Public Charitable Hospitals (Amendment) Bill, 1931—Committee Stage (Resumed).
(1) In this section and in the next following section the expression "the available surplus" means the balance of the moneys received from the sale of tickets in the sweepstake in relation to which the expression is used remaining after paying or providing for the prizes distributed in such sweepstake and the expenses incurred in holding such sweepstake.
(2) The available surplus in any sweepstake held under the Principal Act shall not be less than twenty per cent. of the moneys received from the sale of tickets in such sweepstake.
(3) Where a sweepstake held under the Principal Act is so held by the governing body of one hospital only, three-fourths of the available surplus in such sweepstake shall be paid to such governing body.
(4) Where a sweepstake held under the Principal Act is so held by the governing bodies of two or more hospitals the following provisions shall have effect, that is to say:—
(a) three-fourths of the available surplus in such sweepstake shall be divided between and paid to such governing bodies in such proportions as the Minister shall direct having regard to the needs and circumstances of such hospitals respectively;
(b) the committee of reference appointed under this Act for the purposes of such sweepstake shall, when requested by the Minister so to do, report to the Minister as to the proportions in which the said three-fourths of such available surplus should be divided under this sub-section between the governing bodies concerned;
(c) the Minister shall not determine the proportions in which such three-fourths is to be divided until he has received the report of such committee of reference in relation thereto and in determining such proportions the Minister shall have regard to but shall not be bound by such report;
(d) before determining the said proportions, the Minister shall consult the Minister for Local Government and Public Health in regard thereto.
Debate resumed on the following amendment:—
In sub-section (3), line 25, to delete the words "three-fourths" and substitute the words "one-half." (Seán T.O Ceallaigh.)
I do not propose to debate this particular point much longer, but possibly as the debate on this amendment progresses and as the various points at issue have had time to be digested over the week-end there may be some room for compromise as between the two distinct views held. I was wondering if the Minister and Deputy Seán T. O'Kelly would consider some way out of the deadlock by allowing some margin of discretion to the Committee of Reference. It is agreed that 50 per cent. be given to the charitable hospitals. It is desirable to give the other 50 per cent., if necessary, to the county hospitals, but as it has been suggested that this may be too much, why not compromise by giving 50 per cent. to the voluntary hospitals, 25 per cent. to the county hospitals and leave the other 25 per cent. to the discretion of the Committee of Reference? If they find the county hospitals can absorb more than 25 per cent. without any danger to themselves or the ratepayers, the Committee of Reference would have discretion. Another reason why I would like to see 25 per cent. kept from the voluntary hospitals is that it might be found possible to introduce into this country a radium institution. We have no place where radium treatment can be given, and it might be possible to establish a centre where radium treatment could be availed of by all hospitals. I am informed that the total amount of emanation of radium in the country is only valued at £5,000, and that it is held by the R.D.S. Members will know that where a person is sent for radium treatment to London, he has to undergo an expenditure of at least £20 per week. I am only suggesting this so that the country will get the best out of the money accruing to it out of the sweepstakes. It has been suggested to me that if we did start radium treatment, we might be able to benefit from the Rockefeller foundation.
Another thing I want to introduce is the advisability of giving this Committee of Reference some power over this 25 per cent. in dispute. It has been suggested that mental hospitals should get certain help from the money. Perhaps they would consider installing a state pathologist to develop research work in mental cases.
Last Friday I mentioned that Connacht was badly served in the way of hospitals. The nearest large hospital would be Limerick or Waterford. Since Friday I made inquiries and found that Connacht is badly in need of a fever hospital. I am told that typhus is rampant and that people find it hard to get nurses or doctors in view of the tremendous number of deaths of nurses and doctors in that area. People here from Connacht will know the situation. If that is the case it is one of the strongest arguments in favour of granting a full 50 per cent. to the county hospitals, because they would require tremendous expenditure to bring hospitals up to the requirements. I am only putting forward these suggestions in the hope that there will be some means found to make the best use of the money obtained from the sweepstakes.
It is all very well for the voluntary hospitals to argue that they must get a full 75 per cent. and leave it at that. I would suggest that Deputy Sir James Craig would be satisfied, as he is the moving spirit in this matter, with 50 per cent. for the voluntary hospitals and that 25 per cent. should go to the county hospitals. The Committee of Reference should have discretion for the spending of the other 25 per cent. All hospitals, including the county hospitals, would be very pleased to see the setting up of a radium centre in the Free State. I understand it is of urgent necessity. I hope the views that are held here will meet the difficulties and that we will develop something which will be of absolute benefit to the whole community and not to one place. There is a good deal to be said in favour of giving a great deal to the voluntary hospitals, but there is an equal amount to be said in favour of the other argument. Possibly if the two sides give the Committee of Reference some powers, which they would not have otherwise, we might find that benefits will come.
Before the House decides this matter I think it would be well to realise what the proposal means. If this amendment is accepted it will not mean that the voluntary Dublin hospitals at present in the sweepstakes will receive 50 per cent. of the entire sum allotted for hospitals. On the basis of division in the Derby Sweep the Dublin hospitals received 69 per cent., and the county hospitals 31 per cent. If the amendment is carried, the voluntary hospitals in Dublin, that all the agitation is about, will receive 68 or 69 per cent. of fifty per cent., or, roughly, 34 or 35 per cent., and the county hospitals 31 per cent. or about 15 per cent. of the money available for distribution. I am as keen as any Deputy on the counties receiving their due proportion of any benefit that will accrue from the sweepstakes, but I think that we have to be just in the matter. Everyone will admit that the hospitals in the three great centres, Dublin, Cork and Limerick, serve very large areas in the country. I should say that the Dublin hospitals especially serve patients from a hundred miles area, as a large number of country patients are treated there. In like manner, the Cork hospitals serve a large area in the Southern province, while Limerick serves Limerick. Tipperary and Clare. The case of the counties is to a very large extent met by what I call the proprietary hospitals in these large centres. Assuming that the next sweep is as big as the sweep on the Derby—and I certainly think it will be—proceeding on the present distribution, the counties would have an average income of about £21,000, and probably more. To anyone looking back twelve or fifteen months that would seem impossible. A very large sum, £20,000 annually, will go for a number of years to the counties in aid of the hospitals. The sweepstakes have been such a huge and phenomenal success that we should not quarrel amongest ourselves about the division of the spoils. As one Deputy stated, it would be very unwise to do so.
As far as I can see, the needs of the county hospitals in the way of equipment and if you like in building the necessary adjuncts will be fully met from the proceeds of the Sweep dealt with in this amending Bill. Except the proposal is to come to the relief of the rates—and I think every Deputy is agreed that we should not do that—by sweepstakes, we have quite enough money to provide for all the needs of the county hospitals. Deputies should remember the position if the fifty per cent. proposed in the amendment is carried. It will mean definitely that the Dublin hospitals will not receive fifty per cent. of the proceeds but 68 per cent. or 69 per cent. of fifty per cent. which on a calculation is about 34 per cent. It has been stated in the course of the debate that as a result of the Sweepstake voluntary contributions will fall off or will not be renewed to the extent that they were given in the past. I am imbued with that fear. I think there is grave danger that subscriptions which were hitherto forthcoming for voluntary hospitals will not be forthcoming, at least to such an extent. It will be incumbent on all the great hospitals to build up such reserves as will supply the loss of income owing to the loss of these subscriptions. That is a point that should not be forgotten. The county hospitals will not be in that position. If we get the hospitals fully equipped we will be safe in future as an income will be provided for them. Until we definitely make up our minds that the State through sweepstakes should come to the aid of the hospitals I think the 25 per cent. limit proposed by the Minister would meet all the needs of county hospitals. I may make one suggestion—I do not know how it will be received—that as the voluntary hospitals in Dublin, Cork, Limerick and Waterford have already received very large sums through these sweeps, it might be possible to provide some amendment whereby those boroughs would be excluded from any further participation in the sweeps. Something like that might be put into the Bill. I do not think these places want any more than they got for the voluntary hospitals.
Something like that might be put in. I do not know how the suggestion will be received, but a little concession might be afforded by the Minister. There is only one part of the country for which a real case could be made. That is Connemara. It is not proper, I suppose, for any Deputy to say that his own province has been well treated, but I must say that my province has been well treated both by voluntary contributions and the amount at the command of the Minister to help the hospitals. Connacht is not so well situated as the other provinces. It is mostly at a great distance from any of the big centres where there are large hospitals. There may be some way by which a little help could be given to that province, perhaps in the way of setting up a big central hospital in Galway. I have not heard that suggestion made by any of our western Deputies and it is merely a suggestion of my own. I think that the twenty-five per cent. offered by the Minister should be accepted. For myself, I thought that at the beginning he was rather generous but, so far as I can prophesy, I think that the amount will meet the needs of all the hospitals in the south if the sweeps last for the next four years, as I confidently hope they will with increasing measure of success.
The original intention in the first Bill was to help hospitals which rendered service to the poor. When Deputy Bennett speaks of Dublin hospitals as serving a radius of 100 miles he gets away from the Bill. A Dublin hospital does serve a radius of 100 miles but it serves the patient who can pay three, four or seven guineas a week and also a fee for an operation. It does not, however, serve the poor. It serves the poor of Dublin all right, but the poor within a hundred miles radius are dealt with by the county hospitals, and if they cannot deal with such cases they are sent to Dublin and the boards of health have to pay from two to three guineas a week per case. Any of the poor who come to Dublin hospitals are paid for. Perhaps there may be special treatment, but they are paid for and they are not treated in free beds. The Bill applies to hospitals which have a certain number of free beds. Anyone conversant with the state of things in the counties knows that in the county hospitals there is overcrowding and that every week patients have to be turned away. I have spoken to the local surgeon in Mullingar, to the surgeon in the infirmary, and I know that patients week after week have to be turned away owing to lack of accommodation.
A statement was made here last Friday to the effect that £5,000 would meet the needs of the county hospitals. A maternity ward is needed in the county hospital at Mullingar, for which the estimate is £10,000. An up-to-date sewerage system is needed, and the estimate is £3,000. A sanatorium is needed, the estimate for which is £15,000. There is also needed a new operating theatre. We could find means of expending from £30,000 to £40,000 at present. We are undertaking a sewerage scheme and the building of a new operating theatre, and we have installed a modern x-ray plant. We have, however, to go slowly. We cannot undertake the building of a new maternity ward nor the building of a new wing to the hospital, because our borrowings at present for hospital needs are more than the county can afford. Taking what we need, we could absorb £20,000 or £30,000 immediately from the sweep. Consequently the statement that £5,000 would meet the needs of all the county hospitals is absurd.
Has the Deputy any reason for thinking that under the 25 per cent. arrangement over £30,000 will not be available for his county?
Assuming that we will get as much from the next sweep as was got from the last one, I cannot see the hospitals getting more than £2,000 or £3,000.
There will be well over one million available for county hospitals under the 25 per cent. arrangement.
Will the Minister say whether district hospitals come under the Bill?
So far as I know, there are well over a hundred such hospitals in the country. Assuming that we get a quarter of £500,000, we would get £125,000 between them. That would mean that there would hardly be £2,000 for each institution from the next sweep.
There are to be nine more sweeps.
What guarantee have we that the seventh, the eighth, or the ninth will be as successful as the previous ones? What we are interested in is to secure our due proportion out of the sweep on the Manchester November Handicap. As a person interested in county hospitals, I say that if we got fifty per cent. out of the next two sweeps we would be prepared to go back to the twenty-five per cent. arrangement. Deputy Bennett gave figures indicating that the Dublin hospitals only get sixty per cent. of the proceeds available for hospitals out of the present receipts. I have not the figures here, but I question that very much.
It is approximately correct.
In the matter of hospitals I think that the policy of the Local Government Ministry has been one of decentralisation. I quite agree with that. I would like to see in every county hospital a resident surgeon, and I do not see why there should not be one. If that is the policy, there should be more money provided in the amending Bill for county hospitals. There should be money provided to bring these hospitals up to date and up to the standard of the Dublin institutions. The case of Connacht has been cited, but the same case can be cited for every county. As I have indicated, the basis of this Bill and also of the previous one was the provision of money for hospitals which are giving accommodation to the poor. The poor are primarily treated in the county hospitals. Consequently the amendment that fifty per cent. be made available for county hospitals should be accepted by the House. County Deputies especially should vote for it. I do not think it is a Party measure.
I would like to remind the House that when two Private Bills were introduced by Deputy O'Dowd and myself, the only questions at issue were, firstly, if a sum would be allocated to the county hospitals; and secondly, if a sum would be allocated, what would be the amount? Arising out of these two Bills, the Government undertook to make the matter the subject of a Government measure and we agreed to withdraw our Bills on the proposition that the county hospitals would get 25 per cent. A good deal has been said about the Dublin hospitals and their functions. I would remind the House that the Dublin hospitals are not only Dublin hospitals, but are national hospitals. The clinical work of these hospitals is very important if the future members of the medical profession are to get a decent education. The county hospital is a very excellent institution in its way, but we must bear in mind that it is a one-man hospital. While that man does very important work, he cannot specialise in ten or twelve different departments of treatment. I do not see how you can ever develop a county hospital on the basis on which you could develop a city hospital.
There are some hospitals specially mentioned in the Bill, such as Peamount and Cappagh. We know they undertake the treatment of tuberculosis, but they have, so far as accommodation goes, only touched the fringe of it and they do it on a national basis. They receive patients from all parts of the country. These hospitals, for their full development, would easily take between them one-quarter million of money. I think it would be a very much better national proposition to develop these two hospitals and develop them on the big basis, with which, I am sure, Deputies are familiar, in so far as their initial attempts have gone, than to establish sanatoria in the different counties throughout Ireland. It must also be borne in mind that a good deal of the sweep money under the past arrangement and under this arrangement will go to the provinces. It will go to Cork, it will go to Galway, Waterford and Limerick. I think it would be much better to try out as much provincial development as we can instead of frittering away our efforts on a county basis.
It has been said that the Dublin hospitals do not treat the poor. Latterly, of course, the Dublin hospitals were in a state of bankruptcy and they had to cut down the number of free beds. They now charge £2 2s. 0d. per week to the county boards of health for the treatment of each patient in Dublin, for very special operations, and sometimes also for special treatment. That only meets a very small fraction of the cost to the hospitals. The boards of health get it for the nominal sum of £2 per week, and I think it should not be charged against the Dublin hospitals that that is in any sense profiteering. The Minister spoke of the different sums that went to the provinces. I would ask Deputies on all sides of the House to treat this more on a national and provincial basis than on a county basis. I know it will appeal to some county Deputies to carry home as big a slice of the spoils as they can. That, however, is not for the good of the country or for the good of the poor of the country, because, as I had said, you must develop the system on big lines, and you will not develop it in that way on county lines.
I am very glad that this has been left to an open vote of the House. I intend to make an appeal to country Deputies to support, by their votes, the amendment of Deputy O'Kelly that 50 per cent. should be allotted to the county hospitals. Deputy Dr. Hennessy made an appeal that the question should be looked upon in a larger way, that we should consider the Dublin hospitals as the national hospitals and forget the county hospitals and our duties to our constituents in these counties. I would like to say a word as to the position of the county hospitals, especially that in my own constituency, which has developed considerably in the last few years. The hospital we have in Galway is no longer a county hospital in the ordinary sense of that term. It is a provincial hospital. We have patients coming there from Clare, Mayo and Roscommon, and it has now taken the place that the hospitals in Dublin formerly occupied, as far as these patients are concerned. Apart from the fact that we have patients from other counties, we are now in the position that practically all cases are treated in the county hospital. I remember when I started to practise in 1919 and 1920, the most serious cases had to be sent to Dublin. Nothing except acute abdominal work or urgent operations were performed in Galway at that time.
I received a list within the last few days showing the number of operations carried out there in the past year. I find that the number of major operations done in the Central Hospital was 1.100. The position now is that the Central Hospital in Galway is doing the work formerly done for the country patients by the Dublin hospitals. We have a general surgical and medical hospital, a fever hospital and a maternity hospital combined. It is the largest hospital, of course, in Connacht. It is also the clinical centre for Galway University Medical School. The point was made by Deputy Dr. Hennessy that the hospitals in Dublin are utilised for the training of the future medical practitioners of the country. The Galway hospital now does that work for the Galway Medical School. The staff includes three surgeons, two physicians, a pathologist, a gynaecologist and obstetrician, an eye and ear surgeon, and a house physician. An immense amount of money has been spent on perfecting this hospital. I have here also a list of the voluntary contributions made to the hospital for the last few years. Picking out some at random—in 1925 the amount was £1,096, in 1924 it was £808, and in 1930, £33. They utilised these contributions in installing x-ray plant, a pathological department, and other necessaries for a modern hospital.
This hospital of which I am speaking applied to the Hospitals Committee to be admitted amongst the voluntary hospitals which will be getting three-fourths and which up to this were getting the total amount of the money available. As far as I can hear, they have been refused admission into the scheme. To-day a sheet of paper was handed to me, signed by the Treasurer of the Associated Hospitals Committee. It contains a number of arguments as to why the money should not be devoted in any other ratio than 25 per cent. for the country hospitals, and the remainder for Dublin hospitals. The first reason they give is that the city hospitals are national institutions, that they cater for the sick poor from every county and district in the Saorstát. That is no use as far as Connacht is concerned. We in Connacht are very badly treated under this scheme. Cork, Limerick and Waterford have got their share, but the Cinderella province, Connacht, as usual, has been completely left out. The first statement, "that the hospitals we represent are national institutions which cater for the sick poor of every county in the Saorstát," is not true as far as Connacht is concerned. The next statement is "that these national hospitals, not having the security of the rates behind them, require to be endowed, in whole or in part, owing to inevitable loss of public subscriptions." With that also I cannot agree. Any patients who are now sent to Dublin from country districts are paid for at the rate of £2 per week, the same rate at which they are paid for in the Central Hospital at Galway or any other hospital. I cannot agree that the Dublin hospitals are doing anything for the country people for nothing. Anybody who is aware of the conditions in the hospitals here knows that if a poor person in the West of Ireland requires treatment he must be paid for by the board of health; he will not be accepted free of charge in a city hospital. The city hospitals get a big number of paying patients. I have even heard it said that they know how to charge fairly well. The third reason given is "that the moneys received and to be received from the sweepstakes will not be more than sufficient to carry out our proposals." I believe that the hospitals in Dublin are now in a position—and they certainly will be in a better position by the time the last of the sweepstakes is over—to carry out any proposals that they may have had in mind. When this sweepstake was originated, as Deputy Sir James Craig knows, it was never thought or dreamt of by any of these hospitals that they would get as much money as they have now got. To say that the money they will receive from nine sweepstakes will not be sufficient to carry out their proposals is simply stating something that is not correct. They have more money than ever they thought they would get, and whatever proposals they originally had when they started with the sweepstakes, I am sure, have already been carried out, or they have already sufficient money on hands to carry them through. The fourth reason given against our proposal is "that the reduction of the percentage to be received by the national voluntary hospitals to fifty per cent. will not be at all adequate to provide any reasonable endowments for these hospitals, whereas the sum represented by 50 per cent. of the Hospitals Fund will be largely in excess of what the county hospitals can possibly require." The people who presented this document evidently have very little knowledge of the country districts in Ireland.
They know absolutely nothing about conditions in the ordinary county hospitals, and they know very little of the expense that has already been incurred in Galway to make their hospital a fit and modern institution. I entirely disagree with every statement made by the Associated Hospitals Committee in this circular which was issued to me to-day. Their final statement in favour of the Dublin hospitals is: "It must be borne in mind that most of our large hospitals are teaching institutions which educate the entire medical and nursing professions of the Saorstát. No such claim can be made for county hospitals." That is not correct. In the West of Ireland we have a medical school and university and a hospital that is doing the work that those people claim they are doing for all Ireland. It is not correct to say that they are not doing it as well as the Dublin hospitals are doing it for their own students.
Deputy Dr. Hennessy said that the county hospital is a one-man hospital. That should not be so. That is one of the reasons why we ask that fifty per cent. be allocated for the county hospitals, to enable them to cater for the sick poor and for people who are not wealthy enough to come to Dublin. It is not correct to say that one man can attend to all these people. It shows a very bad state of affairs in the different counties if that is the position. I know that in the county adjoining ours there is only one man acting as physician and surgeon to the whole county in the hospital. I do not see how that man could do eye and ear work, the work of a gynaecologist, and all the other work that has to be done in a modern hospital.
The only Deputy who spoke against this proposal so far was Deputy Sir James Craig. I must say that I disagree with every word of what Deputy Sir James Craig said. Deputy Sir James Craig's statement would lead one to believe that he is out of touch with the conditions prevailing in county hospitals and with what county hospitals have to do. The Deputy said that he would like to see the provision of a small operating theatre. Of what use would a small operating theatre be in a county where there have been 1,100 major operations in one year? Even if there were only 300 operations to be performed a small operating theatre would not be sufficient. At present we have two and they are not sufficient. £5,000 would not go a long way towards the provision of these, because £40,000 has not already done very much. How could it be expected that £5,000 would do for a country hospital what £50,000 is required for for a city hospital? It is not that the numbers of patients are not the same. Why should the people in the West of Ireland have to depend on a grant of £5,000 when other people who can afford to pay their way are not satisfied with £50,000? "A man must be trained specially in the use of the x-ray instruments." We have an x-ray specialist, but in that connection, even with our modern equipment, in hospitals in Galway there have been three or four cases recently of superficial cancer where patients died for want of treatment. These were people who refused to come to Dublin for one reason or another. We want as up-to-date apparatus as any hospital in the city. After all there is a lot of duplication in the Dublin hospitals. You may have in one hospital, say, a certain x-ray plant which may be a very expensive one. It may be for diagnostic purposes alone or for deep therapy. You may have similar plant in other hospitals, when perhaps two would be sufficient. I believe that when this money comes into the different hospitals every one of the hospitals will equip themselves and you will have duplication. The money can be applied to the purchasing of ten, fifteen or twenty very expensive x-ray and therapeutical plants in the city, while the hospitals in the West of Ireland will be without these facilities. If it requires £10,000 or £15,000 to instal a perfectly modern x-ray plant, and, if it can be done here in four or five hospitals, I claim and I hope the country Deputies will support me, that in each county or two or three counties combined, the same plant should be installed.
So far, Deputy Sir James Craig appears to have been the only Deputy to have spoken against this amendment. I imagine from his speech that he does not understand the conditions that we have to put up with in the country, or that he does not understand the difficulty there is, at times, in sending patients to Dublin for treatment, a thing that should not, now, be necessary in the case of what is very often a very commonplace thing. It should not be necessary to send those people up to Dublin at very great expense, when the work might be equally well done in the different county hospitals. I know that Deputy Hogan has referred to the metropolitan mind, and I would like to disabuse, if I possibly could, a number of the Dublin Deputies of the idea that nothing can be done outside of Dublin. This metropolitan outlook is very well developed in the mind of Deputy Sir James Craig.
That is why he supported the Bill to benefit 34 hospitals in the Saorstát, 19 of them outside Dublin have been benefited by it.
How many hospitals inside Dublin benefited by it?
The difference between 34 and 19, whatever that is.
I do not want to argue at all with Deputy Sir James Craig on this matter. I know that a man who has been living in Dublin and in touch with Dublin could not see my point of view, and I find it difficult to see Deputy Sir James Craig's point of view in the matter too.
You both should get medically examined.
I appeal to the Minister in case this money is increased from 25 per cent. to 50 per cent. to see that the different counties benefit in proportion to the amount of work they are prepared to do themselves. The Minister for Local Government will have the distribution of this grant, and in certain counties where nothing has been done, the case can now be made that they are entitled to a bigger share of the money than those counties who have, at great expense, erected hospitals, and gone to great expense in providing a staff, and in maintaining them. I think it would be very advisable for the Minister to see that each county gets its share of the grant in proportion to the amount of work already done, and the amount of money already expended in that county.
I think I could make the same sympathetic appeal on behalf of the county hospitals as has been made by any ordinary member of the House. I agree with everything that Deputy Tubridy has said, especially in so far as he is anxious to make it possible for the Minister to make better provision for county hospitals and thereby make it possible to have a larger number of major operations carried out in these hospitals and so to prevent, what I would like to prevent, the necessity for people to come here to the hospitals in the City of Dublin from distant parts of the country. I would like to save people from the necessity of such journeys unless where it was absolutely unavoidable. I served on the original Committee that was set up by the House to deal with the original Bill, with Deputies O'Kelly, O'Dowd, Moore, and other members of this House. I would not like to say how amazed everyone of us was at the success of the sweepstakes. They have succeeded in providing revenue to an extent never anticipated by the most optimistic members of that Committee. I do not think that Deputy Sir James Craig would have dreamed that a sum of £786,000 would have been realised by any sweepstake, much less that we should have received, as we have received, £2,786,000 in the last sweepstake.
I think it was the desire of all of us who served on that Committee and of every member of the House who supported the original Bill, that this thing should be looked at rather from the national point of view than from the city or local point of view. I do not like the suggestion made by Deputy Kennedy, though he has made a very moving appeal on behalf of the county hospitals. He said he would be willing to go back to the 25 per cent. allocation after the county hospitals had received a 50 per cent. share, as is suggested in this amendment, out of the next two sweeps. I would prefer to receive a certain stipulated revenue from the sweep until the necessary work was done rather than change from one sweep to another. I seriously suggest to Deputy O'Kelly to agree to this thing rather than have a division. The figure might be altered, if the Minister would agree, from three-fourths to two-thirds and thereby allow a better margin than is at present provided or than is in the present Bill for hospitals outside Dublin. I hope Deputy O'Kelly will look at that suggestion in a favourable and sympathetic light rather than risk putting it to a division and losing what he is anxious to get. It might be possible, by agreement, to get one-third rather than 25 per cent. that is now provided for. I would also like if Deputy Sir James Craig would see my point of view and adopt that suggestion. After all, Deputy Sir James Craig has been mainly responsible for this matter, for it was he who took the original responsibility in introducing the Bill.
Up to the present, as Deputy Dr. Tubridy knows, it is necessary, by reason of local circumstances, to send patients from the country to Dublin hospitals. That is because they cannot be properly treated in the county hospitals. If the county hospitals get better and more favourable treatment under this Bill, or under this amendment, I am hoping that it will be possible to prevent a large number of country patients who have been coming to the city hospitals up to the present, and a good many of whom have been paid for out of the local rates, from being forced in the future to come up to those hospitals. That is the only purpose I have in suggesting to Deputy O'Kelly that he might, provided the Minister is agreeable, leave the figure at two-thirds instead of at three-fourths, as in the Bill. If the Deputy agrees to that, the result will be that in future sweepstakes the county hospitals will benefit to this extent.
Has the Minister made any suggestion to the Deputy that he will agree to the suggested alterations?
No; I am making the suggestion openly to the House. I am making it to the Minister as well as to Deputy O'Kelly.
I think every one on all sides of the House sympathises with the position of the hospitals, whether situated in the city of Dublin or in the country, when they find themselves in financial difficulties and hard up for finance to carry on. Hospitals are not anxious so much for the money as to be placed in a position that will enable them to do the best for their patients. I do not think, however, that the future of any hospital, either in the city or in the country is being well served by trying to make this matter an issue as between the city and the country. Hospitals and hospitalisation in all countries are viewed from a national angle as national institutions. An appeal repeated here several times to country members to vote for a certain thing on account of geographic conditions is certainly not viewing the thing in the spirit that Deputies should view it in, and more particularly medical Deputies.
In this debate, as far as I have followed it, the main distinction between the county hospitals and the city hospitals, seems to be the fact that one set of hospitals, namely, the city hospitals, are supported by voluntary contributions, freely given by the charitable public, and that the other hospitals, the county hospitals, are really semi-State institutions in so far as they are supported and assisted by the rates; also the fact that the whole position with regard to sweepstakes was brought about by the case made for the voluntary hospitals. At that time there was no case made for, or no mention or suggestion made of county hospitals in the matter. In fact, some people who most deplored the initiation of sweepstakes are most anxious to share in the sweepstakes now, when the donkey work has been done by the city hospitals. The particular case made at that time was that these were hospitals supported entirely by voluntary contributions, and on that basis the sweepstakes were initiated. Later on, a case was advanced for the county hospitals. I want to urge the point that this was a dish really prepared in order to nurse the voluntary hospitals back to convalescence, and now the county hospitals are anxious to eat out of that dish. In a broad-spirited way, the people interested in them said they would give one-quarter to the county hospitals. At the time that appeared to be agreed upon. Now there is a demand coming in for the quarter to be made one-half.
Deputy Tubridy gave us a picture of Galway county hospital and told us that there were something like 1,100 major operations per annum performed there. That is a very big number of operations, and I take it that it is a fair average for a year's work in Galway county hospital. If that is the average number of major operations per year in Galway county hospital, then that hospital should get some very special consideration. But that is not the average for the county hospitals. There is no hospital in any other county that would do 1,100 major operations in six years, and the case for the county hospitals generally should not be confused by the Deputy's presentation of the case for Galway hospital. That hospital stands out distinct and separate from any or all of the other county hospitals. It is a bigger institution and it carries a much bigger staff. The Deputy told us that it has four operating theatres and the volume of work handled, as deduced from the number of major operations, seems to be considerably more than that of any of the City of Dublin hospitals. In that way it must be taken not as a sample of the Dublin hospitals, but rather as a peculiar situation to be dealt with specially and to be set aside from the others.
The Minister for Justice pointed out that in the course of the next nine sweepstakes there should be, in the ordinary course of events, £1,000,000 available for distribution amongst the county hospitals. Deputy Kennedy appeared to disagree with that. He wanted all his share at once. I could not exactly see his point. He disagreed with the figure given by the Minister and he said that they would require £30,000 in his county. The Minister pointed out that in the ordinary course of events they would get that £30,000 and considerably more. The Deputy's attitude was that we had passed the high-water mark with regard to sweepstakes. It is extremely difficult to argue with a prophet. The only way you can argue with a prophet is to take the ordinary signs, figures and facts as they appear to everybody. I think it will be generally admitted that the indicator with regard to sweepstakes is set in an upward direction. That has been our experience so far. The reports with regard to the next sweepstakes would indicate a yet bigger sum than has been realised by any sweepstake so far. If signs and figures mean anything, in the next nine sweepstakes the figure mentioned by the Minister should be considerably exceeded. The very minute that we get a contribution for any county hospital that exceeds the amount necessary for extra medical equipment or extra scientific equipment we are on very thin ice; we have reached the point where we utilise sweepstakes in aid of rates. If Deputy Kennedy or somebody else brings along a Bill when this period of sweepstakes is over to use them openly and honestly for the relief of rates I will not say that I will not find myself in the same Division Lobby. But let us call a spade a spade. At present we are more or less shy of bringing sweepstakes to the assistance either of rates or of taxes. As long as that is the position, we should not endeavour to do it under another label, under the label of hospitals. If a certain county gets £30,000 or £40,000 out of these sweepstakes I venture to predict that there will be a considerable reduction of the rates in that particular county; in other words, that the £30,000 or £40,000 would not go towards the benefit of patients to the same extent as it would go in the voluntary hospitals.
There is another consideration. The cities of Dublin, Cork, etc., are paying rates. They are running the poor law hospitals just the same as any county. In addition to that, out of their charity they are supporting so many voluntary hospitals. The people in most of our counties, through the rates, are supporting the county hospitals, but they are not supporting any voluntary hospitals. The claim put forward by them is that they should get exactly the same out of this machine for the aid of county hospitals as those who do in fact support voluntary hospitals. I do not think that case can be genuinely upheld. We are told that there should ordinarily be £1,000,000 available for the county hospitals out of the next nine sweepstakes. If that figure is realised I think that every county hospital would be very well and very adequately put on its feet. If more money was available you probably could use it in a very beneficial manner, but we must not forget that these sweepstakes were instituted to go to the assistance of the voluntary hospitals when they were on the verge of bankruptcy, when they were nearing the point that they would have to close their doors, and that the position so far is that the voluntary hospitals have merely been pulled out of debt. There is a little bit of money left, but there is a danger of the voluntary contributions falling considerably as a result of the sweepstakes. The voluntary hospitals have to be put more or less firmly on their feet before there is any surplus to be divided generally over the country. The offer of 25 per cent. is a very good offer, and it is an offer which I believe would be welcomed in nine out of every ten counties. It has provided an opportunity that twelve months ago nobody ever thought would arise. The sum of something like £30,000 or £40,000 going to the ordinary county hospitals is equivalent to a sum certainly eight times as great going to the city hospital.
The city hospital has a multitude of departments dealing with a great variety of specialist cases. Only, at most, one-sixth of an hospital can be regarded as a general hospital. The expenses are far higher and the cost for staff and equipment is far heavier. I would like more or less to refute the suggestion that our city hospitals are not catering for country cases. Deputy Kennedy started off by telling us that the Dublin hospitals were not catering for the country or for the poor of the country, and in the next breath he proceeded to demonstrate the fact that they were dealing with the poor of the country. The question is not a financial, it is a medical question whether the poor of the country are or are not being treated in the Dublin hospitals. The Deputy, having first said that they were not so treated, proceeded then to tell us that they were so treated at the cost of £2 per week. It was not a question of figures, but a question of facts. It was a question of what class the City of Dublin hospitals were catering for, what class of patients they were treating, and what class of patients were getting into them. Deputy Sir James Craig said that they were treating the poor within 100 miles radius of Dublin.
The suggestion made by the Deputy was that the boards of health paid £2 a week for the patients treated in the Dublin hospitals. If Deputy Kennedy knows anything about the cost in the Dublin hospitals he knows that nothing is made out of £2 a week. Every case that comes from the country is a very special case, requiring such treatment that our highly efficient county hospitals are unable to deal with them, equipped as they are with special surgical appliances. They are very difficult cases and very serious cases and very expensive cases. I have seen cases in wards in Dublin hospitals where three guineas a week would not cover the cost of injections and dressings alone.
It is up to everyone of us to stand by what we have got. The hospitals, particularly in Dublin City, are doing an immense amount of public work and doing it at a loss. Let us at least recognise that—and not suggest commercial motives to them. They have been compelled in recent years to look to boards of health for contributions towards the cost of treatment of cases sent to them, not with the view to making money but with the view to endeavouring to keep their doors open and to do greater benefit to the people of the country as a whole.
In dealing with another amendment proposed by Deputy O'Kelly, the President said that the hospitals should not be too grasping. I think that rather illustrates the situation at the moment with regard to this amendment. We must not forget that we are dealing with this question at a stage when the City of Dublin hospitals and the Cork and Limerick hospitals have already received £1,200,000 out of the sweepstakes fund. At this stage the hospitals in the country come forward and ask for a fair share of the spoils of the future. And the future is a rather doubtful thing. I think it is not unreasonable for the county hospitals in Ireland to ask for 50 per cent. of the surplus from the sweep to be distributed amongst them, for several reasons. In the first place, notwithstanding what Deputy O'Higgins has said, the ratepayers are bound to pay, and bound to maintain whatever equivalent or improvement is going to be made in the county hospitals, and they are bound to pay that out of the rates.
There is no suggestion in this Bill, and it has not been suggested by any Deputy who has spoken, that any sum which is going to be allocated to the county hospitals can by any stretch be given in relief of rates. Deputy O'Higgins seems to be under the impression that there is some underhand method by which whatever is given to the county hospitals can be brought to aid in the relief of rates. It is clearly laid down no such thing can happen. There is another reason why the 25 per cent. should be increased to 50 per cent. If you look at amendment 15 you will find that it is a completely new Section 7. Under the condition of the Bill as it stands, it means that whatever amount is going to the county hospitals is going to the existing institutions. Under this new section, which we will have to deal with later, I think both should be read together; it gives the Minister very much wider power. Section 7, as it stands in the Bill, deals with the existing hospitals which may put in a claim for a portion of this money. I do not think I am out of order in reading the new Section 7. It says: "Can be applied by him in such manner as he shall think fit in or towards the provision, improvement, or equipment of institutions for the prevention, treatment, or cure of physical or mental diseases or injuries of human beings."
That enlarges the scope very considerably. It brings in the mental hospitals, and those would absorb far more money than it is possible to allocate to them; but having regard to this section which may be passed at a later stage, if it is passed it would mean that even the half share suggested would not be sufficient to deal with the requirements of the county hospitals in the future in the matter of equipment. It certainly would be quite necessary to give 50 per cent. in order to provide any new institution which may be suggested.
We must also bear in mind that if there are such things as new buildings —such as sanatoria and new hospitals for other purposes—they must be maintained by the ratepayers.
I think an unanswerable case has been made out for the change of giving at least half the proceeds to the county hospitals. I do not appeal to country or city Deputies in asking them to vote on this matter. This is, as Deputy O'Higgins said, not a city or a county question, it is a national question, and it should be treated as a national question; and, after all, this question of hospital treatment should be regarded as national and not thought of as if the whole thing was concentrated in Dublin. We should try to understand the amount of work done in the county hospitals already established. I can speak of the amount and of the variety of the work done in my own county. I would like to correct a few of the statements in Deputy O'Higgins's speech. Deputy Tubridy referred to the number of major operations in Galway, and gave the figure as something like 1,100. Deputy O'Higgins said if there were 1,100 major operations in Galway it was not a case to be dealt with under the County Hospitals Scheme but that it should get special treatment. In other words, that it should come in with the Dublin hospitals. Deputy O'Higgins said that in six years there would not be 1,100 operations in any other county institution.
That there would not be 1,100 major operations in any county outside Galway. I happen to have the figures for the county hospital in Cavan for the twelve months ending 1st May, 1931, and they show that 690 major operations were performed in that county hospital.
For the same period there were 3,000 extern cases treated, 20 per cent. of these minor operations, such as tonsils, adenoids and other things, bringing it up to 600 more. Furthermore, the ratepayers of Cavan provided a new wing with something like 35 or 40 extra beds and now the number of major operations is going to increase greatly, as evidenced by the last month. Last month in Cavan Hospital 100 major operations were performed by what Deputy Dr. Hennessy called this one-man show. That is what I call good national work done in an institution pretty well equipped by the ratepayers but which requires greater assistance. Possibly there may be some jealousy in Dublin, but when the ratepayers of the counties have assisted so far out of the rates to provide equipment to enable such work to be done I think the county hospitals should get at least 50 per cent. of the available surplus out of the sweeps.
I might say, in passing, that one of the best acts by the Local Government Department since this Government came into office has been in insisting upon proper hospital accommodation for the counties. Greater relief to the poor and greater saving to the ratepayers have been effected through properly equipped county hospitals than by any other means. I would appeal to members of the House without distinction to give the county hospitals a fair crack of the whip. they are entitled to fifty per cent. of the future proceeds. Let them remember that the one and a quarter million that has already been given to the hospitals was as much a surprise to the Dublin hospitals as it was to everybody else. They never expected to get it, and having got it I think it is not an unreasonable demand to ask one half the proceeds in the future when they have already one and a quarter million in their possession.
Some time ago in the course of the debate Deputy Davin made a suggestion that the figure of thirty-three and one-third per cent, should be substituted for fifty per cent. as an agreed figure. I think it is very unfortunate that this debate has developed precisely in the way it has developed and in a way in which there has been a certain amount of attack, counter-attack and defence. I take the view that both voluntary hospitals and county hospitals do good work and it is recognised, and I think it is a pity that there should be any attacks. To end that I would suggest that if Deputy O'Kelly would withdraw his present amendment, at the next stage I would introduce an amendment substituting thirty-three and one-third per cent. for twenty-five per cent. I think that would be to the advantage of all parties, because, as I say, if it is taken as a compromise it will assuage any differences that might arise.
The position I am in is that I did say to my colleague, Deputy Ruttledge, after listening to the debate that I would personally be prepared to accept thirty-three and one-third per cent. Some other of my colleagues who were with me hearing this said that they would not accept that and they wanted the full fifty per cent. That is the position I am in. If I agreed to withdraw the amendment they would not accept that. They were behind this amendment just the same as I was. Personally I said I would be prepared to accept the Minister's suggestion and the suggestion of Deputy Davin. I wonder would it be possible to strike a farmers' bargain and split the difference?
I think that would be rather impossible. I take a very conservative figure which would be that each county hospital would get at least £40,000. That would be, I think, on a conservative basis. It would probably get on twenty-five per cent. very much more. I think £40,000 would be ample. Some counties will receive considerably more, some less, because some have already benefited to a large extent. I think that would be ample for each one of the counties. If you increase that to one-third instead of one-fourth you will have added to that sum very largely, and the counties should have every possible need satisfied and more than satisfied.
From what I have heard, I am inclined to think that if the fifty per cent. amendment goes to a division it will be carried. That is, from what I have heard from all sides of the House. I think, from the Minister's point of view, it would be wise to get the agreement of the House. I suggest 37½ per cent. to the county hospitals, and 62½ would probably meet the others. I do know that some of them say that if I withdraw they will insist on a division on the fifty per cent. basis.
Now that a definite agreement is within reach, Deputies might moderate their demand under the persuasive influence of Deputy O'Kelly.
If anything less than fifty per cent. is suggested there will be a division.
The Minister has deliberately prejudiced the whole consideration of this affair. He is talking in terms of one million pounds and £40,000. He said every county would get £40,000. Twenty-six counties with £40,000 is £1,040,000. There is no such thing in the offing. Is the Minister not aware that the running of these sweepstakes has created a problem of the enforcement of law in other countries?
Let us keep to this debate.
The Minister's whole attitude is that sweepstakes are to be allowed.
If they are not the voluntary hospitals are burst.
The voluntary hospitals are not burst.
We are considering whether the amendment should be withdrawn.
It was suggested that I was against the county hospitals getting a fair share of the money. I considered that twenty-five per cent. was a fair share, and I was supporting that proposal. According to my reading of the amount that we are to get from the sweepstakes, there will be almost £7,000 out of each sweep. If that is multiplied by nine, one gets at least £60,000.
I do not think anybody can get away from the fact that there is going to be £50,000 or £60,000 on the twenty five per cent. basis for each county. You might say how do I know. What I was going to say is that I am in favour of following the Minister in suggesting that a compromise must be made. If that is not accepted then I am going back to the original proposition. Let us decide the matter on the fifty per cent. basis. I would suggest to Deputy O'Kelly that it is wiser to accept the thirty-three and one-third per cent.
Deputy Sir James Craig has made a point. Does Deputy Sir James Craig realise what the amount would be to the voluntary hospitals? It will mean that they will get six and a quarter millions. Are the voluntary hospitals to be in a position to spend six and a quarter million pounds while the county hospitals are spending £60,000? I think it is a ridiculous thing to ask us to compromise on this because the counties are not getting at all what they are entitled to.
Ten or twelve years ago when the President as Minister for Local Government started this question of amalgamation our whole argument was that we would get people in the counties such good county hospitals and homes that it would be in their interests to agree to the amalgamation scheme, that it was ridiculous to have four district hospitals and that they should have one county hospital. They were to obtain a surgeon who would be capable of doing all operations and it would not be necessary to come up to Dublin for an operation. The President sent us out like apostles all over the country to try and get the amalgamation scheme through. We are told now that those county hospitals are a one-man show, that the county hospitals only should have an x-ray and that it would be unnecessary in any other portion of the county to have an x-ray. Every argument is put up to try and give the impression that proper treatment cannot be given in the counties so that a person who had anything seriously wrong with him must go to Dublin to be treated.
I did not convey that impression. I deny that I did so at any time. I have the greatest admiration for the work done in the county hospitals and I have the greatest desire to see that the county hospitals and infirmaries are properly provided for. I will not allow the suggestion to go forth that I suggested that they are not able to do as good work in the counties as in the cities.
I may have mistaken what Deputy Sir James Craig said, and I withdraw. At any rate the Deputy said that there was no necessity for more than one x-ray apparatus in each county, that it required an expert to look after it, and that otherwise it would be useless. I do not believe that that is a fact. I think in certain cases of fracture, even students in the Dublin hospitals are able to diagnose without any particular training. Even for cases of that sort in the counties the x-ray would be necessary. I want every Deputy to realise that if the case Deputy Sir James Craig made is correct, that sweeps are going to be successful, that every county will be getting £60,000 under the next nine sweeps the other three-quarters, amounting to five millions, goes to the voluntary hospitals that have already got one and a quarter millions. Surely a county can make provision to spend more than £60,000. What are the voluntary hospitals going to spend 6¼ millions on?
A proposition was made a few years ago, to the voluntary hospitals, whereby they could benefit to the extent of £1,000,000 if they did certain things. People in medical circles in Dublin could hardly believe that it would be possible to get £1,000,000 for the hospitals. We thought at that time that all our difficulties were solved if we could get £1,000,000, and that we would never again be in trouble about raising subscriptions. Now, according to the Minister's calculations, the voluntary hospitals are going to get 6¼ millions, and we are told that they are not prepared to give away half of it to the county hospitals. We were told by Deputy O'Higgins, that the voluntary hospitals were very generous when they agreed to give 25 per cent. Who asked these hospitals to be generous? What have they to do with it? The Deputy talked of these hospitals doing the donkey work, and of the ratepayers' hospital now wanting to come in and reap the benefit. What did the Dublin hospitals do to get the money?
How could they have started the sweeps?
It was the promoters all the time.
We were told that people are sent to the city from the country and that they have to pay only £2 a week, which is only a nominal charge, according to Deputy Hennessy. Deputy O'Higgins said that the amount went nowhere towards supporting a patient when everything was taken into account. Contrast the position of the county hospitals with that of the city hospitals. In the city hospital, you have free medical treatment, free nursing treatment practically, while in the county hospitals medical and nursing services are paid for out of the rates. As far as the cost of food and maintenance goes it is about the same in each place. Deputy O'Higgins told us that Dublin had this disadvantage, that the voluntary hospitals have to be maintained by subscriptions, and that the Union had also to be supported out of the rates. Is Dublin keeping the Dublin hospitals? It is not. People all over the country subscribe to the Dublin hospitals, and I am quite sure that they are subscribing more than their due proportion for the services they receive from these hospitals.
We are asked to look at this in a national way. That is exactly how we are looking at it. We want to see the hospitals all over the country brought to a state of perfection. If you go into some of the county hospitals you will see that they were built in the style of architecture suitable to a prison. They have still small prison windows, with practically no light in the wards, and are unfit for the work. Better buildings are wanted. Look at the beds, the clothes, and the furniture in the wards. They are not at all what they should be in hospitals. Then look at the position in regard to instruments and operating theatres.
I remember on one occasion, when I was acting as locum tenens for two days in a hospital just before the amalgamation scheme, a case came in which necessitated craniotomy, and there was no possibility of getting instruments to deal with it. The case had to be kept while a telephone message was sent to Dublin to send on instruments. I believe it is the case in many county hospitals that instruments required to do certain very urgent operations are not available. I think we could very well spend at least 50 per cent. of this money on the equipment of county hospitals. If we got the 50 per cent. it would mean, according to the figures supplied by Deputy Sir James Craig and by other Deputies who are in favour of the Dublin hospitals that there would be something like £4,000,000 left for the voluntary hospitals. If they are not satisfied with £4,000,000, and if they can make a good case, when the next nine sweeps are over, the Dáil would then be in a position to get up more sweeps for them.
I have not heard the whole of the debate or whether any statistics were brought forward to show the proportion of hospitals in Dublin and in the rest of the country, but by listening to the speeches I would like to call the attention of the House to the fact that Dublin is the metropolis.
If the hospitals in Dublin were merely to cater for the residents of Dublin there would not, in my humble opinion, be any necessity for a quarter of the hospitals that already exist here. Undoubtedly these hospitals are great national institutions, catering for and serving people from all parts of the country. As Deputy Dr. Ryan has quite rightly said, they are supported also from sources other than the City of Dublin. That, to my mind, shows that in no sense can they properly be described as Dublin hospitals. That being so, I think that the compromise that has been proposed is a very just one. In fact, I think it errs on the side of generosity towards those hospitals that happen to be outside Dublin. These great institutions in Dublin render services to citizens of the State in all quarters of the State, and, Dublin being the capital city of the State, it is only right and fitting that the great bulk of the money raised should go to these hospitals, which, in my view, are in no sense of the word accurately described as Dublin hospitals.
The question as it strikes me seems to be this: The intention is, I suppose, to convey medical science to the poorest people of the country in the best and easiest possible way. I take it that heretofore medical science was not at the service of the poorest of the population. Undoubtedly, through voluntary efforts in Dublin, the very poor in this city were to a large extent looked after; but what about the country districts? Amalgamation was proposed and carried out, and it had some very good results. When it was carried out I think that most of the county hospitals found that through the shortage of money they were not able to become as efficient as they expected. I do not think that there should be any great difference of opinion over a question like this, because, undoubtedly, the intention of every Deputy here is to make medical service available, convenient, and suitable to the very poor of the country. I think that the only way in which that could be done is by giving the county hospitals an opportunity of becoming up-to-date. We know that people in the country very often refuse, even at this stage of the world's history, to leave their homes to go to hospital. When they do leave them they usually go to a county hospital.
Is not the Meath County Hospital one of the voluntary hospitals?
The Minister apparently does not know the difference between a county hospital and a county infirmary.
The Meath county hospital is not a voluntary institution. I think that the attitude of these people to whom I refer should appeal to Deputies, because there is a good deal of sentiment in it. These people do not go to Dublin hospitals as their relatives could not find the money to bring them to Dublin or to visit them there. Another reason why the amendment should be adopted is that we have efficient medical men who are condemned, as Deputy Dr. Ryan said, to practise their profession under unfavourable conditions. They have not got the requisite training and practice, with the result that they must pass the majority of their patients on to Dublin hospitals. I do not think that any question should arise as to what should be done with the money. A good many of these county buildings are unsuitable for their purpose. The accommodation is by no means perfect. We have a good county hospital in Meath, and, although I know nothing about medical science, I occasionally visit it, and as an ordinary layman I notice things to which I could take some exception. When I asked for an explanation I was told that there was not sufficient money to give facilities for segregation and other necessary accommodation. I do not think that we would be over-generous in giving the full 50 per cent. to the county hospitals. It is not a matter of raising any question as between Dublin and county hospitals. It is to give an opportunity to county hospitals to treat the poor and give medical practitioners an opportunity of developing their abilities. I do not think that there should be any difference of opinion upon the matter.
I have great difficulty in making up my own mind on this matter. I have been listening to the debate, and the information which I wanted most I have not got, namely, what are the needs of the Dublin hospitals and what are the needs of the county hospitals expressed, somehow or other, in figures? I was not here when the original Act was passed, but I think I am right in saying that the sum of money now available from the sweepstakes is altogether beyond that expected when this scheme was promoted in the first instance. I take it that those who promoted the scheme had in mind certain definite needs which they wanted to satisfy. I would like to know whether these needs have, in fact, in the case of the first hospitals which participated, been satisfied. If they have, it should be remembered that other hospitals are coming in now, and I am wondering whether this large sum is going to be spent in the best possible way. I take it that the fundamental idea is to provide medical treatment for those who need it, through these hospitals, for the community as a whole. I feel that there is need for some controlling committee that will examine this question of hospital needs in general, that the services and requirements of these hospitals will be taken into account, and that it will not simply be a matter that by getting in first, or by getting a majority of votes on the committee, certain hospitals will get certain grants. I feel that although opportunities for getting money are being created by this House, we have no real knowledge as to the uses to which this money will be put—whether it will be used in the best possible way, or whether it will be spent in an extravagant manner and with unnecessary duplication.
Possibly the Deputy is not aware that the Bill provides for a committee to look after the distribution?
I understand there is to be a committee, and that is one of the difficulties I have about it—as to the extent to which this committee will have real power. It seems to me that the Minister was inclined, in the speech which he made on the introduction of this Bill, to leave it to the Hospitals' Committee to decide pretty largely how the money was to be spent, and the proportion, as far as I could understand, to be given to each hospital. I know there are reserved powers for this Committee not to sanction a scheme if a fair amount did not appear to be given to one particular hospital. I believe that these powers are reserved here for a special Committee which the Minister proposes to set up under the Bill. I do not think there is any provision in the Bill to give this Committee sufficiently wide powers to examine the whole question and to make certain that the money is being allocated in accordance with the needs and the services of the hospitals in general. If that were so, and if it were possible for the Committee to consider the needs of the country at large, I think it would be very much better than having a scheme like this, where we fix a certain amount in the dark and say: "We will divide it into two parts and give a certain amount to hospitals in the city and a certain amount to hospitals in the country." We think that the question should not be settled in that haphazard way in the dark. The Committee would be in a position to examine the needs of the different hospitals and to allocate the money in accordance with these needs, whether the hospitals were in town or country. If I had anything to do with the farming of the Bill, that is the way I would like to see the system arranged. Taking the arguments put up by the Minister, and by Deputy Sir James Craig against Deputy O'Kelly, it seems to me that Deputy Dr. Ryan's point against Deputy Sir James Craig cannot be put aside, namely, that if under the terms of this Bill £63,000 is allowed to each of the county hospitals, and if such a sum would be available for the Dublin hospitals together with the sum already given them——
The Deputy should not speak of Dublin hospitals alone in this connection. There are 43 voluntary hospitals all over the country from Donegal to Waterford.
There are 43 voluntary hospitals. Deputy Sir J. Craig's point in regard to the county hospitals having more than their needs comes back on himself. I think we should have some idea, before we allocate one percentage or another, what are the needs of these hospitals, both the county hospitals and the city hospitals, and express somehow or other, by means of figures or money, what should be given to these hospitals. I find it very difficult to decide, and the fact that we have a compromise of 33? per cent. suggested instead of 25 per cent. only shows that we are simply bargaining and do not know what we are bargaining about. We do not know whether we are bargaining justly or not. Taking the matter as it has been left at this particular stage, I will be compelled to vote for the 50 per cent. for the county hospitals. I would like to see some attempt being made to have the needs of the hospitals examined and to have some manner of allocating this money to the county hospitals in accordance with their needs and the services which they render to the community, without having it done in this haphazard way, by compromising between the various percentages.
My position on this matter is a choice of two evils. I object on one ground to the extension of the sweeps so as to include hospitals which should be supported by public funds, because I foresee in that way that the promoters of the sweepstakes are going to elicit in support of the sweepstakes a considerable volume of public opinion which otherwise might not be at their command. On the other hand, I hear those who are associated with these projects talking in terms which seem to indicate that they anticipate that the amount of money which ultimately will come for disposal as the result of the sweepstakes will be in the neighbourhood of £8,000,000. Then I find that in the Bill and in Deputy O'Kelly's amendment there is introduced a principle which I will put this way: that under the Bill the expenditure of 25 per cent. of the money is to be subject to some regulation, some control, some attempt at coordinating the purposes upon which the money will be expended, and that the remaining 75 per cent., say £6,000,000, is to be left at the disposal of the hospitals themselves, a number of voluntary hospitals, to a certain extent responsible, I suppose, to public opinion but very largely autonomous bodies. That money will be expended by them without the amount of control or without the co-ordination which I think it requires. To my mind, the great merit in Deputy O'Kelly's amendment is that it definitely regulates to a larger extent the expenditure of that £8,000,000 than the Minister's Bill does. For that reason I am strongly in favour of the amendment, even though it is open to the objection that it will elicit the support of a body of public opinion which otherwise might not be at the command of those who are undertaking the sweeps.
In regard to the necessities of the case I am speaking, naturally, as a layman, but I have been in a considerable number of county hospitals, rate-supported institutions, in the country, and I have never yet been in one of them that fulfilled my idea or conception of what a hospital should be. I have never been in one of them that was at all comparable from the point of view of equipment and the comfort of the patients to any of the voluntary hospitals in Dublin which are to receive a proportion of the proceeds of the sweepstakes. In a great many cases these buildings are converted workhouses. The patients are housed in buildings in which the primary conception seemed to have been a place of detention rather than a place of public charity or a place where healing processes had to be undergone. They are ill-lit, they are built in a very poor way with a considerable amount of timber, narrow passages, narrow doors, no attempt at comfort or internal decoration whatsoever. If I were asked for an opinion as to the probable needs or the probable capital amount that would be required in order to provide hospitals with proper equipment and accommodation, I would put the sum at £110,000 per county at least, or £3,000,000 for the country as a whole. That only relates to the ordinary county hospitals.
I do not take into consideration the mental hospitals which, under one of the amendments to come before the House, will now be included in the Bill. There are about eight of these mental hospitals in the country, and with the one possible exception of Portrane none of them is modern. Carlow, to take one that I know, was built over 100 years ago. Mullingar Mental Hospital was built about 1854. Not one of them was laid out in accordance with modern ideas of the treatment of mental diseases. None of them can be adapted to modern ideas or to give treatment on modern lines in regard to these diseases.
Practically every one of them will have to be rebuilt from the ground up and I am certain that as far as the treatment of mental disease in this country is concerned another million or a million and a half would have to be expended by public bodies in order to provide it. That I think brings me back to the idea as to what would be a fair proportion. According to what Deputy Sir James Craig said in relation to the sharing of the money that would be made available for county hospitals, I notice that he anticipates that these sweepstakes will secure something like £8,000,000. Of this he proposes that about 6¼ millions should be spent amongst the 43 voluntary hospitals and 1½ millions amongst the 83 country hospitals. He proposes to allocate about £20,000 to each of the 25 county hospitals. That million and a half pounds would go to rebuild and re-equip the 25 county, and 58 district hospitals. There would be available for each of these, something like £20,000 to rebuild and re-equip them, and there would be 6¼ millions to be allocated amongst the 43 voluntary hospitals.
Surely the discrepancy in the figures must appeal to every Deputy in the House. If there is a case at all, so far as arithmetical examination of the matter is concerned, the case is for nothing less than an equal distribution as between the county hospitals and the voluntary hospitals. Then surely the argument is in favour of the county hospitals as against the voluntary hospitals, and instead of the county hospitals receiving only 25 per cent., I think a very good case could be made out for their receiving 75 per cent. It is on that basis that Deputy Ryan and myself feel that a fair compromise was the compromise suggested in Deputy O'Kelly's amendment. The more you examine into the matter the more every fair-minded Deputy will be satisfied that the amendment is a fair one and a just one. I believe it is not wholly just to the county hospitals, but it is not unfair to the voluntary hospitals. It is not for that reason that we are not prepared to accept the compromise of 33? per cent. which has been accepted by the Minister for Justice and by those who spoke rather for the voluntary than for the county hospitals.
There has been a considerable number of matters raised here on the debate into which I do not want to go. I do find this in regard to those county hospitals, that I have never been in one that has not been fairly well filled. I am not going to say that I found every bed occupied, but I have found a considerable number of patients in every one of them. That satisfies me that the need for these hospitals exists, and if it does exist, there is to my mind a case, and a case that cannot be met or overcome, for providing them with the best equipment and the best staff that can be secured.
I feel perfectly satisfied that if the public authorities were once able to deal with the question of capital expenditure with regard to building and equipment they would not be slow in providing the necessary funds to pay an adequate staff. From my experience of them I am aware that the one thing that deters them from modernising these hospitals is the fact that they are faced with a huge capital expenditure. Such expenditure would put a huge burden on the rates for a considerable number of years. The local bodies could not face that, because they feel that after that expenditure had been undertaken they would have to make the necessary provision for a staff. They cannot see any possibility out of their present limited resources of being able to meet the capital charges upon the new expenditure and at the same time provide adequate remuneration for the staff. If the problem of capital expenditure were to be solved I feel that the adequate staff would be immediately forthcoming, and that the public bodies would make every effort to provide the necessary and adequate remuneration for them.
Deputy MacEntee said that the voluntary hospitals were at the present moment to some extent dependent upon public opinion. I just asked one of my friends what the definition of a voluntary hospital is, but I have not been able to get that definition. I understand that a voluntary hospital is an hospital which is supported by voluntary subscriptions. As soon as a voluntary hospital no longer depends upon voluntary subscriptions it will cease to be a voluntary hospital. All that internal management, self-control and autonomy and everything that went to show that they were voluntary hospitals and depending on voluntary subscriptions given ad hoc to them by people interested in these hospitals— all that position will be imperilled.
The suggestion that the State should provide machinery by which something like £6,000,000 is going to be collected in this country and other countries and handed over to voluntary hospitals, and that those voluntary hospitals shall, after they have received that money, remain in the same position of self-control and self-dependence in which they are now, seems to me to be an impossible proposition. The more money that State machinery of this kind provides for voluntary hospitals the less claim they have to autonomy, self-control and independence and that individuality which they have had up to the present.
I have heard no case up to the moment showing why voluntary hospitals as at present defined and which will cease to come under that definition should be regarded as places to which the vast preponderance of the money which is supplied could usefully go. If that argument has been put forward I have not heard it, and if it has not been put forward I would like to hear it. We have no better reason to believe that voluntary hospitals as they have been constituted in the past will usefully use a huge amount of money as compared with other hospitals. That is my first difficulty. I warn every voluntary hospital that gets from the State a huge amount of money, and an amount of money which is going to be, on these calculations, altogether more than they have been getting from voluntary sources, as to what is going to happen under the new conditions. When they take that money they are imperilling that position and the claims they have previously made will not necessarily be recognised.
I am very much of the same opinion as Deputy de Valera. I find great difficulty in putting any argument of a definite character behind any of the figures, whether 25, 33, 37½ or 50. These seem to me to be empiric figures. I have heard no suggestion which would make any of these figures sacrosanct. My feeling is that in the absence of a definite argument showing that a huge proportion should go to the voluntary hospitals, the proportion that should go to those not now so designated should be increased. I would like to see the whole of this money—assuming that we are going to get this money— paid into a central fund and distributed not upon this empiric basis at all——
At first it would have to go into some central fund which would have to be a State fund to some extent, and the regulation of that fund would undoubtedly have to be settled by the State.
To the degree to which State control would be exercised. That is again a question. If the State, through this House, sets up any machinery for the selection of the people who will control that fund, to that extent it will be a State fund. The less interference there is by the State, in the way the State ordinarily interferes with things of this kind, the better. I would like to see the State setting up an impartial body of competent people who knew what use to make of it, and not interfering with them once they were satisfied that they had set up that competent body. We are in agreement to that extent, that it must be a State fund in so far as it is set up under the authority of the State, and the regulations for its carrying out would have to be settled in this Dáil or through some State source.
That would mean a State lottery.
It is a State lottery now.
It is a State lottery. So do not let us fool ourselves. I do not believe in any camouflage about it. If we are fooling ourselves that this is not a State lottery we would fool ourselves about anything. I would like to see that money put into a central fund of that kind, under competent, scientific and medical control, and I would like to see every penny paid out of that fund on a case stated, not some empiric figure to voluntary hospitals, not some empiric figure to county hospitals, but just in the same way as a county council deals with a road scheme, a sanitation scheme, or something else. Anyone who wanted money out of that fund would have to show a case in relation to the work they were doing, the inadequacy of their equipment, and so on. A second case would be founded on the developed work which they could and ought to do if they had an adequate fund; and a third point the financial position of that concern and their difficulty in facing up to the work which they had to do in the future.
Show me such a case, and I will vote for fifty per cent. seventy per cent. or ninety per cent. unless some one is prepared to give me a case which shows that the seventy-five per cent. should go the other way. If a case is shown that the voluntary hospitals are in some peculiar way able to make better use of this money than anybody else, then I will vote entirely with them in this matter, but unless and until that case is stated, it seems to me that the general burden of evidence is in favour of a wider proportion to the hospitals which now are not called voluntary.
Deputy MacEntee has certainly made his position quite clear so far as those who were listening to his speech can put an ordinary meaning upon his words. He stated quite bluntly that his objections to the principle contained in this Bill— he previously said the same thing in reference to the original Act—were so strong that if he had his way there would be no Act of any kind and, therefore, there would be no money, either for the voluntary hospitals or the country hospitals.
I said nothing of the sort.
The Deputy objects to the extension of the principle contained in the Bill. He explained it in far greater detail in a speech which he made on the Second Reading of this Bill. He also said that he would not be prepared to agree to a measure of this kind whereby such large sums of money can be expended unless they were expended without being subject to the supervision that State expenditure requires. Did he mean by that that he is in favour of a State lottery, or a system of raising money under the auspices of the State, and thereby having that money allocated by the State through some particular channel? Deputy MacEntee can assure himself, if he is not already aware of it, that when I was making the suggestion of a compromise I did so without considering the position of the voluntary hospitals. I agree with Deputy de Valera that we are discussing this matter in the dark in so far as we are not aware of the needs of the voluntary hospitals, or of the county hospitals, or as to the proportionate needs of the institutions that are likely to benefit under the terms of this Bill
I am only concerned in any vote which I may be asked to give as to whether it is possible to get fifty per cent. If it is possible to get fifty per cent. I am prepared to vote for it, but if there is a possibility of losing the fifty per cent. I want to see agreement, if agreement is possible, on some lower figure. I do not want to risk the chance of getting for the country hospitals thirty-three and one-third per cent. instead of twenty-five per cent. which is provided for in the Bill. Therefore, I want to know, first of all, from the Minister what attitude he is likely to adopt on the Report Stage if Deputy O'Kelly's amendment is defeated on a division. I also want to know from the Chair the form in which it is proposed to put the amendment. Is it that the words proposed to be deleted stand?
Would it not be better to put the figures of fifty per cent., thirty-seven and a half per cent., or thirty-three and one-third per cent.? I can see Deputy Davin's difficulty. He does not want to fall between two stools. We are not trying to score over one another or to catch anybody out at all. It is a question of finding out what the House wants done in the matter. The Chair could put an amendment that fifty be the figure, or thirty-three or twenty-five, and we would find out what the House intends.
I am not professing to be an expert on procedure. I submit, for the information of those who desire agreement, that if the amendment is put to the House in the form "that the words proposed to be deleted stand," it will preclude the Minister on the Fourth Stage from interfering with the decision of the House.
I think it is only a matter of procedure that the Chair puts the amendment in a particular form. In this case it would be very much better if Deputy O'Kelly's amendment were put directly. It would leave the Minister free afterwards. It would be open to him then to propose thirty-three and one-third.
Of course Deputies understand that the suggestion of thirty-three and one-third per cent. was an effort to reach a compromise. That, I am afraid, has been rather scorned. I would urge upon the House, rather than have this matter go to a division, that it would be wiser to accept that compromise. I have a completely open mind in the matter. I came to the conclusion that twenty-five per cent. would amply meet the needs of the county hospitals. I am willing, however, to abandon that attitude and accept thirty-three and one-third per cent. There was no tendency to move in the other direction. You cannot have a compromise in which one person stands firm and expects all the "give" on one side and all the "take" on the other.
The Minister's way of looking at it does not appeal to me. He ought to be anxious to do that which he thinks is fair, not that which is politically convenient at present.
It is not a question of political convenience.
The best method of getting the views of Deputies on this matter is by putting the amendment as an amendment usually is put, independently to the House. Then we can vote either for or against 50 per cent. If the amendment is lost, it will still be possible for the Minister, if he really thinks 33? per cent. is fair, to introduce an amendment to that effect afterwards.
I agree with the Deputy that it is not a question upon which you can completely make up your mind as to whether the thing is fair or is not fair, because we have not, and we cannot possibly have, sufficient data before us upon which we could decide the matter with any degree of certainty. We can only approximate. I personally think 25 per cent. is fair for the county hospitals, from such evidence as I have got—not complete evidence. I think that would be better and fairer between the two than 33? per cent. But I think that in a compromise both sides must give way to a certain extent, and this is not a question in which you have any absolute certainty.
Let us be clear as to what is the point.
The point I make is that the Chair ought to put this amendment first, and put it in its own terms, and not in the negative way which we have been accustomed to for convenience, so that Deputies might come down from the Division Lobby on their own side, or some such reason as that, by putting the question in the form "that the words proposed to be deleted stand part."
There is more reason for it than that.
As far as I can see, putting the question, "That the words proposed to be deleted stand part," is a negative form of putting an amendment for convenience, and is not in accordance with the rules of order at all.
Will the Deputy suggest what difference it makes in this case?
If Deputy O'Kelly's amendment is put and carried, that is all right; there is a majority in favour of that particular proposal. If it is lost, then the Minister, or anybody who thinks that 33? per cent. should be inserted, would be in a position to move that afterwards. This one would be disposed of, and another amendment could be brought forward.
It does not make any difference in what form the amendment is put. If the question is put, "That the words proposed to be deleted stand part"—that is, "three-fourths"—and if that were carried, it would not preclude the Minister or any Deputy from moving on the Report Stage to make it 33? per cent.
May we take that as a definite ruling from the Chair?
I am giving it from the Chair.
That makes the matter very much easier. I should like to refer to some remarks made by Deputy Davin. I think Deputy Davin ought to go to an auralist and have his hearing tested, because I certainly did not say that I was prepared to vote for Deputy O'Kelly's amendment because certain large sums which would thereby be allocated to the county hospitals were going to be spent without supervision. One of the reasons why I shall vote for Deputy O'Kelly's amendment is because there will be supervision over a large proportion of the money that is to be provided through the sweepstakes, otherwise than there would be under the proposals made by the Minister.
The Deputy has not read the Bill. There is complete supervision over both.
There is no supervision over the expenditure.
There is no attempt at co-ordinating the manner in which this money will be spent by the several hospitals. The Minister also said that he had an open mind with regard to the matter, and later on he said that so far as he had made an examination of it he thought that twenty-five per cent. was a fair allocation. If he has made any examination of the problem at all he cannot have an open mind— he must have come to some conclusion. If now, with an open mind in the matter, he thinks thirty-three and one-one-third per cent.——
What I said was that I approached the question with a completely open mind and completely unprejudiced and that I came to the conclusion, on such evidence as I had, that twenty-five per cent. was fair.
Perhaps if Deputy O'Kelly withdrew his amendment, on the assurance of the Minister that he would move to insert thirty-three and one-third per cent. on the Report Stage, it would meet the point. The reason I suggest that is this: I pointed out, when speaking on the amendment, that the next section, Section 7, is proposed to be amplified by the Minister and that he is bringing in under this heading the provision of buildings, which was not brought in before, and the provision of new institutions. So far, as we have only got down to Section 6, we are only dealing with existing institutions. The case put up is that they are entitled to fifty per cent. as against 25 per cent. But, if the Minister is going to enlarge the scope and make provision for mental hospitals, and, possibly, new institutions, it may be necessary to revise that figure again after we deal with Section 7. Therefore, I think that the whole matter should be left over for the Report Stage.
In dealing with the necessities of the hospitals 12 or 18 months ago you were dealing with them in the light of what you expected as a result of the sweepstakes. The result has created a new position which you did not contemplate at all at the time. The necessities of most of the voluntary hospitals, certainly those in Dublin, do not include equipment. They are already provided with equipment. They are already provided with buildings and accommodation. When you come to deal with the hospitals in the country you will find that they have not most of these things at all. As a matter of fact, it has been said that prisons would be a more fitting description for them. The necessities in their case are infinitely more than was ever contemplated, if you want to have a county service at all. I think the opportunity has come now for giving to the county hospitals something approaching what is necessary. I want the Minister to view it from a different angle altogether from 12 months ago. There are only the overheads in connection with the voluntary hospitals here—the other items of expenditure, whatever they are. Certainly they have their equipment and their buildings, and these are up-to-date. That is not the case at all with the county hospitals. You will need a much bigger sum if you are to have proper hospitals in the country. You will want to contemplate more than you contemplated before.
I want to be quite clear as to your ruling, sir. Do you intend to submit the question to the House that the words contained in the Bill, "three-fourths of the available surplus," stand part?
I shall tell the Deputy that when I come to put the question.
It would save a good deal of this discussion if we were quite clear about that.
I do not think I could make it any clearer. I think I made it quite clear that it does not matter very much from the Deputy's point of view in which form the amendment is put. If I put the question, "That the words proposed to be deleted stand part," that does not preclude the Minister, or anybody else, on the Report Stage, from moving an amendment to the effect that it should be thirty-three-and-a-third instead of twenty-five.
As far as I can see, several Deputies who have spoken here, and particularly Deputy Sir James Craig, have very little knowledge of the condition of the county hospitals. They would seem to have absolutely none. Now up to the present the Dublin hospitals have got £852,000. That would take fifty years to collect voluntarily in Dublin or in the country. They have got far more than three times what they expected to get. They have got £852,000 in Dublin, compared with £364,000 to the rest of the country, that is, the other twenty-five counties. I know the conditions of the hospitals in Cork County. I am sure it would rather surprise Deputy Sir James Craig to know that in the best county hospital in Cork patients for operations have to be taken up two flights of stairs in blankets. That might surprise Deputy Sir James Craig, but it is the actual position in the Cork County Hospital at the present moment. Does Deputy Sir James Craig think there is any money wanted there?
I am not going to tell you what I think.
I know you will not. In Midleton, for the last 5 years the sum of £15,000 is wanted and it has not yet been found; nor can that money be found. I quite realise the position of Deputy Sir James Craig and those other Deputies here who see nothing outside Dublin and never want to see anything outside Dublin. Their whole idea is that patients who want to be operated on must be brought up to Dublin. Deputies in this House should be concerned for those unfortunate people who cannot afford to come to Dublin to pay for operations. They should be the concern of this House and they should be catered for by the sweepstakes. We have had too much of the other talk at the present time. I think that some of the voluntary hospitals in Dublin have got enough already and should be out of the sweeps for the future. That would be far nearer the mark. I am well aware of the situation in the country, where those representing the poor would not or could not, in justice, put a burden upon the ratepayers to provide proper hospital facilities or proper hospital accommodation. I am well aware of the situation. It exists for a number of years, but now there is an opportunity of remedying the situation and I think it should be remedied. If any amendment were brought in here it should be to cut out the City of Dublin hospitals from the sweeps. They have got more than their share as compared with the rest of the country, and that is what I am in favour of. I am in favour of this amendment, and I hope it will be carried and that those who represent country constituencies will support it. We have had too much talk that everything must come to Dublin. There is too much of that in the country at the present time. The unfortunate poor who cannot afford funds to get them to Dublin for operation are deserving at least of some facilities.
The Deputy is cutting out Cork City as well as Dublin.
I am not, but I am in favour of cutting out Cork City if we could get the money for the country hospitals in Cork which want it far more, and if we could get it for the Cork County Hospital, which wants it far more. That Cork County Hospital is supposed to be the best county hospital in the Twenty-Six Counties, and if that is so, considering its condition, the condition of the others must be very bad entirely.
I think I can clear the ground in one direction. The original Bill had its conception in the National Maternity Hospital, Holles Street, the walls of which were falling in. It had no money to build, and a statement was made to me that the hospital would have to close. The Holles Street people saw they could not promote the Bill themselves. They applied to other hospitals, also in great need, and the result was they brought together a small committee of the representatives of at least half a dozen hospitals and they promoted the Sweepstakes Bill. That Bill was brought to me, and I was asked if I would sponsor it. I sponsored it to some extent with the help of all sections in the House, and it went to the Seanad. I want to say this, that as far as the Act is concerned, after it passed the Seanad I had no hand or part in anything done under the Act. I refused to act as trustee, and I refused to go on the Hospitals' Committee.
The original Hospitals' Committee was enlarged by the inclusion of two representatives from each hospital that came into the sweep, and these were the people who had before them the needs and requirements of the hospitals that were brought in after it. I began by speaking about Holles Street, and I want to say this, it is an example of the state of affairs in a good many of the others and would be some answer to Deputy de Valera's remarks. Holles Street Hospital has received, I think, something like £80,000—I am not sure of the exact figures, but I think they received out of the three sweeps something like that figure. Am I correct?
Somewhere in the neighbourhood of £80,000. At all events the point I make is that that hospital consisted of old tenement houses and was falling in. They could do nothing else, if they were to do any good work in the future, than pull down the entire structure. The result was they sent out proposals for rebuilding the hospital themselves. I am not sure of the figure, but I understand it came to something like £130,000. That means they still require a certain amount of money to erect their building. Are they going to set up a white elephant that they can never support after? It will require the capitalisation of at least £110,000 to secure an income of £4,500. The amount of money which came to Holles Street in voluntary subscriptions varied from £400 to £600. That was all they received from the public. Therefore, they are bound to make provision for the future. Their entire outlay was something like £6,000 or a little over it in a year. If in rebuilding their hospital they make more accommodation it will cost more and therefore they will have to look for the investment of a large sum of money. The least amount I would put that sum down at would be £110,000.
[An Leas-Cheann Comhairle took the Chair.]
I do not think that they are likely to get in the future £10,000 out of each of the nine sweeps, that is to say that they are going to get £90,000 on the basis of the figures I have been using here. From that they will have to deduct what will equip the hospital after they build it, and then they will have to look for their income for the future. I could give figures with regard to other hospitals that would bring out the same idea namely, that it is no use for these hospitals to erect buildings and then make no provision for income in the future. With regard to the one hospital I have something to say to, although I am not on the Board, the first effect of getting the money was that they were able to raise their nurses' salaries to something like what you would pay your cook, to a decent wage, something that many of the Deputies here would not think a very large sum for a cook. The next was to pay the servants, who were getting only £18 a year or something like it, decent wages. The third was to provide the laundresses with wages they were never able to give before and about which they had been pestered. Increased pay to nurses, servants and laundresses means capital expenditure of £12,500 a year; that has to be earmarked at once. If we go on the assumption of what the Minister said, that at least half the voluntary subscriptions would disappear, that means that another £10,000 would have to be provided for which would take twenty-two and a half thousand pounds. The hospital was being run each year at a loss of £1,000 a year. The expenditure was £1,000 over the income. That means that provision would have to be made for that. There you have £40,000 with the £12,000 before anything has been done in the way of equipment. I have been listening to Deputies saying that the hospitals have been all equipped. Not a single thing has been done except putting aside money to meet the future expenditure of the hospitals. That shows that there is another side to the case I give than what is shown here that the hospitals were getting hold of money and throwing it about without any control.
I have no objection to the suggestion made here that there should be some committee which would have control over the expenditure of the hospitals. I remember making a speech here five years ago in which I stated that it was a great mistake that any one, on his own, should be able to start a hospital for his own sake or aggrandisement or anything else without any supervision from the Government. They started a little hospital in a small way and got the committee to come and begin to collect funds that should be going to the regular hospitals. After that they got grants for the hospital. There was no proper board. There was no control over the financing of the hospital which was only run by one person.
I would like to see the county hospitals provided with every convenience that would bring them up to date. There was no suggestion in my mind that the county hospital surgeons are not capable of doing excellent work. I would be very sorry that anything to the contrary went forth from this House, but when I hear people like Deputy Corry suggesting that the Dublin hospitals should be thrown out of this, why does not Deputy Corry bring in a Bill and get the whole of the money for the county hospitals when this Bill is passed? Any one of us would support that. He says that what was provided for the county hospitals should be divided with the others in equal shares. My opinion was that 25 per cent. was a very large amount, because if we are able to foresee things it is quite obvious that there is not going to be a falling away but an increase.
Some Deputies wanted to know what is meant by a voluntary hospital. A voluntary hospital means that physicians or surgeons connected with it give their work for nothing. I say that for over forty years I have given my services to the poor of Dublin without any fee or reward, and as far as the sweepstake is concerned I have not benefited by one sixpence. Voluntary hospitals are manned by people like myself who have given their time for years and years without getting a single fee, attending poor suffering patients. I think those hospitals should be considered.
As far as the voluntary part is concerned, reference was made about voluntary subscriptions. Fortunately some of the hospitals are well provided with voluntary subscriptions; others are not nearly so well provided. Some of the hospitals getting £5,000 or £6,000 a year can only count on getting half that at present. There were three or four in the last, and what is regarded as voluntary hospitals were those who were receiving a certain amount of voluntary subscriptions. I reiterate that there were 34 hospitals, of which 19 are included in the City and County of Dublin. As against that there were only 6 in Cork, 4 in Limerick, 3 in Waterford, in Louth 1, in Donegal 1, in Kildare 1, and in Wicklow 1. Therefore, it is quite absurd to be thrown in my teeth that I am only metropolitan and only take a metropolitan view. I am sorry that Deputy Tubridy went out, because some years ago I was sent to Galway to examine a hospital to see whether students should be allowed to go there to be taught their clinical surgery and medicine, so that I know something about conditions there. What surprises me is that Galway did not come in. Why Galway, which deserved it most undoubtedly, has not come in I do not understand.
It is maintained by rates.
Does it get no voluntary subscription at all? That excludes it from under the original Act. The original Act says that the hospitals must be getting some voluntary subscriptions and must be attending 25 per cent. of their patients free. As far as I am concerned, I would like to see Galway hospital, where there is any teaching done, equipped in the most up-to-date manner possible, and I would like to see every county hospital equipped and fitted throughout the country. I think the amount that is to come from this is quite sufficient to do all that. I may be wrong. I do not know.
Deputy Briscoe suggested on Friday that as I had pressed the Government to appoint county medical officers of health I should see that their salaries were provided for in this way. It is all nonsense to talk in that particular way.
I got a letter from a very excellent doctor in Mayo. He says that there should be a research hospital set up to inquire into the causes of the defective mental conditions of children down in Connemara. That is a most excellent thing. It is so good that I would like to have it extended to some adults. That is only in passing. The other suggestion that was made to me is that something should be done for the district nurses. I do not think there is any better work done in the country than the work done by the district nurses, and if it were possible to bring them back into this Bill I would be very glad to do it. I am sorry that Deputy O'Kelly did not accept the offer of the compromise made. I do not consider it is any compromise. He is going to vote as to whether he is to get 50 per cent., and then, if defeated on that, to vote as to whether he would get 33? per cent. I understood that the compromise was to have 33? per cent.
Deputy Flinn and Deputy Corry rose.
Deputies may speak more than once in Committee. Are we to start the debate again? One can be relevant for a long period on this topic.
I submit that these are very big issues, and that the issues are widening all the time we are discussing them.
That is the difficulty. We have started one Bill. We have got a second one. The issues which we are driven to discuss in making any attempt to get to grips with the question are getting so big that we should be either prepared adequately to discuss them or to say simply that we will not discuss them. I have listened with great interest to what Deputy Sir James Craig said. I think Deputy Sir James Craig, like everyone else, is acting in good faith. That is the spirit. The first thing I suggest to Deputy Sir James Craig is that we should get rid of the word "compromise" altogether. That is not what we are here for. We are not here to make bargains. We are here to pursue what is the opinion of the House on this question. It is not a question of finding a compromise between two different people in relation to a figure. It is a question of finding out what proportion this House on a free vote— each person independently exercising his judgment—desires should be made in the matter. Such a question as compromise is not what we are here for, and I do not think it is what Deputy Sir James Craig intends. If you once use the word "compromise," you suggest interests. You suggest that there are two interests which have to compose their differences. That is not a suggestion I am prepared to make, and if it is to be made it must be made in set terms by someone. Therefore we cannot use the word "compromise." What we are here to find out is, what the figure should be. Like everyone else, I think the Minister was acting entirely in good faith, and when he formed the opinion that 25 per cent. was a fair figure for the county hospitals, as far as I understand it, that means that he must have formed the opinion that 75 per cent. was the figure required by a voluntary hospital.
I want the Minister to explain upon what basis he came to that opinion. A point was made—and I do not think it was intended to be a political point—that Deputy Corry, in relation to what he was saying about Dublin, was neglecting the City of Cork. I am a Cork representative, and I would not be expected, I suppose, to say something which is unpopular in Cork. I adopt quite freely the attitude of Deputy Corry, and I say that if it can be shown that any voluntary hospital in Cork would receive money from this proposal which it could not properly use then it ought to go out, and some other institution which has not sufficient money ought to come in. In exactly the same way we are faced by the fact that £850,000 has gone to the City of Dublin. A sum of £110,000 went to one place and £80,000 to another. Has the Minister satisfied himself that that is not adequate for the present and the immediately prospective needs of these hospitals in relation to other hospitals? If he is satisfied by making the basis 25 per cent., I take it that some attempt has been made to do that. If there is an hospital which, due to the fact that it got in on the ground floor when this thing was started, has already received an amount which relative to its necessities and the necessities of other hospitals seems fair, then it might drop out. Are we to take the line that those who got in on the ground floor have a vested interest to remain in, and simply that they have an obligation to use the money which is automatically going to flow in from this fairy fountain of gold? Is that line taken? Is the line taken that the hospitals which originally came in have a vested interest? Are they to get the money all the time this is going on?
A certain amount of it probably. I do not know. I have nothing to do with it.
That is clear. We are talking of 25 per cent. and 75 per cent. being fair. On what basis are they claiming part of the 75 per cent.? Is it on the ground of vested interests because they got in on the ground floor? You have to face that issue. Or are you going to say that whoever came in and whatever the amount of money they are going to get for their hospital is to be in proportion to the needs of that hospital and the work it is doing? I want to know from the Minister—and I am not putting this question in any controversial sense— on what basis he has calculated that six millions is required for these nominal voluntary hospitals as distinct from one and a half millions for the hospitals that are said to be non-voluntary. Deputy Sir James Craig told us that one hospital received £80,000. He also said that the subscriptions were from £400 to £600. If he cannot see the danger in that to the whole principle of voluntary hospitals——
I saw the danger of the hospitals falling.
If any other hospital happened to get in on the ground floor which received £400 or £600 in voluntary subscriptions, are you going to say that it should go on, develop and pull down buildings in order to absorb £80,000, £18,000, or whatever hundreds of thousands of pounds may automatically fall into its lap because it got in on the ground floor?
I am glad. Here is the issue, and I suggest to the Minister that he has to find the basis of the 25 per cent. and the 75 per cent. or of the 50 per cent., or whatever figure is taken, based on one of two considerations, either the vested interest consideration or the consideration that he is convinced by examination of the question that that proportion of money can be better used than any other proportion distributed as between two people. I would ask the Minister to tell the House why he has come to the opinion that six millions, or we will take the figure of 75 per cent., are required by the voluntary hospitals relative to the one and a half millions required by non-voluntary hospitals?
In this amendment I think there is a great risk of the county hospitals suffering, from the very fact, as Deputy Davin put it, that we have 25 per cent. in the Bill, 50 per cent. in the amendment and, at the same time, 33? per cent. offered as a compromise. If, as An Leas-Cheann Comhairle declared in reply to Deputy Davin, the question be put that the 25 per cent.. stand part of the Bill, and if we pass it, it will embarrass the position of county hospitals very much because it would deprive them of accepting the offer of 33?. Every Deputy who spoke to-day represented a county hospital, a county home and the poor, sick, and infirm. It is his business and his interest to see that the best possible provision is made for the sick, poor and infirm in county hospitals. He has no personal greed or avarice regarding the money to be contributed and his only desire is to see that the greatest possible amount of luxury is provided for patients in the county hospitals in the county in which he lives. I am sure that every Deputy would regret very much if he sacrificed any benefits that would be coming to such hospitals provided for in the Bill. Deputy Sir James Craig has made a strong case for the city hospitals, and rightly so, and he deserves the greatest possible credit for making such a fight for them. It is questionable whether any doubt can be cast on the validity of his statement. He is trying to make provision for them in the future, and no one can find fault with that. He initiated this scheme and carried it through successfully, despite much opposition and heckling. I quite see his point of view, and I can see that he is right in looking to the future when the hospitals may again be embarrassed, but I think that the county hospitals, which are in a dilapidated condition, and whose equipment is of a very primitive character should also be assisted.
I am sure that if Deputy Sir James Craig had an opportunity of visiting the county hospitals in the midlands and the west he would be prepared to ask the Minister to grant the greatest possible share of this money for the equipment of those hospitals. I do not think that it is a matter of 25, 50 or 33? per cent. It should be a question of what the House can agree to give, the largest amount possible to relieve the position of such hospitals. It is a matter that will pass from the control of this House and we will not have to consider it again, but that is all the more reason why it is highly desirable, when we are dealing with it now, that we should decide it in the way that would be most beneficial to all concerned. I think that we should agree to accept the compromise. It can, after all, hardly be said that this is going to be a free vote. There is no such thing as freedom in this matter for the simple reason that you have a barrier, clear and distinct, as between 25 and 50 per cent. A Deputy representing a constituency in which there is a county or district hospital, would be required by the people he represents to vote for the 50 per cent. On the other hand if he voted for the 25 per cent. he would not have freedom either. I suggest that a compromise is essential. We should be unanimous. If each Deputy expresses his opinion I am quite certain that we would all agree to compromise on the matter.
I would like to correct the misapprehension which apparently exists in Deputy Connolly's mind. The Leas-Cheann Comhairle informed the House that if this amendment were defeated there would still be an opportunity of introducing, on the Report Stage, an amendment which might provide a compromise acceptable to all.
That there will be an opportunity.
Yes. Therefore, if Deputy Connolly feels that it is only fair that the county hospitals should get 50 per cent., he is at liberty to vote for the amendment and he will have an opportunity on the Report Stage of considering and supporting any compromise that is desired.
There could not be a compromise then at all.
There might be because there are, I believe, a considerable number of Deputies, a majority of Deputies, who, even if they are not going to support the 50 per cent. proposal, are prepared to support 37½ per cent., or some other amendment less than 50 per cent. but certainly much more than 25 per cent. If this amendment is defeated there will be another amendment fixing something more than 25 and less than 50 per cent., so that those in favour of this amendment should not allow themselves to be misled by believing that they are going to dispose of this question as to what is a fair allocation to the hospitals. I should like to go back to the speech of Deputy Sir James Craig, as he has referred to the circumstances under which the original Bill was introduced. When the Bill was introduced it met with considerable opposition from influential personages in this House. It would have met with considerably more opposition from this Party and, speaking for myself, from me certainly, were it not impressed upon us that the Bill was designed to relieve the pressing necessities of a few hospitals in Dublin which were faced with a situation that they would have either to close their doors or secure relief from sources other than public subscriptions. We felt that the Government were not prepared, at the time, to undertake the investigation which a considerable number of us felt was required into the whole position of the hospitals in Dublin. We were prepared to support the Bill as a temporary measure designed to deal with a very circumscribed situation. In allowing that Bill to go through those of us who spoke on Second Reading made it clear that we hoped when opportunity offered that this, or some succeeding Government, would institute an inves- tigation into the whole position of the Dublin hospitals.
A number of us had been informed, by those competent to speak on the matter, that the whole situation was unsatisfactory, that there was a number of redundant, inefficient hospitals which ought to be in the public interest closed down, and that there should be some amalgamation of certain of the hospitals. In the case of the original Bill we qualified our support of the measure by stating that at some future date some investigation should be set on foot as a result of which these hospitals would be put on a satisfactory basis. What were the speeches made here to-day? Deputy Sir James Craig heard the views which were then expressed, and I think he assented to them. In the speech to which we have just listened from him, there was a plea for permanently endowing the present unsatisfactory position of the hospitals in Dublin. He said that there were nineteen or twenty hospitals, a considerable number of which were in debt. A considerable number were going to have that debt cleared off, and, he said, when all that has been done, he hoped that they would set aside a proportion of the proceeds of the sweepstake in order to create an endowment which would perpetuate the present unsatisfactory condition of these hospitals. That is precisely what we do not want to see. We want to limit the endowment of the inefficiency of the Dublin hospitals. That is one of the reasons why I am in favour of the amendment rather than the proposals contained in the Bill, because I believe the more money that is allocated to the hospitals, the greater the difficulty any authority is going to have in dealing with the hospitals' problem and in reorganising the Dublin hospitals, if they have to be reorganised as a result of examination and investigation later on.
Deputy Sir James Craig, in the course of his speech, said he was against one-man hospitals instituted for the aggrandisement of single individuals. I do not know whether any county hospitals have been instituted for the aggrandisement of a single individual, but it seems to me that amongst the hospitals which it is proposed to benefit by this money in Dublin there are hospitals which are one-man shows instituted by single individuals, which grow up in that way and which do the same work as the other hospitals. It would seem to me that Deputy Sir James Craig's speech in this respect was in favour of the amendment and against the permanent endowment on the present lines of the voluntary hospitals in Dublin.
The main point which I would like to stress again was that the original Sweepstakes Bill was introduced to deal with a certain limited number of hospitals which were in a position of dire necessity. Now the proposition is brought forward here, and seriously advanced, that the proceeds in the sweepstakes are to become the perquisites of the voluntary hospitals alone. That was never contemplated when the Bill was originally before the House. That is the introduction of a new principle to the Bill. For that reason again, in order to preserve the right of public authorities and of the local authorities in the matter of a fair proportion of the proceeds of the sweepstakes, which though they are now run in the guise of being private sweepstakes are really, as Deputy Flinn stated, public lotteries, in order to be clear that the proceeds of the public lotteries will be under the control of a central authority, as they will be in the case of the county hospitals, where the expenditure will be under the supervision of the Minister for Local Government and the competent officials of his Department and where there will be no waste or unnecessary expenditure, the amendment ought to be supported rather than the proposals in the Minister's Bill.
In the year 1923 I reintroduced into Ireland after a great number of years a Hospital Sweepstakes Bill. The gods then were not propitious, and my Bill did not become law. I am glad to see that, as time rolled on, some of the members of the old Dáil who then bitterly opposed my little Bill became, in the years 1930 and 1931, enthusiastic supporters of sweepstakes for hospitals. I was informed when introducing the Bill, by my friends here in Dublin, that the metropolitan hospitals from a financial point of view were in a very bad way, and it was also intended under that Bill that the money obtained from sweepstakes would be allocated, not only to metropolitan hospitals, but to provincial hospitals. As the original introducer of the hospitals sweepstakes in 1923, I am more than delighted to see the extraordinary success with which sweepstakes in the Saorstát have met in the last year or two. I hope their success will go on growing until, perhaps, the present amount subscribed will be doubled.
There is no doubt that some of the county hospitals do require money. I am not prepared to say what percentage of the money from the sweeps should be allocated to the county hospitals, but I think that if an agreement could be arrived at 33? per cent., it would be a reasonable amount for the present. I do not subscribe to the doctrine that the Dublin hospitals should be cut out of the sweepstakes at all. We all know what the metropolitan hospitals have done and are doing, and what very important institutions they are in the life of the nation. If they have got £852,000, and if the provincial and county hospitals and county infirmaries have only so far obtained £364,000, I say good luck to Dublin, and I hope Dublin will get in the near future another £852,000. No doubt the county hospitals do require equipment. I must say that in the case of the county hospital to which I am attached, whenever I require any equipment, I have only to inform the Local Government Department or the county board of health, and I have no trouble in getting any equipment we require. Structural alterations are undoubtedly required in the Waterford county hospital. The scheme is on the tapis, and they are urgently required. I would ask the Opposition seriously to consider the question of 33? per cent., and perhaps we might have agreement on it.
Might I point out that this is not a matter for the Opposition? It is an open vote, and every Deputy has an open mind on this matter.
I feel that it is most regrettable that so much time has been taken up discussing the difference between 50 per cent. and the lesser percentage suggested by the Minister. So far I have heard no substantial grounds of objection raised to the 50 per cent. I think the whole discussion was most unseemly. The matter could easily have been referred to a Committee of the House at which it could be discussed possibly to the greater advantage of the hospitals and to a greater advantage of the country. Whilst I intend to vote in favour of Deputy O'Kelly's amendment, I would like to give some explanation, or at least to offer a reason or reasons why I intend voting that way. So far I have not heard any speaker opposed to the amendment suggest that the county hospitals are not doing good work. It is admitted on all hands that they are very useful adjuncts to the city and metropolitan hospitals. But there is a point which should get some consideration and which should weigh very considerably with the Minister and with anybody who has any doubt whatsoever with regard to the utility of these county institutions: Remember if these county hospitals will get 50 per cent. from the results of the forthcoming sweepstakes, that will largely relieve congestion in the metropolitan and city hospitals. As a city representative I feel that if I were to take an insular view of the matter, I would be all out in favour of the suggestion or compromise offered by the Minister. But I do feel that there are numbers of those county hospitals which, as I have already said, are doing very useful work and performing work which might otherwise have to be performed by the city hospitals and infirmaries.
I think Deputy Sir James Craig, Deputy White, and other medical Deputies will agree with me that there are occasions when it is absolutely essential that patients in the country districts should have at their command the best medical and surgical aid. When I say the best medical and surgical aid I want to include in those terms the best that can be done by way of operating theatres and so on. Those of us who have any connection with county hospitals are aware that in the majority of cases they are not provided with up-to-date apparatus. The consequence is that many of these patients who require the kind of treatment I have indicated have to be removed at considerable expense either to Dublin or Cork.
Surely that is a consideration that should commend itself to the Minister. It should also commend itself to Deputy Sir James Craig who, I feel, has taken a wonderful interest in the promotion of these sweepstakes. He has taken a very great interest indeed in seeing that all these hospitals are properly equipped. We all give him credit for his humane feelings in that matter. I cannot see where the objection to giving 50 per cent., as suggested in Deputy O'Kelly's amendment, can come in. But this is an aspect of the question which I think should be discussed in a Committee of the House. Some Deputies to-day have spoken as if these sweepstakes are to go on for ever. I hope that the attitude adopted by some of us on the sweepstakes is not going to be misconstrued in that direction.
I hope that this country will never be turned into a second Holland, and that we are not going to have only one reputation in the world as being the country which stands out pre-eminently for the promotion of sweepstakes. In saying that I do not want to throw any cold water on the forthcoming sweepstake or on the ones that may follow it. I would, however, like to correct the impression that might be in the minds of some Deputies, and to point out that we are not all in favour of continuing these sweepstakes ad infinitum. There must be an end to them some time, and I suggest that that end is very near. It has been stated by some Deputies that a very large amount of money has already been subscribed to the Dublin and Cork hospitals. All these institutions were in dire need of financial help at the time when the Act was introduced into the House. I can now see and appreciate the long-headedness of the President who, whilst he did not oppose the sweepstake, was not very active in support of the promotion of the original Bill. I felt then, and I feel now, that many of those institutions would have to close their doors were it not for the fact that these sweepstakes were promoted. Many of us felt that we had to choose the lesser of two evils. The money that had accrued as a result of the sweepstake was a God-send to these hospitals. I hope that as a result of these sweepstakes these hospitals will be so well financed that they will be able to invest the money which will accrue to them so that they will never have to ask for assistance in this way again.
I want to make this suggestion to those who are opposing the 50 per cent. division for the county hospitals. Let them bear in mind that by the granting of this 50 per cent. they will not alone be helping these county hospitals but they will in addition be helping the very hospitals they have already helped. I say that because giving the money to the county hospitals will relieve congestion in the city hospitals and relieve it in a way that will be reflected in the balance sheets of the metropolitan and city hospitals in the future. For that reason I support Deputy O'Kelly's amendment.
I was not present during the whole of the debate and am therefore speaking now at a slight disadvantage. I understand that the question is as to whether 50 per cent. or 25 per cent. is to be allocated to the county hospitals. Naturally I am very largely interested in the county hospitals and being a member of a board of health there are few who are more conversant with the record of the great and good work done in these hospitals, and also conversant with the very many things required in order to place these hospitals in a position to be able to give the most modern treatment for the innumerable diseases that they have to treat. I understand that the Minister has made a suggestion to compromise the matter by giving 33? per cent. What I would like to know is this: if Deputy O'Kelly's amendment is defeated will the Minister at a later stage be able to bring in an amendment to allow 33? to be given? Another thing which is most important is, what is the probable amount that will be received on the basis of an allocation of 33? to the county hospitals? If the sweepstakes develop as they are developing they will bring in three times as much as the enormously successful Derby Sweep. I assume that the county hospitals will get at least £20,000 a year during the next three years— that is £60,000 before the end of 1934. They will get this sum assuming that it is not going to increase beyond the limits of the Derby Sweep. Undoubtedly this would be a tremendous benefit to the county hospitals and naturally I am very strongly in favour of it. At the same time we could overdo it. One important note I would like to strike is that this matter here to-day should not really be made a controversial one. There should be no tinge of politics in it; that is a matter I would very much like to avoid. These sweeps have been such a gigantic success it would look very bad before the world if the Parliament of the nation were to be divided on any issues connected with them. Deputy Anthony suggested also that this matter should be referred to a Committee. I strongly object to any tinge of politics being brought into this. As one who is deeply interested in the county hospitals I realise the tremendously great work that the Dublin hospitals are doing, but at the same time the county hospitals are to receive a huge sum on the 33? per cent. basis.
Not enough. May I interrupt Deputy Shaw to tell him what the financial position is. Under the present proposal in the Bill 26 counties received 1½ million. That would be allocated amongst, I think, 25 county hospitals and 58 district hospitals. That 1½ million will be divided amongst these 83 hospitals, leaving out of consideration the mental and fever hospitals. As against 1½ million to 83 hospitals there will be 6¼ millions available for division amongst the 45 voluntary hospitals. That is the position. We ask that that money should be split on a 50-50 basis.
There would be three millions for the county hospitals.
Yes, and three millions for the voluntary hospitals.
The sum I have suggested would go to the county hospitals. I would like again if the Minister would say if on the Report Stage he could bring up an amendment to increase it to 33? if this amendment is now defeated.
The proposal now put forward of giving 33? is not a reasonable attempt to meet our point of view. It is ridiculous and does not go half way to it.
I do not want to continue the debate any further, but I would ask the Minister to go even a little further in the way of compromise. I repeat that it would look bad before the world, in view of the enormous success of the sweepstakes, to have the Parliament of the nation divided on a matter that we are all interested in, and not with a view of anyone wanting to score off the other person.
I do not think Deputy Shaw is right in suggesting that anyone wants to make this a political matter. Several Deputies on Deputy Shaw's side of the House have supported this amendment. There is no question of politics. I think the figure given by Deputy MacEntee should be conclusive, that under the amendment proposed by Deputy O'Kelly the county hospitals and the Dublin hospitals will get a fair share of the proceeds of the sweep. There is no doubt about that. The voluntary hospitals have got one and a quarter million, and if they are to get a further six and a half millions it will be unfair. There are well over a hundred country hospitals and sanatoria, and the sum would not amount to very much per hospital if they were only to get one and a quarter million.
I think the House is of the opinion that the country hospitals are entitled to more than twenty-five per cent. I am sure the Minister will see the logic of the arguments that have been put up, and that he will agree to this amendment. I would like to ask the Ceann Comhairle whether if this amendment were defeated another amendment can be brought in on the Report Stage.
I think the Leas-Cheann Comhairle explained that. The question will be put that the words proposed to be deleted stand. If the words stand no amendment can be proposed on the Report Stage, which proposes to substitute for three-quarters one-half. It must be for less than half.
Can it be more than half?
Would the Minister increase the amount and have a compromise on it?
It was not my intention to add anything further. I have already spoken twice upon this matter. I will just say that I think Deputy MacEntee's figures are very fantastic. The figures that I will put before the House will probably prove to be correct. The voluntary hospitals in getting three-quarters would probably get about three millions and the rate-aided hospitals would probably get one million. It should be borne in mind that in addition to the hospitals that have already participated and that still have needs, six new hospitals have been brought in and there are a great number of county infirmaries on a voluntary basis. In consequence you are not giving to what I call, strictly speaking, voluntary hospitals, hospitals whose main source of support is voluntary subscription, anything like half of the amount, because the hospitals which are entirely rate-aided will get one-half and the hospitals that are partly rate-aided will get one-third of the remainder, with the result that the voluntary hospitals will get a comparatively small proportion. By the voluntary hospitals I mean the hospitals that do charitable work and are maintained almost entirely, if not entirely, by voluntary subscriptions. It was because these voluntary subscriptions fell off that this hospital scheme was started at all and I think we should keep as close to that as possible.
Could the Minister tell us, on the fifty-fifty basis, how much actually would go to the voluntary hospitals?
It would be utterly impossible. There are hospitals like the North Infirmary, Cork; the South Infirmary, Cork; the Louth County Infirmary, and infirmaries of that kind which are receiving substantial proportions of this money already and their proportion will not come out of the rate-aided hospitals fifty per cent.; it will come out of the voluntary hospitals' fifty per cent. What percentage that would be it would be impossible for me to tell. The Committee of Reference will have to go into that and decide. It seems to me to be more than one-third and the purely voluntary hospitals that it was the intention of the House to benefit when this scheme was first brought in will get really about two-thirds of the half. I personally quite agree with what Deputy Shaw said. I think it a pity that there should be a division of the House and I ask Deputies to consider again the substitution of one-third.
I hope the House understands my position. I have tried to make it clear that I would personally favour accepting the amendment offered but that I was joined in this amendment by at least half-a-dozen of my colleagues. It was agreed that the amendment should go down in my name. They repudiated my acceptance and they insist on a division. I tried to get them to accept the further suggestion I made of thirty-seven-and-one-half per cent. and even that they are not willing to accept. Perhaps if the Minister would see his way to accept that we might get agreement of the House upon it. I would rather that there was agreement in the House.
I do not think we can start bargaining across the House. I think it is most undignified. I do not see any way except by taking a vote on it.
As the city hospitals have got a good deal of money already, I would ask the Minister to agree to the 50 per cent. and give the county hospitals a chance.
The Minister said that under the present system the whole of the county infirmaries can benefit to a certain extent.
As voluntary hospitals, yes.
Under this Bill, when passed, would they not be segregated and placed with the rate-aided hospitals?
They will not be, as a matter of fact, because they are entitled to participate. The only way in which they could be segregated would be if I refused to sanction a scheme in which they appeared as voluntary hospitals. Then they would be put in with the others. If I administered the Act in that way this amendment would really have very small effect.
I take it that every county infirmary can come under the term "voluntary hospital"?
Not except they are mainly voluntary, which none of them is.
Deputy Gorey is completely wrong.
What I was going to say is that the amount of money given to county infirmaries at present is a very small fraction of the total, and it does not affect this argument. As 50 per cent. of the money would go to voluntary hospitals, that 50 per cent. will not be affected by one per cent., or by the fact that Louth——
The Deputy is quite wrong. The hospitals which receive substantial rate-aid would receive something like one-third of the proceeds. That is my recollection.
Mr. Kennedy rose.
Is not the Deputy debating the question again?
I am trying to make a case for agreement.
I think that all that can be done to get agreement has been done.
I would be prepared to accept the suggestion of Deputy Reynolds that they should get 40 per cent.
I would ask the Minister to agree to 40 per cent. It will not look very well to the outside world if we are divided on this issue of what is to be done with the money received from the sweepstakes.
The question will be put that the words "three-fourths" stand. If that is carried these words will stand and on the next Stage another amendment may be moved, but it must be for less than one-half. If the words "three-fourths" are deleted, the question put will be: "That the words `one-half' be there inserted." If that is carried that settles the question for this particular Stage. If that figure is not inserted, another figure, less than one-half, can be moved immediately and the question put without debate.
Can that be done after this is decided?
Question put: "That the words `three-fourths' stand."
The Committee divided: Tá, 63; Níl, 53.
- Alton, Ernest Henry.
- Beckett, James Walter.
- Bennett, George Cecil.
- Blythe, Ernest.
- Bourke, Séamus A.
- Brodrick, Seán.
- Byrne, John Joseph.
- Carey, Edmund.
- Cole, John James.
- Collins-O'Driscoll, Mrs. Margt.
- Conlon, Martin.
- Cosgrave, William T.
- Craig, Sir James.
- Daly, John.
- Doherty, Eugene.
- Dolan, James N.
- Doyle, Peadar Seán.
- Duggan, Edmund John.
- Egan, Barry M.
- Esmonde, Osmond Thos. Grattan.
- Finlay, Thomas A.
- Fitzgerald, Desmond.
- Fitzgerald-Kenney, James.
- Good, John.
- Hassett, John J.
- Heffernan, Michael R.
- Hennessy, Thomas.
- Henry, Mark.
- Hogan, Patrick (Galway).
- Holohan, Richard.
- Jordan, Michael.
- Kelly, Patrick Michael.
- Keogh, Myles.
- Law, Hugh Alexander.
- Leonard, Patrick.
- Lynch, Finian.
- Mathews, Arthur Patrick.
- McDonogh, Martin.
- McFadden, Michael Og.
- Mongan, Joseph W.
- Murphy, James E.
- Murphy, Joseph Xavier.
- Nolan, John Thomas.
- O'Connell, Richard.
- O'Connor, Bartholomew.
- O'Donovan, Timothy Joseph.
- O'Higgins, Thomas.
- O'Leary, Daniel.
- O'Mahony, The.
- O'Reilly, John J.
- O'Sullivan, Gearóid.
- O'Sullivan, John Marcus.
- Redmond, William Archer.
- Rice, Vincent.
- Roddy, Martin.
- Ruttledge, Patrick J.
- Sheehy, Timothy (West Cork).
- Thrift, William Edward.
- Tierney, Michael.
- White, John.
- White, Vincent Joseph.
- Wolfe, George.
- Wolfe, Jasper Travers.
- Aiken, Frank.
- Allen, Denis.
- Anthony, Richard.
- Blaney, Neal.
- Boland, Gerald.
- Boland, Patrick.
- Bourke, Daniel.
- Briscoe, Robert.
- Buckley, Daniel.
- Carty, Frank.
- Cassidy, Archie J.
- Clery, Michael.
- Colbert, James.
- Connolly, Michael P.
- Corish, Richard.
- Corry, Martin John.
- Crowley, Tadhg.
- Davin, William.
- Derrig, Thomas.
- De Valera, Eamon.
- Dwyer, James.
- Fahy, Frank.
- Flinn, Hugo.
- Fogarty, Andrew.
- Gorey, Denis J.
- Gorry, Patrick J.
- Goulding, John.
- Hayes, Seán.
- Jordan, Stephen.
- Kennedy, Michael Joseph.
- Killilea, Mark.
- Kilroy, Michael.
- Lemass, Seán F.
- Little, Patrick John.
- Maguire, Ben.
- McEllistrim, Thomas.
- MacEntee, Seán.
- Moore, Séamus.
- Murphy, Timothy Joseph.
- Nally, Martin Michael.
- O'Connell, Thomas J.
- O'Dowd, Patrick Joseph.
- O'Hanlon, John F.
- O'Kelly, Seán T.
- O'Reilly, Matthew.
- Reynolds, Patrick.
- Ryan, James.
- Sexton, Martin.
- Shaw, Patrick W.
- Sheehy, Timothy (Tipp.).
- Tubridy, John.
- Walsh, Richard.
- Ward, Francis C.
Tellers: Tá, Deputies Sir James Craig and E. Doherty; Níl, Deputies Kennedy and Corish.
Question declared carried.
Is it now in order to propose a lesser amount than 50 per cent.?
Not at this stage. The Committee has decided that the words "three-fourths" stand part. At a later stage an amendment would be in order, but not at this stage.
I think that division covers the next amendment, No. 9.
Yes, that disposes of amendment 9.
Amendment No. 9 not moved.
I move amendments No. 10 and 11:
In sub-section (4) (a), page 4, line 33, after the word "bodies," to insert the words "or such one or more of them exclusive of the other or others and".
In sub-section (4) (b), page 4, line 38, before the word "report" to insert the words "and after consultation with the Committee managing such sweepstake".
It was agreed that these amendments should be put into the Bill, and then Deputies opposite would reconsider the Bill when they see them in it. For the time being, and temporarily I understand, my amendments go in.
Question put, and agreed to.
Amendments 12 and 13 not moved.
Section 6, as amended, ordered to stand part of the Bill.
(1) One-fourth of the available surplus in any sweepstake held under the Principal Act shall be paid to the Minister for Local Government and Public Health and shall be disposed of by him in accordance with the following provisions, that is to say:—
(a) such one-fourth shall be apportioned by the said Minister between the several counties and county boroughs in Saorstát Eireann in proportion to their respective populations according to the general census of population which is for the time being the last such census;
(b) the proportion of the said one-fourth so apportioned to any county or county borough shall be allocated by the said Minister in such manner as he shall direct to such one or more as he shall think fit of the hospitals (exclusive of any hospital entitled under the next foregoing section to any other part of the said available surplus) for the sick poor of such county or county borough maintainable under the enactments relating to the relief of the destitute poor;
(c) any sum so allocated by the said Minister to a hospital shall be applied in such manner as he shall direct for the improvement of such hospital or the equipment thereof;
(d) the allocation under this sub-section by the said Minister of a sum to a hospital may be made conditional upon the fulfilment by the local authority by whom such hospital is maintainable by law of such conditions as the said Minister shall think proper to impose.
(2) Money allocated under this section by the Minister for Local Government and Public Health to a hospital shall be in addition to and not in substitution for the moneys required for the ordinary maintenance of such hospital and shall not be taken into consideration by the local authority by whom such hospital is maintainable by law when determining the amount to be expended by them on the maintenance of such hospital.
Amendment 14 not moved.
I move amendment No. 15:
To delete all from and including the word "disposed," page 4, line 53, to the end of the section and substitute the words—
"applied by him in such manner as he shall think fit in or towards the provision, improvement, or equipment of institutions for the prevention, treatment, or cure of physical or mental diseases or injuries of human beings.
(2) The following provisions shall have effect where the Minister for Local Government and Public Health applies or proposes to apply any money under this section in or towards the provision, improvement, or equipment of an institution which is wholly or partly maintained by a local authority, that is to say:—
(a) such application may be made conditional upon the fulfilment by such local authority of such conditions as the said Minister shall think proper to impose.
(b) the money so applied shall be in addition to and not in substitution for the moneys expended by such local authority for or towards the ordinary maintenance of such institution and shall not be taken into consideration by such local authority when determining the amount to be so expended by them."
This amendment shows the powers the Minister for Local Government will have in the distribution of the proceeds.
With regard to the amendment, I think the Minister would agree on reading it again that the phraseology might with advantage be changed. Sub-section (2) (a), for instance, says "such application may be made conditional upon the fulfilment by such local authority of such conditions as the Minister shall think proper to impose." There is no suggestion at all there of consultation with the local authority. I think the Minister will agree that it will be necessary the local authority should be consulted or asked to put up a scheme, or have some say as to how the money should be spent. It should not, as the wording here would suggest, be in the power merely of the Minister to send down an order to the local authority and say this is my belief as to how the money could best be spent, and to impose certain conditions upon them without reference in any way to them as to what their wishes were.
If the Deputy likes I shall discuss the matter with the Minister for Local Government, but I do not think that there will be the slightest danger of the county boards and boards of public health and other similar bodies not making application for this money.
I think that there will be very great keenness on the part of every county body to get their proportion, and I do not think there will be any danger of the Minister for Local Government not receiving enough applications. I think his difficulty will be to decide between a large number.
The amendment says: "The fulfilment by such local authorities of such conditions as the said Minister shall think proper to impose." I think Deputy O'Kelly's point is that the Minister may impose any conditions he likes, and that if he has any particular hobby he can order that to be carried out without consulting the local authority at all. Certainly the local people are the best judges of what is most needed in the particular area.
I do not think that it will take away from the Minister's power to add "if after consultation with the local authority."
I will consult with the Minister for Local Government, and if it appears that such words would be helpful, we will insert them. If necessary, I will actually move them myself. I will bear the matter in mind.
With regard to clause (b) in the amendment, is it intended that this money will be used entirely for capital purposes? I think, as worded at present, that it is linked up with money for maintenance. "The money so applied shall be in addition to and not in substitution for the moneys expended by such local authority for or towards the ordinary maintenance of such institution."
"And not in substitution."
They can be used for maintenance purposes.
I suggest, as it reads, that it can be construed as applying to maintenance. "The money so applied shall be in addition to and not in substitution for the moneys expended by such local authority for or towards the ordinary maintenance of such institution."
"In addition to." That is over and above the amount spent in maintenance. Everything spent in maintenance must be spent out of the rates, but this is to be different from maintenance. It is to be for improvement.
I submit it is not clear at all. I think as it stands it can be read to mean extraordinary maintenance. It is to be in addition to such moneys expended by such local authority for ordinary maintenance. Therefore it can be used for extraordinary maintenance. Then a further question arises. Is there not room for tremendous friction as to what is maintenance and what is improvement? The local body may very well contend that certain expenditure which the Minister would judge to be maintenance, would not be incurred in the ordinary course. They might say that what the Minister is demanding is improvements, new furniture, for instance, new beds, the addition of a porch, the addition of anything you like.
That would not come under the heading of "maintenance." That would be under the heading of "improvements."
I submit that it is very hard to draw the line between "maintenance" and "improvement." The ordinary householder regards these things as maintenance of his household. If a building has to be preserved and maintained a lot of these things have to be done.
Maintenance would mean the payment of all salaries and wages. The food of the patients and everything of that kind would be regarded as the cost of the maintenance of the hospital.
Ordinary repairs are maintenance.
If you get in new surgical instruments those would be regarded as ordinary maintenance. The distinction may be fine, but in practice it will be able to be drawn quite easily.
Would the salary of an extra medical officer be maintenance?
Therefore it can be used for that purpose.
There is nothing in this amendment to indicate to the Minister the lines on which he should apportion these moneys over the counties.
I am aware of that, and I thought myself that it would be better to have it on a population basis, but I have not been successful. I was very anxious that this should be a completely agreed measure. Therefore, I surrender that point to the Party opposite, and have left it now to the unfettered discretion of the Minister.
Not to the Party opposite. There is no Party vote on that.
To the Deputies on the benches opposite, particularly Deputy O'Dowd.
Under the amendment there is, I think, grave danger that ratepayers in a county who have hitherto done their duty by providing hospital accommodation will not get the same consideration as ratepayers in counties where absolutely nothing in that respect has been done. Considerable sums have been spent in County Cavan in the equipment and enlargement of a surgical hospital. They are so well equipped that unless there are safeguards possibly in the way of power given to the Minister where he has no guide that counties that have not done so well will make application, while counties like Cavan will get nothing. No hospital is so well equipped that it could not be improved. Some steps should be taken to ensure that counties that have done well will get a fair proportion of the money.
I think the Deputy will find that there will be more than enough money to go round.
It may go round but counties like Cavan might get the thin end. There is provision in the Bill under which a new hospital could be provided. There will be applications from counties to provide new hospitals where there are none at present and where the representatives of the ratepayers have been negligent. The consequence is that the money will be absorbed to make good what the ratepayers should have provided for the relief of the poor.
You must leave that to the discretion of the Minister.
[An Leas-Cheann Comhairle took the Chair].
I prefer it as it was originally in the Bill. I think there should be some guide for the Minister in the administration of the money.
If the Minister likes he can take the population basis as one of the principles on which to act.
He will take a considerable number of things into account. The objection was that he would be too tied down.
Deputy O'Hanlon has raised a point which it was difficult to decide in connection with the original measure. Certain hospitals got a great deal of money to put them into a proper condition. They had to get that money. Other hospitals were so well off that they did not need to come under the Act at all. As far as Deputy O'Hanlon is concerned I am afraid he is not making a good case when he suggests that because a county has done well it should get as much money as counties that have not done well.
Unfortunately that is the situation and it arose in connection with the other Acts. I think it should be left to the discretion of the Minister to decide what the requirements are.
The original scheme dealt with voluntary hospitals which are different to hospitals maintained by the ratepayers.
I think Deputy O'Hanlon is wrong when he says that there are some counties without hospitals. Every county has one hospital and some have several hospitals. If the Deputy stated that some counties had not x-ray apparatus and had not proper operating theatres or sanatoria he would be nearer the point. I think it is only the poorer counties that have not hospitals. Most of the counties are fairly up to date in that respect. As regards the fear that any county would pay the salary of the assistant medical officer of health from this money I think the counties would be very glad to get the money and devote it to capital expenditure. No board would be so foolish as to pay £400 or £500 out of what they got to an assistant medical officer. No one need fear that any very fine distinction will be drawn between maintenance and expenditure of a capital nature. The boards of health and the county councils are composed of practical people and they know as well as anyone the difference between these items. The sums available from the sweeps between the present time and 1934 will not, to my mind, be nearly sufficient to meet the requirements of the various counties. There is no fear of a reduction of a penny in the pound on the rates as a consequence of any money the hospitals get from the sweeps. When that occurs Deputies can make provision to meet it. I hope it will arise, but I cannot see the possibility of it doing so.
May I congratulate Deputy Kennedy on his change of heart with regard to the Minister for Local Government. Up to the present we have had nothing but complaints from Deputy Kennedy as to how impossible the Minister was when he laid down rules, and how he would not allow any departure, verbal or otherwise, from them. The Deputy is now satisfied that the Minister is going to be reasonable——
I said nothing about the Minister.
— and that the chairmen of boards of health and county councils will do nothing but embrace each other.
I must thank Deputy Moore for his misinterpretation of my speech.
Amendment put and agreed to.
Amendments 16 and 17 not moved.
Section 7, as amended, put and agreed to.
Sections 8 and 9 agreed to.
This Act shall not apply or have effect in relation to any scheme which has been sanctioned under the Principal Act by the Minister before the passing of this Act or to any sweepstake held under the Principal Act, whether before or after the passing of this Act, in pursuance of a scheme so sanctioned.
In page 5, line 31, to delete the words "passing of this Act" and substitute the words and figures "30th day of April, 1931."
It has been arranged that this and the other amendments in my name will go through by consent for the time being.
Amendment put and agreed to.
To add at the end of the section a new sub-section as follows:—
(2) Where a scheme for a sweepstake has been sanctioned by the Minister under the Principal Act after the 30th day of April, 1931, and before the passing of this Act, this Act shall apply in relation to such scheme and any sweepstake held in pursuance thereof subject to the following provisions, that is to say:—
(a) the Minister may after the passing of this Act revise such a scheme in such manner as he may think desirable having regard to the provisions of this Act including this section;
(b) any hospital to which the Principal Act is applied by this Act may participate in such scheme and any sweepstake held in pursuance thereof;
(c) the committee of reference for such scheme shall be appointed when such scheme has been so revised by the Minister.
Amendment agreed to.
Section 10, as amended, agreed to.
Sections 11 and 12 agreed to.
Portions of the Principal Act Repealed.
1. Paragraph (g) of sub-section (4) of Section 2.
2. The words "the trustees in whose names and" in paragraph (h) of sub-section (4) of Section 2.
3. Sub-section (1) and paragraph (c) of sub-section (2) of Section 5.
"In page 5 to delete lines 47 and 48."
Amendment agreed to.
Schedule, as amended, agreed to.
An Act to extend the Public Charitable Hospitals (Temporary Provisions) Act, 1930, to certain hospitals, and to amend that Act by providing for the appointment of committees to act as trustees in relation to sweepstakes, and to advise the Minister in relation to the sanctioning of schemes and the allocation of the proceeds of sweepstakes, and by providing for the allocation of a proportion of the proceeds of sweepstakes to hospitals maintainable by law for the sick poor, and by making special provision in relation to deposits in respect of prizes calculated by way of percentage.
In page 2, line 8, after the word "extend" to insert the words "and amend" and to delete all words from and including the word "to" line 9 to the end of line 21.
Amendment agreed to.
Title, as amended, agreed to.
When will the Report Stage be taken?
Before the Report Stage is taken there is an arrangement that the Bill will be recommitted.
Report Stage ordered for Wednesday, June 10th.