as I can understand, the cost in some counties to-day exceeds that when the old unions and workhouses were in existence. I cannot understand the cause of that. I feel that there must be mismanagement somewhere, because I am satisfied from my experience that, if the amalgamation scheme is worked properly and if careful attention is paid to details, it must mean a considerable saving to the ratepayers.
In connection with roads, I agree with the Minister that roads in this country are not by any means as bad as some people, especially those connected with motoring associations, make them out to be. I think that the roads in the West of Ireland can bear comparison with those in any other part of the country, and I am satisfied that they have been considerably improved within recent years. I am sorry that the Minister, when outlining his scheme, made no reference to the tourist routes. I understand that the Roads Advisory Committee recommended that important tourist routes should be considered by the Ministry. It seems to me that it is quite useless talking about developing tourist traffic in this country unless we make provision for access to the tourist resorts, especially those in the West. As a rule those resorts are off the main arteries of traffic and are connected with the main roads by link roads which are often very narrow with dangerous turns. I hope that the Minister will be able to hold out some hope that he will be in a position later to set aside some money for the improvement of these roads. I must complain also that I consider that the West of Ireland has been rather badly treated in regard to the division of this money. In a big county like Galway you have only one trunk road leading to Galway city. In Leitrim there is only one small portion of a road, that from Carrick-on-Shannon, coming within the scheme, and another road, about four miles long, along the Tirconaill border. Sligo has not been treated so badly but, considering its importance as a trading link between the various provinces, I think that the Minister should have given it more consideration. There is one important roadway which the Minister has overlooked, namely, the road from Sligo to Enniscrone, Ballina and Belmullet. That is one of the most important agricultural districts in the West. It has no railway facilities and I thought that it would be one of the first areas which the Minister would have taken into consideration in formulating these schemes, and that due attention would be given to the development of agriculture. Nevertheless, this important district, which has no railway facilities, has been left entirely out of account in a big scheme of this kind.
Another matter about which I wish to speak and which has been referred to by Deputy Murphy, is the question of the purchase of labourers' cottages. Three or four years ago, when I was a member of the General Council of County Councils, a scheme was put forward for the purchase of these cottages. I do not know what consideration it received from the Minister but we have heard nothing further about it. A number of schemes was also formulated by local councils, and I may say that there is a general desire among cottiers to have the option of purchasing their cottages. I think the Minister should formulate a scheme to enable them to do so.
In regard to the question of housing. I must congratulate the Minister on the valuable work done in regard to the Housing Act. The Housing Department has done its work remarkably well, and the Minister deserves to be congratulated on the efforts made in this direction. There are, however, a large number of people in the congested districts for whom no provision is made under the housing scheme, and I think that their claims should be considered in future legislation. I refer, chiefly, to the small landholders who were provided for in the old days by the Congested Districts Board, but since the abolition of that Board their interests seem to have been overlooked. There is no provision for them in the Labourers Acts; they are not in a position to avail of the grants under the Housing Act, while the loans to be obtained under the Board of Works do not suit their interests. The problem is, I admit, a big one, but even so, it should be within the competence of the Minister and the Government to deal with it. Any future Housing Act should make provision for houses for these people, and there should be something in substitution of the grants made under the Congested Districts Board. I suggest to the Minister that he should give this matter special consideration owing to the peculiar circumstances of these people, and that in future legislation their claims will be considered.