Public Charitable Hospitals (No. 2) Bill, 1931—Second Stage.

Seosamh O Mongáin

Is ar mhuintir na mbailte móra, go mór mór ar bhoicht na mbailte móra, is mó a bhitheas ag teacht i gcabhair leis na Billí a tugadh isteach annseo cheana faoi'n scéim seo. Níl mise ina dhiaidh ortha dá bhfuigheadh siad an oiread eile, ach tá sean-ráidht ann gur ceart an trócaire a roinnt agus sin é atá mise ag iarraidh a dhéanamh faoi'n mBille seo. Bille beag gearr é, ach ní in sna billí fada ná ins na daoine fada bhíos an mhaitheas uilig. Sé'n bharúil atá agam-sa gurb' é seo an Bille is fearr do na boicht—do bhoicht na tíre seo go mór mór—a tugadh isteach in san Teach seo ariamh. Tá sé ró-dhona bheith bocht, tá sé níos measa a bheith bocht agus a bheith tinn gan duine ná deóraidheach agat a bhreathnóchadh i do dhiaidh. Sin mar bhí sé ag go leor de na boicht, nó gur cuireadh na banaltraí amach ar fud na tíre, agus ní cheilfidh duine ar bith sa Teach seo, ar a laighead duine ar bith a bhfuil croidhe le boicht na tíre seo aige, nach bhfuil na mná seo ag déanamh go leór maitheasa. Go mór mór in sna ceanntair mhóra atá ag dochtúirí, tá cuid aca chúig mhíle dhéag ón dochtúir is goire dhóibh, agus na mná seo, tá siad le fáil maidin is trathnóna san oíche agus gach aon uair a nglaodhfar ortha agus ní fhiafruíonn siad den duine a bhéas da n-iarraidh a bhfuil ticéad ná eile aige ach dul leob —leis an duine is boichte chó maith leis an duine is saibhre—gan pighinn ná leith-phighinn mara dtogruighidh duine féin rud eicint a thabhairt dóibh agus annsin féin ní choinníonn siad féin é mar caithfidh sé dul dá gCumann.

Anois cé againn féin a bheadh tinn a ghabhfadh go dtí an t-ospidéal go gcinnfeadh sé air, agus an uair sin féin, cuid againn a bhfuil maoin an tsaoil againn, d'fhéadfadh muid a dhul go dtí ospidéal ar bith ba mhian linn. Agus nach bhfuil fhios againn gurb é an rud deireannach déidheanach is maith le duine bocht ar bith a dhéanamh a bhothán féin—dá shuaraighe é—agus a mhuirín fhágáil agus fios acu nach bhféadfadh siad aon roghain a dhéanamh ach a dhul go dtí Ospidéal na mBocht. Na banaltraí atá sa tír seo, tá siad lánoilte ar gach saghas banaltrachais a dhéanamh. Tugann siad congnamh an domhain do na dochtúirí nuair a ghlaodhann sé ortha. Déanann siad a chuid orduíthe míanna 'na dhiaidh. Anuraidh amháin d'fhreastal siad 712,096 cásannaí.

Anois b'fhéidir go bhfiafrochadh duine éicínt 'tuige ar thug mise isteach an Bille seo. Seo é an fáth: tá sé de cháil nach bhfuil aon airgead ag an gCumann agus go gcaithfeadh siad go leor de na banaltraí a chur ar siúbhal. In mo cheanntar féin, tá sé ráidhte go bhfuil ceathar acu dhul dá dtabhairt as—as na cheithre ceanntair is boichte i nEirinn! Nuair a chuala na sagairt seo, d'fhiafruigh siad dhíom-sa a mb'fhéidir tada a dhéanamh le cuid den airgead seo fháil agus mara mb'fhéidir go mba droch-scéal, amach agus amach é, do na boicht na banaltraí seo a chailleadh. Is ar a gcomhairle siad-san a thug mise isteach an Bille seo.

Anois cén bealach a raibh an t-airgead seo á chruinniú. Sa mbliain 1887, cruinníodh go leor airgid le h-aghaidh an ruda seo. Níl de thigheacht-isteach ag an gCumann ach £266:13:4—an gaimbín ar an airgead seo, níl pighinn eile a bhféadfadh siad lámh fháil air, ach an méid a thugas daoine grádh-diadhúla dhóibh. In mo cheanntar féin fághann siad go leor. Le ainm a chur ar chúpla duine a thugas síneadh láimhe dhóibh 'chuile bhliain, tá an Dr. Mac Giolla Mhártain, Ard-Easboc Thuama, agus go leor de na sagairt atá 'na dheóise agus daoine eile dá réir a bhfuil maoin shaolta acu tugann siad ó chéad púnt anuas go dtí scilling. Bíonn níos mó fáilte go minic roimh fhear na scillinge.

Tá go leor de shagairt agus de dhochtúirí na tíre ag scríobhadh chuig an gCumann seo ag iarraidh banaltraí fháil dá gceanntair. Ní féidir seo a dhéanamh gan airgead. In mo cheanntar féin tá fhios agam go bhfuil áiteacha—ar nós an Chlocháin, Baile Confhaola, an Líonán, Uachtar Ard, Leitir Fraic, Rinn Mhaoile, Garumna, Bo-Finn, Innis Mór agus Cíll Einne— ina gcall. Tá áiteacha dá réir, i gContae Mhuigheo, i dTír Chonaill i gCiarraighe agus ins gach Contae eile.

Tá na banaltraí seo ag déanamh togha oibre agus bheadh a dhá oiread in sna hospidéil, marach iad. Ní bhíonn siad ag cainnt, ach oiread, faoi na tíghthe a ndéanann siad freastal ar dhaoine ionnta, ná ar an méid a fuair siad uaidh seo no uaidh siúd nó ar ticéad dubh no dearg a bhí le fáil acu. Chó cinnte agus gur cuid den ghé an t-iogán is cuid den ospidéal na banaltraí seo. Iarraim ar an Teach glacadh leis an mBille d'aon ghuth agus a dtrócaire ar na boicht a chruthú ós fuar an trócaire an trócaire gan roinnt.

Mr. Law

I formally second the motion.

Proinnsias O Fathaigh

Táim ar aon aigne le Seosamh O Mongáin. Teachta Dála, sa mhéid a dubhairt sé fá'n obair mhaith atá dá deunamh ins na ceanntair bhochta ag na banaltraí go ndeárna sé tagairt dóibh; agus níl aon amhras ná go bhfuil árd-mholadh tuillte acu. Acht tá taobh eile leis an scéal. Deirtear go mba chóir dúinn cuid den airgead a thiocfas as an gcrannchur nó "The Hospitals' Sweepstake" a thabhairt dóibh. Do réir mar thuigim an Bille seo, ní thiocfadh ach dhá dhream isteach fé, sé sin le rá, The Jubilee Nurses agus The Dudley Nurses agus b'fhéidir aon Chumann amháin eile—Cumann Ban-riaghalta áirithe. Níor mínigheadh dúinn cioca pinsin nó árdú páigh a tabharfaí do na banaltraí seo dá nglacfaí leis an mBille seo. Nuair a bhí Bille na n-Ospidéal da phléidhe sa Dáil, dubhradh linn gur scéim sealadach a bhí ann, scéim a ceapadh le fóirthint ar na h-ospidéil a bhí i gcruadh-chás de bharr ganntanais airgid.

Maidir lem bharúil féin, níl fhios agam an maith an rud don phobal crannchur a bheith ann chor ar bith. Tá fhios agam go bhfuil caoi mhaith ar na h-ospidéil anois, agus is áthas liom san. Is maith an rud go bhfuil obair fachta do thrí míle duine i n-oifigí an chrannchuir, go mór mór na laetheanta seo. D'aimhdheoin sin is uile, tá sort mí-shuaimhnis orm, agus ar dhaoine nach mé, ina thaoibh. Cloistear ráflaí fá choimisiún atá dá íoc agus is cúis droch-amhrais a leithéid. Do h-iarradh orm-sa bliain ó shoin tabhairt fá chuid de thoradh an chrannchuir seo fhághail le scoileanna a thógáil. I gceann bliana eile b'fhéidir go mbeadh dream eile ag iarraidh airgid chun stadium do chur ar bun. Cá stadfar de? Má glactar leis an tairiscint seo, cé an chaoi a bhéas ar an banaltraí seo i gceann dá bhliain? An mian leis an Rialtas scéim buan a dhéanamh de? Do réir mar táimíd ag dul ar aghaidh, beidh "vested interests" ann.

Nár chóir don Rialtas banaltraí, dochtúirí agus eile a sholáthairt don Ghaedhealtacht agus don Saorstát uile? Céard mar geall ar na midwives? Nach bhfuil sár-obair déanta agus dá deunadh acu sin? Céard tá acu de bharr na hoibre? £25 sa bhliain acu i gCo. Mhuigheo agus £67 sa Chontae is fearr i dtaoibh tuarasdail. Céard fáth nár tugadh na banaltraí sin fé scéim an Bhille seo? 'Sé mo bharúil nach é seo an cuma ceart leis an sceul a leigheas.

Dr. O'Dowd

I am opposed to this Bill, firstly, because the promoters seek to take the finance required for it from the portion of the sweepstake money that is to be allotted to the country hospitals. The other hospitals have been reaping a rich harvest from the past three or four sweepstakes. The country hospitals, up to this, have not received anything from the proceeds of the sweepstakes. A Bill was introduced here within the last few months which allotted to the country hospitals 33 per cent. of the proceeds from the present sweepstake and from future sweepstakes. This Bill now seeks to take one-twenty-fifth of the portion that is to be allotted to the country hospitals from them. That is actually before they have received anything whatever. It would be far more equitable if an attempt had been made, under this Bill, to take, say, a hundredth part of the total amount available from the sweepstake rather than to take the money from one section of the hospitals only and that a section which has not already benefited by the sweepstakes.

Reference has been made by Deputy Fahy to the work done by other nurses. I am quite willing to pay the highest tribute to the work done in country districts by the Jubilee nurses and the nurses under the Dudley Scheme. The work they have done and are doing could not be surpassed in any country. They are doing at least as good work for the poor as any section of the community. They are not overpaid and I quite understand that the difficulty of raising money by voluntary subscription is increasing. But, as Deputy Fahy pointed out, there are other nurses working in the country. Their work is just as good as the work of these nurses and they are wretchedly paid.

As regards County Mayo, the midwives there receive something like £20 a year as salary. In County Roscommon, where they are supposed to be pretty well paid, they receive £40 and in County Leitrim they receive £30 and £35. The best paid midwives in the whole country receive something like £67 a year. The midwives, everybody will admit, do splendid work. They are wretchedly paid. The county boards of health under whom they work at present are not willing, owing to the state of the country's finances and because they are very wary about increasing rates, to give them what they are entitled to. They will not give them anything like a decent salary and they will not give them anything on which they can live in reason. Personally I would like to see, when an effort is being made to extend the benefits that accrue from the rich harvest of the sweepstakes, that some attempt would be made to include that section of the community who are, I believe, just as deserving as the section that it is intended to include.

In saying that I am not detracting one iota from the good work that the Jubilee and the Dudley nurses do. I do not intend to say either that voluntary hospitals are becoming immensely wealthy out of the sweepstakes. I do not mean to convey that impression. The voluntary hospitals in Dublin and all over the country have been struggling for a very long time in order to keep their doors open. I was one of the strongest supporters of the original Bill. I was anxious to give them what I thought they were justly entitled to out of the money collected by the sweepstakes. I will say, in conclusion, that I do not think the country hospitals, before they have received anything at all out of the sweepstakes money that is to be allotted to them, should have the amount so allotted reduced.

Mr. Law

The opposition to this Bill, so far as I can understand it, is grounded on two factors, first, because the money it is proposed to devote to nursing associations under this amending Bill is drawn from the portion which is handed to the Minister for Local Government and Public Health for county hospitals and not from the other portion of the fund given to hospitals under the Principal Act, and secondly, on the ground that certain nurses and midwives doing, as everybody knows, very excellent work in the country, are not included. I submit to the House that these are not sufficient reasons for rejecting this Bill. So far as the first point is concerned, it is not one that I feel very strongly about, one way or the other, but it does seem natural that provision should be made out of the proportion going to county hospitals and, on the whole, it seems to be most equitable because the work that these nursing associations do is obviously much more directly connected with the work of local care of the sick than with the work of the big central hospitals such as are in Dublin and elsewhere. I submit that whatever way we look at it the first reason given is not a sufficient reason for rejecting the Bill on Second Reading. Still less is the second point.

It is quite true we do not in this Bill propose that assistance should be given to midwives and others employed by the county boards of health. As a matter of fact, the whole matter of the allocation of the grant is proposed to be left to the Minister for Local Government and Public Health. Quite candidly I do not suppose that would be one of the things the Minister would do, but at any rate because you cannot do everything at a particular moment is surely not a good reason for doing nothing. Deputy O'Dowd has paid tribute to the excellent work done by certain nursing associations which we have in mind. He must not make the mistake of supposing—and I want to make this clear—that there is anything in the Bill which confines its operations to the associations which he named. I know no reason, for example, and I hope I will be corrected if I am wrong, why such bodies as the Little Sisters of the Poor should not receive assistance in this connection if it seems proper to the Minister. At any rate, there is a substantial case for giving help to these main associations which carry on a work in the country of which everybody approves.

I think all we are called upon to do on Second Reading is to show, first, that the object itself is worthy, indeed the most worthy of objects, and, secondly, that a great need exists for assistance. These are the only two points I propose to press. Let me take one of the principal associations which is undoubtedly intended to be benefited by this Bill, the Dudley Fund for providing nurses for the poor and sick in the poorest parts of the country. Let me give the House one or two points in connection with that. That association has to its credit in the last year the formidable number of 712,900 visits paid to sick persons in their own homes by nurses. Let me say that the institution, in addition to direct nursing, also trains nurses in courses which are approved by the Minister for Local Government and Public Health. The nurses are trained in school medical inspection, tuberculosis work, treatment of eye diseases, midwifery, health visits and so on. Previous to 1922 the work was very largely subsidised from across the Channel. In that year £2,000 was made available for our poor. Since that time that help has been very largely cut off, and the association has been obliged, properly and rightly, to rely on itself. It has managed to struggle on and it has been trying to build up an endowment fund. The House will, I am sure, be sorry to hear that it has been obliged during the last few years to close thirteen districts for want of funds. I may say that it has opened certain others, too.

Anybody who knows the West of Ireland will agree, I think, that the association is very far from having reached the full measure of its possible activities. As a matter of fact, if it had the funds I am informed that it could within the next few months place at least twenty more nurses in districts which are in great need of such assistance. There have been many applications from priests, doctors and others interested in respect of the need that exists for nurses. These applications come from many areas. In my own county, County Donegal, there are the districts of Fanad, Malin, Moville. In Co. Galway there are the districts of Annaghdown, Carraroe, Letterfrack, Leenane, Ballyconneely, Renvyle, Lettermullen, Tulley, Clifden. In Co. Mayo we have Lahardane, Achill Sound, Killawalla. In Kerry, Dingle, Dunloe, and Tarbert. Applications have been also received from Oldcastle and Mount Nugent, Co. Cavan; Glasslough, Co. Monaghan; Mountmellick in Leix; Boyle, Co. Roscommon, and Castlepollard, Co. Westmeath.

These applications are made by certain people interested in the poor in the district—by priests and others. That therefore shows one of the chief points the onus of proving which lies upon us, namely, that there is a need. I again emphasise the fact that the Association to which I have referred and whose figures I have quoted is only one of several which can be, and which I hope will be, benefited by this Bill

In order to show that the work of that and similar associations is appreciated, perhaps I may be allowed to quote a brief extract from a paper circulating in Connacht, "The Connacht Tribune," a paper well known to many persons here. The article is so good and so much to the point that perhaps I may be pardoned for reading a small portion of it:—

To be poor in a world of plenty is bad enough, but to be poor, ill, and uncared for is to be in sorry plight. No one will deny that the Dudley Nursing Scheme has done excellent work along the west coast of Ireland, and that these self-sacrificing women who have been doing splendid service in Knock, Bealadangan, Rossmuck, Carna, Recess, Roundstone, Cleggan, Clonbur and Cornamona deserve well of the people of the Saorstát. And everyone who is interested in social welfare work and sick nursing amongst the poor will deplore the fact that because of the lack of funds some of those nursing districts are likely to be closed

Then there is a reference to myself:

In many of the remoter districts of the west coast, as will readily be recognised, resident nurses are often more essential than doctors. Far from restricting the number of those district nurses there seems to us to be a very real need for extending them. For instance, to name but a few places, district nurses for the poor are badly needed in Lettermullen, Ballyconneely, Renvyle, Leenane and in many parts of County Mayo where they are not now available. The purpose of the Bill is to set aside a small proportion of the available surplus from the Hospitals' Sweepstake for the purpose of maintaining such district nursing organisations in areas where they are shown to be necessary and desirable.

And may I recommend to the House the concluding sentence:—

When the aim of the measure is understood, we feel sure that it will meet the unanimous assent of both Houses of the Oireachtas.

Mr. Derrig

This is a Bill that every member of the House must examine in a spirit of the most sympathetic consideration. But I regret to see that the Government have not stated what actually is the intention if the Bill if carried into law. Deputy Law has just read a statement indicating that if this Bill becomes law additional facilities will be provided in the poorer districts, which I think generally speaking, judging by the list that he has read out, are the poorer districts in the Gaeltacht areas where nursing associations are not already in existence. The first thing that strikes me is: Is the Minister going to take over this nursing scheme altogether in the Gaeltacht areas?

The President

No.

Mr. Derrig

Even if there is a skeleton control left by the people who now control the association, it would be a pity to take the work out of their hands. I do not know who they are, but anyway they are very sincere and devoted workers, and I have already expressed the opinion in this House that where we have voluntary associations of that character, where the people in charge have done such excellent work, it would be a pity that the work should be taken out of their hands. I think that it should be made quite clear what the position is to be in regard to the control of these organisations.

The next point is: As the matter is in connection with the Gaeltacht I think it should be stressed that any nurses who are in the Gaeltacht or who are likely to be appointed to the Gaeltacht should have a good knowledge of the Irish language. That is a thing that may be impossible to achieve within a year or two, but at any rate, steps ought to be taken to give the nurses who are in training and even the nurses who are actually doing work in the Gaeltacht an opportunity of acquiring the language. I know that some of them who are there already at work and who do not speak Irish feel their position very keenly.

Another point in connection with this is, in my opinion, the most serious of all: This is a matter that cannot easily be dealt with in this manner—it must be dealt with in regard to the general position of the Gaeltacht as a whole. I have stated before that the most serious omission in the Gaeltacht Commission's Report was that there was no reference to poor law or to the provision of proper medical services for the poor people in these districts. I have also stated in the discussion on derating that in fact the ideal we should have in mind ought to be to abolish rates altogether in these areas. As an English authority described it on one occasion—it is a case in these counties along the western seaboard of the poor maintaining the destitute.

The Dispensary Medical Service is not satisfactory in these areas. Deputy Hennessy, who was a member of that Commission which investigated this question, knows that it has been charged against that service that the poor people are not getting the services to which they are entitled. It is all very well to say that the poor people are not applying for the red tickets. The fact is that if you look at the figures which show the number of attendances of dispensary medical officers in the Gaeltacht counties, as given in Appendix 8 of the Report, you will see that they are very small. You will see that for some reason or another these poor people prefer to go long distances to doctors and pay them fees rather than have them come to their houses on a red ticket. Whatever the explanation may be, that is the position. If you look at the returns for County Mayo, for example, you will see that the total number of cases attended by medical officers at patients' residences in the year ending 31st March, 1925, was only 1,572. I have not had an opportunity to go fully into the figures, but we must remember that the population in Mayo is between 180,000 and 190,000. In County Galway the number of patients attended on red tickets at their own residences was only 2,713; in West Cork, 2,014; and in Tirconaill, 3,130. If you examine the other counties, which are certainly in a more prosperous condition, though they may have large numbers of poor people also, you will find that visits at patients' residences were much larger in number.

For example in County Louth, which is a very small county although it has some big towns, you will find that the figures are greater than the figures I have quoted. The figures are 3,289. In Tipperary North Riding they are 2,071; Tipperary South Riding 4,578; Westmeath, 3,413, and so on. It seems to me from a cursory examination that the figures are lower in the Gaeltacht counties than in the other counties. The question is whether this is going to get to the root of the matter. It is only a palliative. I think it is a great pity that the Government, now that they have the opportunity of opening up the whole question instead of transferring their responsibility to the sweepstakes and trying to get out of it in that way, would not prove that they have the real interest in the Gaeltacht and in these poor people that they claim they have by inquiring very definitely into this question of medical services.

An Ceann Comhairle

Does the Deputy propose to discuss medical services on this Bill? I was wondering how he was going to make this relevant to the Bill.

Mr. Derrig

It seems to me that the provision of medical treatment for the poor people in the Gaeltacht has arisen. I do not propose to say very much more on it. I simply wish to call attention to the fact that the problem is there and that this is not a real effort to meet it. How are you going to take a certain area in the Gaeltacht or anywhere else, and say that the poor people there should be provided with free nursing service if you are not going to do it all over the country? There are poor people everywhere and while we are all anxious to do as much as we can for the Gaeltacht, once you extend the principle of the Bill beyond the original purpose of applying only to hospitals, I see great difficulty in stopping. It seems to me that it may be extended further and that there is nothing to stop me, for example, from bringing in a Bill to provide that dispensary medical services in the Gaeltacht should be provided for out of the Sweepstakes.

I might also do what other individuals have tried to do, namely, get up a sweepstake for the special purpose of looking after the Gaeltacht. I might say that the Gaeltacht problem as a whole is just as serious and important a matter as the question of hospital services. I might come along and say that, in view particularly of the conditions in the Gaeltacht at present, a special slice of the proceeds of the coming sweepstakes ought to be set aside for the provision of special works in the Gaeltacht. We are all in agreement that something should be done. The point is where you are going to draw the line. My complaint against the Government is that they have not attempted to face up to the situation in the Gaeltacht, that they have not attempted to take over any of these medical services or to improve them. The poor unfortunate nurses are doing all the work and the Government come along now and pretend that they are going to do something good for the Gaeltacht by putting on to the sweepstakes funds the comparatively small amount that will be necessary to found an additional service or services. I think it is simply an attempt of the Government to relieve themselves of the responsibility of the whole matter. I would call attention to the fact that in the Highlands of Scotland there is a special scheme by which the poor people in these areas can get medical services at a low fee. It seems that the people in the Gaeltacht, generally speaking, have an objection to the red ticket system and that system in my opinion ought to be closely inquired into.

Mr. J.X. Murphy

I do not understand Deputy Derrig's point, because I do not think that this is an attempt by the Government to deal with the whole situation, nor is it an attempt by Deputies Mongan and Law to deal with the whole situation. It is only an effort to get a small portion of the money out of the sweepstakes to help these nurses. I do not really very much care whether the proportion that is proposed to be given comes out of the allocation to the country hospitals or the Dublin hospitals. In fact I think it would be fairer if it were distributed all round. As far as I can see, the Dublin hospitals have done very well out of the sweepstakes. I have some experience of the Jubilee Nurses' Association and it is at present entirely supported by voluntary contributions. Unless the Association gets some help in this way the services in the country will have to be very much curtailed. Certainly the services cannot be increased and I believe that the services of these nurses are very necessary in places where there are not nurses at present. I think Deputy Derrig is confusing the issue, as this is not a Government Bill.

Mr. Derrig

May I say in reply to what Deputy Murphy has said that Deputies Law and Mongan and himself seem to have full information, while Deputies on this side have only whatever information they have gleaned from the discussion? We have had no communication, as far as I know, from the associations concerned, and if they were really in earnest about this Bill it is extraordinary that they could not inform the Opposition of what exactly their object was.

Mr. Murphy

I have not spoken to Deputy Law or Deputy Mongan on the subject at all, but it looks clear that it is an effort to get a small portion of the money from the sweepstakes for the Jubilee Nurses.

Mr. de Valera

It does not say even that.

An Ceann Comhairle

This Bill does not seem to me to raise the general question of medical services in the country at all, though we may have to touch on that. The question that arises is whether the sweepstake funds should be used for a particular purpose. The Bill does not raise the general question of dispensary treatment in the Gaeltacht, or outside it.

Mr. de Valera

I think it would, be very difficult to deal with this Bill without dealing, in some measure, with medical services. It is obviously intended to supplement certain services that exist.

An Ceann Comhairle

I know it is intended to supplement certain services that exist, but the main question is whether the sweepstakes are the proper method to use for this purpose. On the Second Reading of this Bill it is correct to argue, as it was argued by Deputy Fahy, if my recollection serves me right, that there are other purposes to which the sweepstakes might be devoted, or that they ought to be devoted to no other purpose but the one originally intended. But to lead us into a general discussion on poor law services, and medical services in the country, on this Bill, and as to the Government's policy in regard to that, would be carrying us too far. I think Deputies will agree with that. The debate would travel altogether away from the Bill. On Second Reading it is always possible to depart from the Bill by a process of saying that if you were solving this problem, you would not solve it this way. Certainly it is not possible in this Bill to take us away completely from the sweepstakes, or the advisability of using them for a particular purpose, to a discussion on what this Government or some other Government ought to do with regard to poor law services generally.

Mr. Anthony

I rise to support the Second Reading of this Bill. I feel that there are certain problems peculiar to the West and amongst them is the nursing problem. We have had it on the authority of Deputy Law that many of the services in these areas had to be dropped because of want of funds. Section 1 of this Bill provides for poor persons suffering from physical disease or injury, and maternity cases. I have had a long experience of one welfare society in particular where very valuable work was done by the nurses of that association. The association was maintained almost solely by voluntary subscription, but it was found that at the end of a period these voluntary subscriptions were gradually growing less and less. The result was that the activity of the nurses had to be very much curtailed. Now while we must expect of course that a Government Department—in this connection the Department of the Minister for Local Government and Public Health—must be responsible, in a measure, for the nursing of the sick poor, at the same time we find that owing to the resources of the country not being strong enough to do all that is required these nursing associations have been able, because of the personal influence of those in charge and possibly other factors, to get subsidies from private sources. As a result of certain circumstances related by Deputy Law we find that since 1922 the Jubilee nurses' fund has fallen away considerably, with the result that many stations previously catered for had to be closed down. I said that this Bill applies particularly to the West——

Mr. Law

I gather there is a misapprehension among many Deputies that the intention of the Bill is that it is to be confined in its operations to what is called the Gaeltacht. That is not so. These nursing associations are operating in Cork, Westmeath and elsewhere.

Mr. Anthony

It is not peculiar to the Gaeltacht, but I feel, in this matter, as far as the borough that I represent is concerned, it will not derive any advantage from it. I am quite uninterested from that point of view, but at the same time I am in entire sympathy with the object this Bill is attempting to achieve. Section 2 (2) provides that the particular areas shall be specified by the Minister. I take it that these areas will be areas in which poverty and sickness are more general than in other areas. I fail to see that any undue discrimination will be exercised. Of course we will have raised, from time to time even in a Bill of this innocuous kind in the sense that it is non-political and non-party and will I hope be discussed in that spirit, questions of partisanship particularly when it is suggested that the particular areas are to be specified by the Minister. No matter what Party is in power for my part I would give authority to the Minister to specify the areas because we do know that this Bill will apply mainly to the Gaeltacht area where they have their own peculiar problems in the Gaeltacht.

[An Leas-Cheann Comhairle took the Chair.]

Mr. George Wolfe

I do not think that there is anyone in any part of Ireland who does not recognise that most capable work is being done by the Jubilee nurses among the sick poor all over Ireland. Not only in the Gaeltacht is this work done but especially along the western seaboard where conditions are extremely bad it is even more valuable. The work done by the nursing association in these particular districts is more valuable than where perhaps the conditions are not so hard. It is a deplorable thing to think that, as Deputy Law said, there are so many districts that cannot have nurses appointed to them because funds are not available. Anybody who has been to the west of Ireland knows from the wild condition of the country the difficulty nurses have to go through very frequently in getting to their patients. They have a great deal to contend with. They are a most capable, self-sacrificing body of women and I think it is quite reasonable that out of the sweepstakes funds collected for the hospitals some share should go to these associations.

What would the hospitals be without the nurses? How would the doctors get on if it were not for the efficient help that the nurses give them? I think that up to this their share in this matter has not been recognised. This is only the beginning. A beginning has to be made with everything and the place to begin is in the poorest parts. No doubt the poorest parts in this country are in the Gaeltacht. I think it is but right that nurses who undertake very difficult and very hard work by night and by day along the sea coast should be assured of decent comfort when they break down in health, and that there should be a fund to help them. Several plans have been adopted so as to provide pensions for nurses. Gardens in different parts of the country have been opened on Sundays and other days in order to raise funds for this purpose. I do not know what the result of that has been, but, I am afraid that it has been disappointing, and that it is not likely to bring in much more money. More money must be got from some other sources in order to open up new districts and to provide a sufficient sum for these noble women who are doing such good work under difficult circumstances. I think it is quite right that the money should come from the enormous and ever increasing sum that is being collected from the sweepstakes. It is but right that this important side of the medical profession, as it is, should have its share. Hitherto nothing has been done for the nurses. It is only right that a beginning should be made now to provide that not only should there be a decent amount of money available for nurses while they are at work but to help them when they are past their work. No district where the services of a nurse are needed should be without one. I hope this Bill will be passed unanimously. It would be a disgrace if out of the three millions that are collected something was not done for the nurses without whom patients would be perfectly helpless. The doctors know perfectly well that their work would be hopeless in many cases but for the assistance they get from nurses. I am sure that all doctors, whatever opinions they may hold, agree that the work of the nurses deserves recognition and that it is our duty to support this Bill, even though it is only a beginning of the recognition of the great services rendered by these women to the country generally.

Mr. de Valera

The terms of this Bill are so wide that it is very difficult for anybody to know exactly what is covered by it. It seems to me that those who have been talking about restricting it to Jubilee or Dudley nurses are talking away from the Bill. The Bill seems to me to give to the Minister for Local Government full discretionary power to apply this money for the service of any nursing organisation that he thinks fit. He can choose any nursing organisations whatever and apply this money to it. He can say in what areas they are to operate. The first question we naturally ask ourselves is this, whether we are justified in giving this full discretionary power to the Minister. It gives to him the power of patronage and other powers which I think it is only fair we should see restricted to definite organisations.

The Bill proposes to get this money from the portion of the surplus which is being made available for the county hospitals. When the last amendment to the Sweepstakes Act was before the House we endeavoured to get that sum increased from the fraction of one-fourth, which was in the Bill originally, to one-half. A compromise was reached and a sum of one-third was made available for the county hospitals. We felt that that was an unfair division but now it is proposed in this Bill to make that division still more unfair, by taking away from the county hospitals the fraction to be made available for this purpose to assist nursing organisations. Deputy Law has pointed out that that could be amended in Committee. We are quite willing to admit that it could be, if the House were willing, but our experience on the last occasion does not, I think, justify us in hoping that the county hospitals are going to be relieved from having to provide this money out of the share that otherwise would be available for themselves.

The next point is that it would seem the Bill is not to bring any assistance to midwives under local control. Excellent as is the work that has been done by the Jubilee and the Dudley nurses—I think every one who has spoken has paid a tribute to their work —excellent work has also been done by the midwives. We think if this Bill were to go through at all there should be an amendment widening its scope. But the moment we think of widening its scope we are brought face to face with the real danger that is in all these Sweepstake Bills. If you were to widen the scope of this Bill and deal with the case of the midwives you would immediately be bringing in, as was brought in in the case of the county hospitals, a principle where we are supporting what should be State services by methods such as sweepstakes.

Our attitude to this whole matter is this, that we think the medical services for the poor should not be left either to charity or to chance, that there is a definite obligation on the community to provide these essential medical services, and that any attempt like this is merely a palliative. Suppose this Bill were passed and that it were made possible to put a few more nurses, say in the Gaeltacht, by doing that you would be making it easier for the community as a whole, and for the State to turn its back on the rest of the work that ought to be done. I think as a community we ought to face that particular problem, and regard it as an obligation and a duty to provide for the poor the medical services that are necessary for them, and to provide them in a definite way, and not merely, as I have said, to leave it either to charity or to chance.

I said the moment you widen the scope of this Bill you begin to realise the dangers you are running. Assume now that this Bill is passed, you will have a service in the Gaeltacht made dependent on the success of these sweepstakes. If, for instance, a time came when it was thought wise in the general interests to discontinue sweepstakes or to take them over and make them a State affair—particularly the question of discontinuing them—you would be up against the difficulty that the discontinuance of them would mean a very severe hardship on, for instance, people who are getting service from these nurses. That is what was intended, I think, when one of our speakers spoke of vested interests that are being created. Every service the continuance of which was dependent upon the continuation of such sweepstakes would be appealed to as a reason why sweepstakes should continue.

When the Sweepstakes Bill was introduced first it was stated very definitely that it was introduced as a temporary measure. Now it has extended beyond the dream of anybody who was in the House when the measure was passed. I was not in the House at the time but I read since some of the speeches that were made. It is evident that nobody who made any speech dreamt that the success of the sweepstakes would be such as they have attained or that they would be so wide as they have become. The sweep is now being looked upon as a means of financing not merely what might be regarded as charitable purposes but what are, in our opinion, essential State services. If it is going to be regarded in that light at all then I say that the whole question will have to be reconsidered.

When the last extension was proposed the Executive provided for certain regulations. They felt that these regulations were necessary in view of the widening scope of the sweepstakes and if there were to be any further extension of the principle there is no doubt whatever that the whole question of the necessary regulations would have to be gone into too. That being the position, although as you know from the votes that were taken here in the past, we gave our votes without as a party at all considering it this time, because we believe there are essential community questions involved, we have decided to oppose it as a body. We intend voting as a Party against this because we cannot see that we can extend it to make it equitable without creating a situation which would demand a complete reexamination of the whole question.

The question of vested interests was mentioned. I indicated how services might be made dependent upon the continuance of these sweepstakes. The more services that are made dependent on them the greater will be the difficulties you will have in your way in any fair consideration of the question anew. I have not any fixed idea myself about this whole question. I do, however, hold strongly, seeing the dimensions it has now reached, and the tendency there is to look upon this as a means of getting finance for State services, that the time has come when we should examine the whole question and see where it is going to lead us. We have heard from the other benches recently a great deal about democracy and the steps that should be taken to safeguard democracy against, for example, anything like an armed attack upon it. Everyone of us here knows that there are other dangers to democracy than merely an armed attack. There are very serious dangers when large sums of money like the huge turn-over there is in this are made available by a monopoly which is conceded by the representatives of the people. When we are conceding a monopoly of this kind we should not forget that we have to face very serious risks and that all the dangers that are attendant when conceding a monopoly in any direction are here and perhaps in a greater measure than they would be elsewhere. So that as I say we have come to a stage now when we on this side of the House anyhow are satisfied that before there is any other extension of this principle the whole question will have to be reexamined. In this apparently we are going step by step until a stage will be reached in which we cannot give sweepstakes up if we wished to, so many people would be affected if we did so.

For instance, when we were discussing barley the question arose as to how difficult it becomes to deal with it when you have one large firm employing thousands of people whose livelihood depends on the continuance of that firm. In the same way, as sure as this extends and as the livelihood of more and more people is made dependent on it, so surely will the time come in which you will be presented with a situation that you will scarcely be able to change. Now is the time to look ahead and to take measures. We see the direction in which it is going and the magnitude it has reached. We say, at any rate on this side of the House, that before we go any further with it the whole question will have to be reexamined. In the last case certain safeguards and so on were introduced. We do not think that these would be sufficient at all to cover the situation. If we propose to extend this Bill now from the hospitals to essential medical services where are we going to stop?

Mr. Doherty

As I interpret the opposition to this Bill, it resolves itself into two heads. Clearly the Leader of the Opposition holds, first, that the Bill is too extended, that it gives power to the Minister for Local Government which he should not possess. Number two is that it conflicts with the idea that he has given expression to, and number three is that it would assist in the general ruin which he thinks these sweepstakes are going to inflict on the country. I will deal with these points briefly. It is notable that in his objection to this extension he raised the question that midwives are excluded. Surely the Deputy is aware that midwives are in a State service. They are already fairly well paid and have fees as well. We are considering here the Jubilee and Dudley nurses. They are engaged in the Gaeltacht, which I know well, because it comprises a large portion of my constituency. I can give him many instances of the good services they render. Around the coast, close to my residence, there are eleven inhabited islands. There is the island of Arranmore which has a population of roughly 2,000 people. Up to recently the people there had to depend on the services of the dispensary doctor who resides on the mainland. During the winter months, it frequently happens there is no communication between these islands and the mainland. The sick, the sick poor especially, were neglected. Since the Jubilee and Dudley nurses were placed there I have been assured by the medical officer that they have been of the greatest possible assistance to him. Without their assistance he would not be able to carry on successfully the work he has to do.

The same thing is true of the mainland. The area there is a very extensive one. It is in the Glenties rural district. The dispensary doctor has three districts to attend to, the area of which would be practically fifty miles square. This area, I may say, is a very congested one. In the case of illness or of an epidemic the doctor would be placed in a hopeless position if he had not the assistance of these nurses. On the mainland they have one Jubilee nurse. The people in that area are looking forward with the greatest hope to being able to place nurses in two or three of these districts when the Bill becomes law. Surely the Leader of the Opposition does not want to deprive the poor in the Gaeltacht of that beneficent assistance because it does not fit in with his ideals of how this money from the sweepstakes should be applied. I support this Bill most cordially and would appeal to the Leader of the Opposition to allow it to pass its Second Reading. On the Committee Stage we can discuss in greater detail many of the matters that were raised. I think it would be a cruel thing to deprive these poor people of the beneficent services of these nurses. At present they are paid by an organisation that has to raise the money required in a charitable way. It would be a cruel thing to deprive the people of the Gaeltacht of the benefits which this Bill provides for them.

The President

When the first measure in connection with sweepstakes was introduced it was designed to help what are known as the voluntary hospitals of the country. At the time they were in a very serious financial position owing to the change in the value of money and the extra cost entailed by reason of that change. That was the sum and substance of the first measure that was introduced. A departure from that proposal came when the measure, which was introduced here a short time ago, took a portion of the proceeds which the Leader of the Opposition has said he endeavoured to have placed at 50 per cent. instead of 33? per cent. That was the first departure that was made, and the Deputy himself, although he derides the departure, according to his speech he supported it. That was the first occasion on which an impost was placed on this method of raising money which normally, in the Deputy's mind, ought to have fallen upon either the State or the local authorities.

We cannot have it hot and cold. We either stand for that particular proposal or we do not. If we support that there is no use in coming along and saying that is a bad principle. The fact is that the House approved of it. In this particular measure the proposal is to review—to place it on no higher basis—that particular proposition. The effect of this Bill, if it passes into law, will be to see to what extent it may be possible in the distribution of the moneys to render help to particular services, to extend and keep in operation services to which Deputies, in practically all parts of the House, have paid tribute. It is unnecessary, I think, in this connection to make more than passing reference to the report of the Committee of Enquiry into health insurance and medical services. Pages 112 and 113 of that report deal mainly with the nursing system. There, too, will be found remarkable tributes to the work that is being done. Now this particular form of assistance, medical assistance if you like, is moderate. It is efficacious in its results and so beneficial to the neighbourhoods concerned that, whenever there was any danger of a limitation of its operations, there have been representations from those most closely in touch with the needs and necessities of the people—the local parish priest or other people.

I had occasion this year to see for myself the usefulness of this organisation. On the coast beside the sea a man got splashed badly with tar. At the time of the accident he was three miles from the local village. Fortunately it was possible to get him into the local village where the nurse was resident, but if there had been no nurse there he would have had to go five miles, and then possibly the local doctor would not be at home. In that eventuality he would have to go another journey. Therefore, one can see at once how useful this particular service is. How did this service come to be provided? In the first instance, through the instrumentality of the late Lady Dudley who apparently envisaged the necessity for a service of this sort. That service started with something like eight nurses, but the organisation of it has now spread to something like 31 centres, principally in the Gaeltacht.

There are other voluntary agencies in other parts of the country, but this particular agency, the one conceived and started by the late Lady Dudley, is supported entirely by voluntary contributions. I am positively certain that contributions were much more easily obtained some years ago than they are now. We need not go into the reasons for that. The fact is that it and kindred organisations engaged in this work are now faced with the necessity either of limiting the services rendered by the nurses, the number of centres in which they carry on their good work, or alternatively, of getting an increase in their revenues from the voluntary and philanthropic bodies which at present are providing the money to enable these services to be carried on. That is the proposition that we have got to face. It is not a State medical service.

Mr. de Valera

The provision of medical assistance should be.

The President

That is another question. If it should, why support the proposal to take away any of this money for the voluntary hospitals? Personally I believe that after meeting the proposal of Deputy Mongan there will still remain enough for the local authorities. I believe that in this particular sweep the sum that will be made available for the local authorities will be in the neighbourhood of a quarter of a million. One twenty-fifth of that is £10,000. This £10,000 should be regarded as an endowment fund, the interest on it to be used to provide nurses and to maintain the service so that there will be no interruption of the activities of this organisation when the sweepstakes come to an end—to see that there will be no hardship as a result of the fact that there will be no further moneys to look for from that particular source. That is the kind of business-like proposition that I expect would be in the minds of those interested in this.

Mr. de Valera

That is not in the Bill.

The President

I do not know that it would be possible to put all the things into the Bill that should be in it. I am simply saying that it is a matter of construction and that such a business-like interpretation of the scheme would be in the mind of the Minister for Local Government. I think any other interpretation would be foolish. To send out nurses all over the country and spend all the money and then, when these sweepstakes stop, to give these nurses notices of dismissal would be cruel to the nurses and to the people concerned. The question we have got to consider is whether this nursing scheme is a useful public service. I think we are very much indebted to the people who first conceived the idea of sending these nurses throughout the country. I think we are very much indebted to the people who voluntarily contributed towards the maintenance of that service. We are very much indebted to the services of the nurses themselves, who have given perfect satisfaction.

Are we satisfied at this moment that we are entitled to refuse this particular method of keeping that service in operation? Are we satisfied, seeing such considerable sums being made available for other purposes, furnishing the hospitals and other things, to say that it is more important that the last penny must be spent in respect of having these perfectly up to date, irrespective of the fact that it may be necessary to give notice of dismissal to certain nurses in certain places or to refuse to send nurses to other places where there is a real and crying need for them? I cannot subscribe to that view from facts I have before my mind in connection with this matter. Is the sum asked for in this measure, to provide for the maintenance of the existing nursing organisations throughout the country, necessary? I say yes, in my opinion. Secondly, is it desirable, if it be possible, to extend that service, to the extent that is asked for in this measure? I say "Yes," to that also. I do not think I would be justified in refusing to reply in the affirmative to either of these questions.

There is a third question: can local authorities suffer the loss of this one twenty-fifth? They did not get anything last year. As a matter of fact they have not got anything yet. The sum will be so considerable in my opinion that this twenty-four twenty-fifths of the quarter of a million divided amongst local authorities will suffice to provide what will be reasonably necessary, taking into consideration the fact that this is not the last of those Sweepstakes, in the way of medical and other appliances throughout the country. The sum of money expended by the State in recoupment to voluntary agencies for the year 1929-30 was £10,252 6s. 9d. That is from State sources. The State, bearing in mind the importance of this service and seeing no other means possible of maintaining it, took the view that it was better to assist the voluntary organisations engaged in the work than to scrap it and take on the whole of the work itself. In the year 1930-31 the sum in the Estimates in respect of recoupment to voluntary organisations was £11,362 15s. 4d. The Minister for Local Government informs me that there is about the same amount this year to local authorities.

There is evidence that the Oireachtas had in mind the necessity for assisting those voluntary organisations. That is a very considerable sum. It is not proposed and I do not think the Minister had it in mind—I certainly would advise him not to have it in mind—that there should be any equivalent contribution to these sums from the sweepstakes, but that is another question. If the money be used as a capital sum the income from it would be devoted towards providing extra nurses. I would not be inclined to close up the pocket in respect of that. Personally I think Deputy Mongan deserves very great credit indeed for introducing this measure. He understands the necessities of his district but he does not confine himself in respect to the introduction of this measure to the Gaeltacht. Whenever it is found necessary and desirable and wherever the resources and revenues of these voluntary organisations will admit of an extension of these services, I think it would meet the general public approbation to see them extended.

Mr. Briscoe

The President read out certain figures showing the State contributions to the particular organisations referred to, or the amounts expected to be made available. Will the President give some assurance that if this Bill is passed the State contributions will not cease, as they did in the case of the voluntary hospitals?

The President

The Deputy surely is not getting foolish.

Mr. Flinn

He has not joined Cumann na nGaedheal.

Mr. Briscoe

Will the President answer the question?

The President

It is a matter for the House. The House votes the money.

Mr. H. Broderick

I welcome the introduction of this Bill. I have been a member of the Athlone District Nursing Committee for some time and I know that this Bill if passed into law will give this association much needed assistance. The sick poor of Athlone have been very fortunate in having a district nurse ministering to them for the last 12 or 13 years. Not only does she minister to the sick poor in their homes in the urban district, but she goes out to the rural district to nurse the sick there. Many Deputies in discussing this Bill seem to be under the impression that there are no district nurses in any part of the country except in the Gaeltacht. We have two nurses in Westmeath, one in Athlone, and the other in Killucan, and I must say that the services rendered by these nurses are simply magnificent. As the House is aware, the cost of maintenance of these nurses is almost wholly derived from voluntary subscriptions. We also receive some small sums from the Government for the upkeep of these nurses. The number of visits paid by the nurse in Athlone would run into thousands per year.

I think the Bill is very necessary in this sense, that we should have some-help to maintain these nurses. Ten years ago we had an epidemic of 'flu in Athlone, and then we had to collect the money to pay two nurses. We have had only one nurse for the last seven or eight years, but we are very glad to have that one. I hope that when the Bill is passed the money which it will provide will be devoted to sending nurses to many other parts of the country where they are badly needed. I entirely agree with the principles of the Bill. As to the proportion that will be allotted to the county hospitals, as the President has stated, we are getting a fairly decent sum out of the sweepstakes and we can agree that something should be taken out of that fund for this purpose.

Mr. Clery

The President seems to argue that because certain Deputies agreed heretofore to the extension of the monies that are paid out from the sweepstakes, they should also agree to this. If he followed up that line of argument he should oppose everything in connection with this matter because he was one of the small minority that opposed sweepstakes at the start. There is no consistency in his argument. I think I can claim to be as great an advocate of the rights and the welfare of the people of the Gaeltacht as any of the Deputies opposite, who considered it wise to sit tight on occasions when they might have done something for the people of the Gaeltacht. Deputy Mongan seems to suggest that the idea for this Bill came from the priests in the Gaeltacht. I would like to know if the priests in the Gaeltacht have come around to the point of view that the only hope for the Gaeltacht is by providing sweepstakes, lotteries and gambles of that kind.

Surely all the resources of civilisation have not run out to such a degree that those people over whom the Deputies opposite have shed such crocodile tears to-day, have to depend for those particular services on the income from sweepstakes, lotteries and gambles. I consider that the people in the Gaeltacht are the most highly taxed people in the world, when one considers the conditions under which they have to live. I consider that we are making this Parliament, the status of which we boost so much, a laughing stock, to have us here discussing every week an extension of sweepstakes and lotteries to assist social services in the State. Is there no other means of assisting social services, or serving the people in the Gaeltacht, the last remnant of our ancient race? Is there no other means by which we can come to their rescue in the matter of medical services than by utilising sweepstakes and lotteries? I say we are making ourselves a laughing stock before the world by advertising sweepstakes in order to use the money so realised for the people of the Gaeltacht.

If we make these people dependent for their medical services and other services on the income derived from lotteries and gambles, will the argument be put forward in a few years time, when it is suggested that these sweepstakes should be dispensed with, that we cannot dispense with them or else if we do dispense with them we will do a great injury to the people of the Gaeltacht, will throw thousands of people out of employment in Dublin, and do other injury? Are we going to allow this to become a sort of vested interest?

No one wants to find the slightest fault with the Jubilee nurses. They have been much greater friends of the poor all along than have the Deputies on the Government Benches who have introduced this measure. When the Jubilee nurses were travelling throughout the country night and day in order to dispense charity to the poor, some Government Deputies did not even dispense charity. In the course of his Irish remarks Deputy Mongan stated "Is ceart an trocaire do roinnt." It is right for us to extend charity to the people of the Gaeltacht, he said. I say it would be much better for us to extend justice to the people of the Gaeltacht, the poor of the Gaeltacht, rather than extend our charity. Let us extend justice to those people and, if we do, we will be doing much more for them than by bringing them now under this scheme of gambling and sweepstakes.

If the success of the sweepstake is not assured it may be a cause of trouble and worry for the people who are dependent on these nurses for attendance. Are they to be left hoping for the success of sweepstakes and gambles in order that they may have some medical services which are not now given them by the Government? I think this is a step absolutely in the wrong direction.

It is very hard for the people of the country to understand the mentality of Government Deputies and of the President who, at one hour's notice in this House, can provide £2,000,000 for the Shannon Scheme after a bungle and who can come in here at an hour's notice and make provision of from £5,000 upwards for the guarding of Deputies in a pretended scare. The Government have not at any time during the past nine years provided anything of any value for the people of the Gaeltacht whom they now talk so much about. The Government are now appealing to the gamblers of the world to come to their rescue by making the sweepstake a success. I say it is an insult to the people of the Gaeltacht.

If Deputy Law has nothing else to offer the people of Donegal than mere dependence upon the success of a gamble, then he is an absolute failure as a Deputy representing the Gaeltacht, and the same applies to Deputy Mongan. I have no objection to giving the people assistance in some way, but I contend that placing them in the position of being dependent on the success of a gamble is an absolute insult, and I will not be a party to it. The plea may be made that you are giving somewhat out of sweepstakes to other sections of the community and why not give it to this section? If that plea is put up by Government Deputies and if they look back on history they will find their answer. The answer to that plea should have been found long ago.

Years ago, when we on this side pleaded for co-operation with the Government Deputies to get down to the Gaeltacht question and the problem of the congested districts by accepting the Gaeltacht Commission Report and providing money for services badly needed there, if the Government had then as great sympathy with these people as they profess to-day, they would not now have to be asking this House to pass this measure. The nurses who have been all along attending to the poor have been doing admirable work. I repeat that to place the people in a position of being dependent upon the success of a gamble is an insult over which I certainly will not stand.

Major Myles

I wish to take this opportunity of adding my support to the Bill. From long association with boards of health and other similar bodies I know perfectly well the value of the nurses, and I am glad that nobody in this House has said one word against the value of those nurses.

Mr. Flinn

Why should they?

Major Myles

The only trouble we find in the County Donegal is that it is impossible, under present conditions, to provide nurses where they are really wanted. It is easy enough to provide a nurse in a district where you have a number of people willing to put their hands in their pockets and form a voluntary association. I have had representations put up to me from districts where such people do not exist, where the people are poor and where there is no possible way of forming a voluntary association. Therefore the people must do without the nurse. I do not think I have listened to a more futile argument than I have heard within the last hour. Is it enough to come here and say that this Bill should not pass because of so-and-so, because the sweepstakes may end in some years' time?

Deputy de Valera tells us it ought to be a State service. Why does he not bring forward a Bill? If it ought to be a State service, then when the sweepstakes end let the Deputy come along and say that some alternative method must be adopted. In the meantime we cannot let the people die or suffer from the want of a nurse. When the sweepstakes end, let him come along and say: "We must take over this. We all recognise this is a useful and a beneficent service, and now is the time to take it over as a State service." Either do that or establish it as a State service to-morrow. If the Deputy succeeds in defeating this Bill, then let us have a Bill to make this a State service. Do not, in the meantime, let those people suffer on until such time as the State can help them.

Dr. Hennessy

The Bill introduced by Deputy Mongan has for its object a very excellent purpose. I believe there is a great need for an increase in the members of the Nursing Association in Co. Galway, especially in the Connemara area. The Co. Galway also is not very fortunate in the number of its district hospitals. There is an excellent county hospital in Galway City where they treat all the major operations, practically all the surgical operations and the serious clinical cases that are met with in the county, and there are several cases not of such a serious nature, at least in their beginning, that have to be treated at home. I believe that more people die from lack of adequate and good nursing than die from lack of good doctoring. I believe the nurse is of most importance.

I am perfectly candid in this and I am making no reflections, as may be suggested by Deputy Fahy, because here is what happens. I was in practice and I found I prescribed rather freely, but there was no one there to carry out my prescriptions. That is much more the case in Connemara because the Connemara dispensary districts are abnormally large and contain an abnormally large population, a poor population. It is well known that there is a greater incidence of illness amongst the poor than amongst the wealthy. I think it is very fitting that a certain amount of the money going to the counties from the sweepstakes should be used for increasing the efficiency of these nursing organisations. I am surprised at Deputy Fahy, who must have a great interest in Galway, lending himself to any opposition to this Bill.

Mr. Mongan

Hear, hear.

Dr. Hennessy

I do not mind what Deputy Derrig says. He brought forward some figures in support of the contention that the dispensary doctors of Mayo did not pay sufficient attention to their patients and the patients were under the necessity of paying the doctors. The Deputy went as far as that. The figures he quoted do not mean very much because several people rather than walk a couple of miles in the morning for a ticket will go to the doctors without a ticket. I remember when I was a dispensary doctor often doing three hours poor law work and when I would come to my file I would not have one ticket to show the work I had done.

An Inspector was sent down to investigate the statements made against the County Mayo doctors, and the inspector returned and reported that the doctors there did their duty most efficiently and attended gratuitously not only those who were entitled to gratuitous treatment but also attended those who were on the borderline.

I should like to suggest that a sum of money should be set aside from the allotments to the city hospitals to form the nucleus of a pension fund for nurses generally and especially for those who are not in the poor law service. I admit that in the poor law service the salary is bad, the nurses are underpaid, and the result is that they will have a bad pension. One follows the other. I am aware of the necessity of keeping the hospitals up-to-date in town and country; but we should think of the nurses who are the human equipment of these institutions. Deputy de Valera in his usual fatal way defers everything. He hates arriving at a quick decision. He will take five years or nine years to come to a decision that any ordinary one of us would arrive at in twenty-four hours. He says, practically leaving the matter rest, that it is an objectionable way of meeting the wants of the county nurses' organisation to provide for them out of the sweepstakes fund. Well, I did not hear any condemnation of this by the Irish Hierarchy; and I think that if there was anything immoral in it, we should probably hear from them.

I have no doubt that in due time Deputy de Valera will come to our way of thinking in this matter. I must say I cannot realise why the Fianna Fáil Party oppose this Bill. Is it because that, no matter how meritorious may be a Bill which is introduced from this side of the House, the Fianna Fáil Party must automatically oppose it? I am making an appeal to every unprejudiced member of the House to support Deputy Mongan's Bill, because it is truly a very excellent Bill, and it will save the lives of hundreds of people in the areas for which it provides, whereas if we were to adopt the advice of Deputy de Valera I am afraid a number of deaths would result.

Mr. Hogan (Clare)

I think the principle of this Bill is to provide money to continue services that are essential to the well being of the poor in certain districts. I think that is the principle of the Bill, and that is the reason that I intend to support it. But, though it is a short measure, I think that it requires a great deal of amendment. In the first place I think that the fund from which the money is going to be taken should not be the first portion of the fund to be raided by those people who have granted it. The county hospitals are very necessary institutions. I think doctors in general will agree, although I do not think they agreed the last time, that county hospitals are not getting the amount of attention that the city hospitals are getting in proportion to the necessary work that they do for the poor in the districts which they serve. If you had well equipped county hospitals you would give the surgeons of these hospitals the means of doing good and very serviceable work, and you possibly would relieve the burden thrown upon the city hospitals. That is the reason why I think that this very much needed first instalment to the county hospitals should not be raided. It is a very bad precedent, and possibly when any other measure of this kind is introduced you will find another attempt made to raid this portion of the county hospitals fund. That is my first objection to this measure. It is a matter that should be amended in committee, and very extensively amended.

I do agree with Deputy de Valera that medical services should not be left to charity or chance; but I think that argument holds good with reference to the relations of the sweepstakes fund to the county hospitals just as well as to these services. I think if we are to see these things become national services that the county hospitals should be provided for and provided for extensively out of national funds. The principle is right, but the point we have to remember is this: that sweepstakes are here and that money is available, and that when these services have to be carried on in the interests of the poor or the sick poor, we ought to take every means in our power to try to carry them on and make them as beneficial services as possible. I do believe that there is another class of nurses who certainly ought to be included and who do possibly just as much work, and, as far as I know, better work than even those nurses are doing. Some Deputy on the Government Benches said that midwives are well paid. The fact is that they are wretchedly paid and that their salary is not capable of keeping them in any decency or comfort. To suggest that they are well paid is not in accordance with the facts. They should be included under this Bill. Deputy Law objects because they are paid out of——

Mr. Law

I do not object. I was trying to remember if anyone said that they were well paid.

Mr. Hogan

I think Deputy Doherty said it. I think that means should be found to include them in this Bill. While I agree with what Deputy de Valera said—that medical and such services should not be left to charity or chance—still the fund is there to make use of, and we ought to endeavour to make use of it for alleviating the circumstances of the sick poor. In regard to the districts: while I am anxious that the Gaeltacht—as possibly the last stronghold of the Gael—should be supported and subsidised as far as possible, there are poor people in other districts who are as badly in need of help and attention as those in the Gaeltacht. I think that this Bill should not apply solely to the Gaeltacht, and, as far as I can see, that is the intention.

Mr. Law

No.

Mr. Mongan

Not at all.

Mr. Hogan

I have heard references to Donegal and Connemara.

Mr. Brennan

Did the Deputy hear Deputy Broderick from Athlone speaking?

Mr. Mongan

They have a nurse in Ennis.

Mr. Hogan

The Bill ought not to be confined to any particular set of areas, and the poor in every area ought to be considered. Whether they speak Irish or Dutch the poor ought to be considered.

Mr. Hogan

I am supporting the principle of the Bill because it is to provide funds to carry on necessary services, but I shall do what I can in Committee to have it amended in the directions I have indicated.

Mr. Flinn

I move the adjournment of the debate.

Debate adjourned.

Dáil Éireann debate - Friday, 13 Nov 1931