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Dáil Éireann debate -
Wednesday, 31 May 1933

Vol. 47 No. 17

Public Hospitals Bill, 1933—Committee (Resumed).

I move amendment 33:—

Before sub-section (4) to insert a new sub-section as follows:—

"If, after the making of a grant out of the Hospitals Trust Fund under this section to any grantee and before payment of such grant or before the making of any particular payment in respect of such grant, the Minister is satisfied that any condition attached under the foregoing sub-section to the receipt of such grant or any such particular payment has not been complied with by such grantee, the Minister may certify to the National Hospital Trustees that such condition has not been complied with and upon the Minister so certifying, the National Hospital Trustees shall not make, and such grantee shall cease to be entitled to, any such payment of or in respect of such grant or to any future payment in respect thereof unless and until the Minister otherwise directs."

This is a drafting amendment to provide for the stoppage of the grant in case the conditions mentioned in connection with grants have not been complied with.

Surely this is more than a drafting amendment. This section, as originally drafted, is now altered very considerably by two amendments, whether they are called drafting amendments or not. The fact is that under the Bill, as introduced, the Minister could make a grant to hospitals in accordance with conditions that were set out in the section. Surely the Minister is not contending that this is a drafting amendment, having regard to the change that has taken place in the section, by reason of the amendment. The amendment states: "If after the making of a grant...and after payment of such grant...the Minister is satisfied that any condition attached under the foregoing sub-section...has not been complied with...the Minister may certify to the National Hospital Trustees that such condition is not being complied with and upon the Minister so certifying the National Hospital Trustees shall not make and such grantee shall cease to be entitled to any such payment...unless and until the Minister otherwise directs." Now the conditions under which it was open to the Minister to make a grant to the hospitals were set out. One of them, I observe, has departed; there was to be no grant in respect to maintenance. That is more than a drafting amendment and the Minister ought to give some reason for it. Is it proposed that the Minister might alter the conditions, because the latter part of the amendment states that no such further payment shall be made unless, and until, the Minister otherwise directs. Directs what? Is the minister reserving to himself power to change the conditions? If, for example, a hospital were to get a grant of, say, £10,000 for an addition and it found that it would cost £15,000, would the Minister consider that a reason for holding up the grant because the hospital finds they could not go on with the work and carry out the Minister's intention? I think that is more than a drafting amendment and surely we might have some explanation.

Under Section 24 the Minister "shall specify the purpose for which such grant is to be expended and may attach to the receipt of such grant such conditions (whether to be performed before or after such receipt), as he thinks proper for securing the due expenditure of such grant on the purposes specified by the Minister for securing or attaining any other object." The Minister may attach such conditions, for example, that a certain proportion of beds in the reconstructed institution shall be free beds for the poor. The new sub-section proposes and is intended to give the Minister the necessary power to discontinue the payment of the grant or the endowments in the event of the hospital committee or governors of the hospital failing to fulfil or ceasing to continue the conditions on which the grant was made. I might say it is not intended, and not proposed in the sub-section, to alter the conditions attaching to any grant.

The Minister has put before us the obligation on the hospital, after reconstruction or the extension of the provision of a certain number of beds, and the percentage of those beds to be devoted to the poor. Now obviously it will be necessary to have complete furnishing installed and the necessary equipment provided before that question would arise; so this is not the particular case the Minister must have in mind in regard to this matter. The question would only affect the moiety completed, I presume, because, according to the estimates we have had for a bed, it would run to something in the neighbourhood of £1,000 per annum; that is including equipment, cost of architect, surveyors' fees, furniture, etc. Obviously that money must be spent, so that the provision of the number of beds arises only in connection with maintenance and that too, I presume, would be a separate item.

It is quite true that a large percentage of the grant will be expended on capital expenditure—the provision of new buildings and the equipment of the institution. The proposed sub-section here is meant to provide for the endowment or the annual grants being discontinued in the event of these conditions ceasing to be fulfilled.

May I point out that, with regard to that, I have just looked up one particular report and in that case the amount sanctioned was £90,000. I take it that the interest on that was the amount proposed to be allotted to the hospitals in the amendment. Thirty-three and a third per cent. of that would be £30,000 and, at least, one twenty-fifth of it would be somewhere about £23,000, as against £70,000. Does the Minister intend to hold up the £70,000 if the specification is for building operations alone? Will that be held up, because provisions in respect of that are scarcely open to the Hospitals' Committee to alter? I think that some pronouncement should be made in connection with a matter of that kind. The Reference Committee deals a good deal, in the course of its report, with the necessity for care being exercised. They lay the period down as probably two years in order to complete all the plans for rebuilding. They do not recommend the shortening of that period to any great extent. Assuming that the plans and specifications relative to the construction of a building are properly complied with, does the Parliamentary Secretary anticipate any hold-up in all that in respect of what is happening now?

Is the allocation referred to by Deputy Cosgrave already made out of sweeps that have been reported on?

I have not referred to any particular allocation at all. I am only referring to this particular amendment now.

Well, I should say that, if the Hospitals Commission approved of the plans for the new construction proposed to be provided, there would be no hold-up of such allocation as a result of this section. The Minister was satisfied at the time the allocation was being made as to the plans and as to the nature of the extension of the building that, in the ordinary course of things, construction would go on and the conditions attaching to that grant would obviously be fulfilled and no new conditions added. When new allocations, in the form of an annual grant or in the form of an income from investments, were added certain provisions would be attached in order to ensure that the free beds already provided for would continue to be made available for the poor; but if at any time the hospitals ceased to make that provision available to the poor, the Minister, under this section, would have power to direct the discontinuance of the annual payments.

I should like the Parliamentary Secretary to look into this matter between this and the Report Stage. As it stands, it looks as if there might be a holdup. It is open to that interpretation. My case is that a hospital makes an application; the money is granted; the hospital has entered into this contract, but it may be that the Minister might propose something that was not contemplated under the contract. For example, there has been a marked development in regard to hospital architecture in recent years. The hospital concerned might, in good faith, pass certain plans, but in the meantime, the Minister might think, as a result of recent architectural developments, that an improvement might be made in these plans. Is there anything to guard against a conflict arising between the Minister and the hospitals concerned? I take it that the relations between the Minister and the hospitals would be cordial. Similarly, with regard to the matter of equipment of hospitals; I understand that there is a considerable improvement in recent years with regard to furniture, appliances, and up-to-date equipment. There may be a necessity for other arrangements in connection with matters of that sort. If the question be only one of maintenance, I think that the Minister ought to look into that matter between this and the Report Stage.

Amendment No. 33 agreed to.

I move amendment No. 34:—

Before sub-section (4) to insert a new sub-section as follows:—

The Minister in considering any application for a grant by any hospital or nursing organisation, and in attaching conditions to any grant, shall have regard to the internal policy of such hospital or nursing organisation.

Would Deputy Sir James Craig give us any indication of what he means exactly by the "internal policy" of the hospital or nursing organisation? To me the term appears to be very vague and might mean anything or nothing. What exactly has the Deputy in mind?

As a matter of fact, this amendment is one of the amendments sent forward to me by a Committee of the united Hospitals. I was not briefed as regards this, but when I made inquiries from various people they said to me that no one would understand what was understood by the phrase "internal policy". I did not go farther to seek any further information with regard to it, because I did not think that there would be any chance of the amendment being carried in view of the attitude of the Parliamentary Secretary.

May I say this—I have not got it directly from the hospitals, but indirectly—that there is a certain amount of uneasiness with regard to this Bill as to the attitude that is taken with regard to the distribution of funds? There is an apprehension with regard to the autonomy of hospitals, and as to what they regard as their independent jurisdiction. That has nothing to do with the provision of a certain number of free beds for poor people. But there is an apprehension with regard to the autonomy of hospitals, and if the Parliamentary Secretary would consider that point between this and the Report Stage I would undertake to get an amendment which he might, perhaps, consider reasonable, in the meantime. In the beginning, the Hospitals Bill was treated as a non-Party matter. It is rather unfortunate that Deputy Sir James Craig said that he thought the Parliamentary Secretary might not consider the matter in that light. I think the Deputy might have been a little more optimistic in regard to it. The Minister will, I have no doubt, be prepared to accept suggestions which will relieve apprehensions.

The hospital position in Dublin has altered within the lifetime of many people. Within the last 60 or 70 years a new arm, one might say, has been added to those we already had in connection with the hospitals. They are rather jealous of that autonomy. It is not an autonomy that has to be considered in relation to isolation. There is rather a certain amount of pardonable pride in the work done, in the attendance given to the sick, infirm and poor. The hospitals have done their best with the limited resources at their command. Even in the last ten or 15 years the hospitals have battled with an adversity which, perhaps, affected those connected with the hospitals more than other people. They deserve some consideration, not alone in respect of the past, but in respect of the present. If Deputy Sir James Craig will withdraw this amendment, I will endeavour to frame one which, I think, the Minister will be inclined to accept on the Report Stage, which will ensure the preservation of the rights of those who have conducted the hospitals in their internal policy and which will have no relation to anything that might be in conflict with the Minister's intentions.

I spent four and a half hours this morning examining in the Mater Hospital and I was extremely proud of all I saw there. I have been examining for about 25 years. I have seen the changes that have taken place in the various hospitals and nothing has struck me so much as the tremendous improvement that has taken place in every direction as far as a hospital like the Mater Hospital is concerned. There is a feeling among the higher officials in the hospitals that some interference might take place with regard to their arrangements. It would be very difficult for me to put my finger upon what the fears are, but undoubtedly there are distinct fears that there may be interference with the management in certain ways that the hospital authorities foresee will not be for their good. That is what my interpretation amounted to—that the hospitals did not wish too much interference with the arrangements connected with their internal work. As far as the attention to the poor is concerned, not only is there the most scientific diagnosis but there is also the most scientific treatment going on. I say this particularly in regard to a hospital with which I am in no way connected. As far as cleanliness is concerned, I do not think I have ever seen anything to equal it. They have hot and cold water in the wards and many other things that did not exist twenty years ago. They have been improving themselves beyond measure and I pay this compliment to them with the greatest pleasure.

I think both Deputy Sir James Craig and Deputy Cosgrave realise that the proposed amendment could not possibly be accepted. The complications resulting from its acceptance must be self-evident. I do not see how the Minister could become acquainted with the internal policy of a hospital. It is conceivable the internal policy of a number of hospitals might be very different. It would be almost impossible for the Minister, when he would be attaching conditions to a grant, to know whether the conditions were likely to be in conflict with what is called a hospital's internal policy. It might mean the internal policy in reference to the administration of free patients. I quite see that Deputy Cosgrave has not that in mind.

It might, however, be interpreted as meaning that. It might be interpreted to mean the policy in reference to the management of finance, the purchase of equipment, or remaining isolated from the other hospitals in refusing to be incorporated in any co-ordinated scheme that might be evolved on the recommendation of the Hospitals Commission. The object of the amendment, although Deputy Sir James Craig apparently is not very well briefed in the matter, as he admits, may be to prevent any possible interference under the guise of attaching conditions. If that is the object, the amendment is altogether too wide in its scope. There is no desire whatever to interfere unduly with the management of the hospitals or with the ordinary automony of the voluntary hospitals. We are concerned with voluntary hospitals in so far as the provision for the poor that will result from the sweepstakes is concerned. The provisions of the Bill are negative rather than positive. Consistent with safeguarding the provision of free beds to the poor in future, as far as it is possible to do that with the moneys at our disposal, I would be quite prepared to accept any amendment on the lines suggested by Deputy Cosgrave that will be in keeping with the principles of the Bill. The Deputy understands, I think, quite clearly what I have in mind.

In the very indirect touch I had in relation to this matter there were grave apprehensions in connection with every section of the Bill upon which I endeavoured to reassure some of the hospital people. I think the amendment I have in mind, and which I will move later, will tend to allay that feeling.

Amendment 34, by leave, withdrawn.

I beg to move amendment 35:—

To delete sub-section (4).

I think it would be as well to take amendment 37 in conjunction with this and the amendment reads: "To delete sub-section (5)." The deletion of those sub-sections was discussed on amendment 28, and the amendments are really consequential on that amendment. On the earlier stages of the Bill there was considerable confusion of thought as to the interpretation of sub-section (4) and (5). A general desire for clarification was expressed and, on further examination of the Bill, the most sensible way of clarifying the position seemed to be to delete those sub-sections completely. I do not know whether that will meet the wishes of those Deputies who expressed disapproval of the sub-sections as drafted, but in the light of the amendments already carried I think this is the simplest way of clarifying the position.

I think it is a very bad principle that the Minister wants to introduce by deleting this sub-section (4). If sub-section (4) is taken in conjunction with my amendment No. 36, the section will then exactly specify how the money can be expended. It does not leave it in the air. It is very full and comprehensive. What is the objection to having it in? It is a direction by this House that when we are interfering with funds which are provided not out of Government sources, but out of the pockets of the public that the House should direct generally how the money is to be expended, allowing, as the section allows, a very considerable amount of discretion to the Minister, but at the same time saying that this money shall be expended in a particular direction, or in one or several particular directions, but not haphazard in any particular way that the caprice of any Minister who may have the administration of this Act should wish.

I would appeal to the Parliamentary Secretary to allow sub-section (4) to remain. There are no less than six different choices that the Minister has for granting the money. I would prefer the sub-section to remain to having it deleted.

Amendment 28 makes this amendment now necessary. Section 24 (1), as amended, now reads "Subject to the provisions of this Act the Minister may, at any time, either on his own motion or in consequence of an application to him under this Act, make to any hospital or nursing organisation in Saorstát Eireann a grant out of the Hospital Trust Fund of such amount and for such purposes as the Minister shall think proper." The original Section read: "such amount and for such purposes authorised by this section..." The words "authorised by this section" have now been deleted. I do not think there need be any apprehension about this amendment at all. The money will all be allocated for the benefit of the hospitals, and not for any other purpose. Setting out in detail in the section the purposes to which the Minister may allocate it seems to me to be altogether unnecessary. In view of the amendment that has already been carried, it would mean a further recasting of the section.

Surely not. Take the Bill as it stands—"For such purposes as the Minister shall think proper." These words are perfectly distinct. It is of the greatest importance that this House, dealing with moneys that are not State property, should have a controlling influence. It is important that the House, even within these very wide limits of the section as it stands at present and with the other amendment which I propose to add to this sub-section—"the future maintenance of the grantee"—should have this control. That is very exhaustive. If there is anything else outside, the Parliamentary Secretary and his advisers can say what it is. You can do anything further to this sub-section, but keep sub-section (4) there.

The section as it stands now provides for endowment income, and it can provide for maintenance and for the payment of debts. The Minister is empowered to make the funds available to such amounts as he thinks proper subject to the provisions of this Act. I think everything can be covered by that. You cannot have anything wider than that.

It can be applied for such purposes as the Minister thinks proper. That means that it can be applied for any single purpose the Minister wishes. There is nothing to control the discretion of the Minister at all.

I think the sub-section should be left. Outside of the arguments used by Deputy Fitzgerald-Kenney the sub-section is useful as a safeguard to the House and it is useful also to possible applicants for grants. For when they read the Act they will understand for what different purposes they could apply for grants. The mere words"the discretion of the Minister" would not give people an idea as to what purpose the money would be available. It is in that respect that the retention of this sub-section would be useful.

I understand from the Parliamentary Secretary that his claim for his amendment is that it makes the section wide enough. That is hardly an answer to those who claim that the powers are too wide. What we were anxious for was not complete powers given to the Minister but a definition of these powers. I suggest that it is not an answer to that claim that he thinks that there are no limits to his powers. His powers are all-embracing. May I make this suggestion to the Parliamentary Secretary—that whatever his own individual intention is at the moment there is undoubtedly enshrined in the Bill as it will stand with this amendment an extraordinary power given into his hands, stretching far beyond what he indicated in his speech, namely, the desire to provide for the sick poor. The powers the Minister has got go much beyond that. The Parliamentary Secretary is carrying through this House a principle that is exceedingly dangerous. How dangerous it is he himself must have recognised last night.

Might I interrupt the Deputy?

There is no principle at stake in this amendment. I was advised that it would improve the section to delete this sub-section but I am prepared to recast the sub-section.

That is accepting my amendment "(g) the future maintenance of the grantee"?

I understand the Deputy has in mind the safeguarding of that in the re-drafting.

Amendments 35 and 36 withdrawn.
Amendment 37:—To delete sub-section (5).—(Aire Rialtais Aitiúla agus Sláinte Puiblí and Deputies James Fitzgerald-Kenney and Sir James Craig.)

Is the whole section being re-drafted?

Yes, it will be re-drafted, practically restored. But the question of future maintenance that Deputy Fitzgerald-Kenney is worried about is not sufficiently clear in the section.

Will there be an opportunity given to the House of expressing its opinion on the Report Stage?

As it stood originally there was no provision for what is called future maintenance. That would fall to be met each year. It has been the system of Local Government finance in connection with certain funds in the Free State and that principle was adopted. That is a bad principle in connection with hospitals, because the hospitals have to estimate before the spending of the moneys, and the thing would be better done if they knew that they would have every opportunity to examine into the dispensation of that money so that any provision could be made beforehand. Otherwise the money would have to be expended before a particular item could come for examination. Personally, I do not think that is a good principle.

How do we stand as regards the section as a whole on the Report Stage? Will there be an opportunity given to the House to express an opinion on the amended section as a whole and, if necessary, to take a vote for the deletion of the section as a whole?

There will be every possible facility.

Amendments 37 and 38 not moved.

In relation to amendment 39, I do not think any recasting of the section would cover it.

If the section were recasted there would probably be no necessity for that. That amendment even if adopted, in the light of what has happened now, would hardly be practicable. In the recasting of the section the Minister might possibly take it into account. There might be some guiding line introduced in the section. It is very arbitrary as it stands and it might be possible in recasting it to alter that slightly.

I am afraid there will be nothing in the recasted section to cover this particular amendment.

There are I suppose 60 hospitals. If each one had not to go and get information, if there was a definite procedure adopted which they could conform to, it might be easier to distribute the funds. However, the Parliamentary Secretary can consider it.

Amendments 39, 40 and 41 not moved.
Section 24, as amended, put and agreed to.

Section 25 is now incorporated in the Finance Bill.

The section has to be deleted now because it is no longer necessary to have it in the Bill. It provides for the application of Section 50 of the Finance Act, and the Minister for Finance has taken the necessary steps in the Finance Bill, so that the section will not be necessary in this Bill.

The following amendment stood on the Order Paper.

42. Before Section 25 to insert a new section as follows:—

"The Minister shall not have power to alter the constitution or to interfere in the administration of any hospital which does not receive any benefit from any sweepstake promoted under the Public Charitable Hospitals Acts, 1930 to 1932, or under this Act, or which does not receive any grant from any local authority."—(Sir James Craig.)

What is going to be done with regard to this amendment?

It might be taken on the Finance Bill. Section 25 is to be deleted because it is practically embodied in the Finance Bill.

Amendment 42 is to insert a new section and I understand the Parliamentary Secretary is accepting the principle.

There could be a new Section 25 if this amendment were accepted.

I want to point out that if the Parliamentary Secretary or the draftsman had done what was suggested by Deputy Thrift and others and made a change in the preliminary part of the Bill by which the hospitals would be defined, this would not be necessary. The Parliamentary Secretary knows what the meaning of my amendment is—that no hospital should be subject to inspection which had not received any grant from the sweepstakes. It was suggested that it might be possible to put into the introductory part of the Bill all the institutions which were to be included. I want to ask the Parliamentary Secretary if he will do that, or if he is prepared to accept my amendment as a new section.

The purpose of this was agreed to, that the Minister was not to have any power to interfere with any hospital that does not participate in the benefits of the sweepstakes.

I have already accepted that.

Then it is only necessary to see whether this section is in itself adequate or wide enough, or whether, in the definition section, it would be better to alter the definition of hospital, because possibly there may be other sections which would have to be gone through, if you merely had this amendment put in. That would be a matter for the draftsman. If the Parliamentary Secretary will undertake to introduce either an alteration in the definition section, or a section of this nature on the Report Stage, it will satisfy the Deputy.

The Parliamentary Secretary has already accepted amendment No. 10 to Section 14 on the same point.

Does not that cover the point raised in this amendment?

I think the Parliamentary Secretary said already that he would submit to the draftsman whether an alteration would be possible in the definition section which would remove all this complication.

That is so, but I am advised that it is not necessary to make any alteration in the definition. I do not believe that this amendment 42 is necessary either, but I am prepared to accept it if the Deputy considers it necessary.

Is the amendment to be accepted in its present form or is it to be reconsidered and redrafted?

Perhaps it is better to have it considered.

I shall leave it over for the Parliamentary Secretary to bring the matter up on the Report Stage when he can do either of the two things.

We shall have a proper amendment introduced to cover the point.

Amendment, by leave, withdrawn.
Question:—"That Section 25 stand part of the Bill"—put and negatived.
This Act may be cited as the Public Hospitals Act, 1933.

I move amendment 43:—

At the end of the section to add the words "and shall continue in force until the 31st day of July, 1938, and shall then expire.

When the original Bill was about to be introduced, the Bill put into my hands provided that the Sweepstakes should end with the Sweepstake on the Derby in 1933. Certain objections were raised to that, and I extended the period for another year, until the end of June, 1934. In my opinion, that was a sufficiently long time.

I have put down this amendment because I do think that the hospitals ought to be very well provided for in another five years, and I think it would be very advisable for the Government to cease trying to raise money for this particular purpose after that time. As soon as the Hospitals Sweep had run its course I was at one time very keen on supporting a Bill that would provide from £5,000,000 to £10,000,000 for housing, but, strange to say, though I suggested that to Senators and to Deputies here nobody seemed to fall in with the idea. My own feeling is that it would be very much better not to continue to appeal to the world for the hospitals beyond a certain period, and that if we wanted to go on with the sweeps for a further period it would be a great deal better to go on with them for housing. The more we prevent people from getting diseases the less money will be required for the upkeep of the hospitals, and I have not the slightest doubt whatever that if we were able to do away with our slums and give people proper housing we would do away at all events with a great deal of sickness in the large cities, and particularly in the City of Dublin.

I should like to press this amendment, because I do not like the hospitals to be for ever held out as poverty-stricken. This Bill is a permanent measure brought in by the Government. The last Bill, as has been frequently stated, was a temporary measure brought in by a private individual. All Parties were consulted with regard to its provisions, and when amendments were suggested those amendments were generally accepted. What annoyed me in particular, with regard to this Bill, is that the Government took it into their own hands to suggest things, without any reference to the proper Parties in the House, which had not been at all the feeling in connection with the original Bill. However, that is past and gone. I am quite prepared to forgive and forget anything either that the Parliamentary Secretary said to me or anything that I said to him. I would ask him to accept this amendment, and, if it is found necessary, to bring in an amending Bill afterwards. I do not think it is a good thing for us to continue those sweeps as a permanent thing for years and years. As I say, I am giving this Bill five years from now, and I think by that time surely we ought to have made sufficient provision to support the hospitals permanently.

The difficulty of fixing a time limit for the operation of this Bill arises largely from the fact that we cannot estimate in advance what degree of success may attend future sweepstakes. The operation of the measure could be brought to an end in two or three different ways. If we have secured sufficient money to solve the hospitals problem in the course of three years', four years' or five years' time the Act can be repealed. On the other hand, when sufficient money has accrued to satisfy the needs and meet the requirements of the voluntary hospitals, the governing bodies will not appoint a committee to promote sweepstakes. In that way also, the Bill would become inoperative. Again, if the Minister for Justice is satisfied that sufficient money has accrued to solve the hospitals problem he could withhold his sanction to the scheme. The Committee of Reference, in the report on the Derby, 1932, estimated that it would take over £7,000,000 to satisfy the requirements of the voluntary hospitals. More than half of that sum has yet to be raised for those particular hospitals, apart altogether from the very large sum of money that will be necessary to finance the schemes of hospitalisation and development that the local authorities, the boards of health and the mental hospitals have in hand.

In the light of those circumstances I think it would be very unwise to fix an arbitrary time limit of five years. As I have said, the Act can cease to operate if and when we have got sufficient money to carry out the intentions of the Bill.

Amendment, by leave, withdrawn.
Section 26 agreed to.
Title agreed to.
Bill reported, with amendments.
Report Stage fixed for Tuesday, 6th June, 1933.