Committee on Finance. - Hospitals Bill, 1938—Second Stage.

In recent years the committees of management of many voluntary hospitals in which the bed accommodation has proved inadequate to meet the demands for institutional treatment have applied for assistance from the Hospitals Trust Fund for the extension and improvement of these institutions, or for the erection of new hospitals. In some instances these institutions are carrying out functions similar to the functions performed elsewhere by local authority hospitals, and when claims for grants from the Hospitals Trust Fund for the improvement of these voluntary institutions were being dealt with consideration was given to the question of co-ordinating their activities with the general local hospital situation, and of extending the areas served by them. As the new or extended hospitals would, therefore, act to a certain extent as regional institutions, it was desirable that the local authorities concerned should have representation on their governing bodies. Agreement to this arrangement has been readily accorded by the committees of management of voluntary hospitals who have hitherto been communicated with on the subject. Legislation was found to be necessary for the purpose of enabling the existing committees to be dissolved and new joint boards to be constituted with the necessary powers for taking over the functions and duties of the governing bodies of these voluntary hospitals In the cases of the Cork and Dublin Fever Hospitals special Acts, namely, the Cork Fever Hospital Acts, 1935 and 1938, and the Dublin Fever Hospital Act, 1936, had to be passed by the Oireachtas in order to implement the agreements arrived at with the committees of management of these institutions. There are now other instances in which governing bodies of voluntary hospitals have agreed to transfer their functions to joint boards on which local authorities will have representation. It has been thought well, therefore, with a view to obviating separate legislation in each such case to submit this Bill to the House for the purpose of enabling the Minister for Local Government and Public Health to grant the necessary powers for implementing such agreements by means of an Order which is termed in the Bill an "Establishment Order." I would like to stress at this point that the power to be granted to the Minister can only be exercised where there is full agreement by the governing body of the voluntary hospital to the terms of the Establishment Order. Section 1 of the Bill prescribes that this legislation is to apply only to voluntary hospitals.

These are defined as institutions which provide for the prevention, treatment, or cure of disease, injury or deformity in human beings, or afford medical, surgical, or dental treatment to human beings, or give asylum to blind, deaf, dumb, or mentally defective persons, or to expectant mothers, or mothers of children under the age of five years and such children, subject to the condition that the governing body of such institution is not a Department of State, local authority or local authorities, or a committee of a local authority or local authorities. Sections 2 and 3 of the Bill set out the procedure in connection with the making by the governing body of a voluntary hospital of an application to the Minister for an establishment order in relation to the hospital and provide for due publicity being given to that application. It will be open to any person within a period of four weeks after the week in which notice of the application has been published for the second time to submit to the Minister a statement of any objection he may have to the making of the proposed establishment order.

On receipt of an application for an establishment order, the Minister may decide, after the specified period for the receipt of objections, either to grant the application or not, and he may hold a public inquiry before giving a decision in the matter. If he decides to grant the application he shall prepare a draft of the establishment order and submit it to the governing body of the voluntary hospital. When agreement is reached with that body as to what, if any, variations are desirable in the draft order, the Minister may make the order in the terms agreed upon. There are certain provisions laid down in the Bill which are essential for inclusion in an establishment order. These are as follows:—

The existing governing body of the voluntary hospital shall be dissolved as from a specified date and a new governing board established, wholly or partly representative of one or more local authorities. This board shall be a body corporate with a specified name, perpetual succession, a common seal, power to sue and be sued and to hold land. The property, debts, duties, and liabilities of the existing governing body shall be transferred to the board on the appointed date.

An establishment order may provide, where necessary, for the transfer to the board of the officers and servants of the governing body of the voluntary hospital, and may include arrangements whereby the service of an officer or servant of that governing body may be reckoned for the purpose of superannuation or compensation for loss of office. The board may be authorised to borrow, subject to such restrictions as may be specified, and power may be given, with the consent of the Minister for Finance, to lend to the board out of the local loans fund. The board may be authorised to do all such things as governing bodies of hospitals of the class to which such hospitals belong are usually empowered to do. Other provisions which may be included in the establishment order are set out in detail in the schedule to the Bill. These may be generally described as providing for the constitution and procedure of the board and for the carrying on of their business.

The Bill prescribes in Section 6 for publicity being given to the Establishment Order when made, and the usual power for annulment of the Order by either House of the Oireachtas is provided for in Section 7. If neither House of the Oireachtas has passed a Resolution annulling the Establishment Order, it is open to any person within a period of one month from the expiration of the time within which the Oireachtas could have annulled the Order to apply to the High Court for the annulment of the Order or any specified portion thereof, and on that application the High Court may either annul the Order or portion of the Order, if satisfied that the Order or such portion contravenes, or is not authorised by, or is not made in accordance with, the provisions of the Act, as passed. Power is taken by the Minister to annul the Establishment Order at any time before he has confirmed it. If the Establishment Order has not been annulled under the above-mentioned procedure, the Minister may confirm it, or, in the event of part of the Order having been annulled, he may confirm the remainder of the Order with such specified modifications as may be necessary owing to the lapse of time since the making of the Order. The Establishment Order or the part thereof which has been confirmed shall have the force of law. Arrangements are made under Section 11 of the Bill for the amendment of Establishment Orders which have been confirmed subject to the above-mentioned procedure being applied as if the proposed amendment were an application for a fresh Establishment Order, and power is taken to amend the Cork Fever Hospital Acts, 1935 and 1938, and the Dublin Fever Hospital Act, 1936, as if these Acts had been Establishment Orders. I move that the Bill be read a Second Time.

Am I to understand that if there are voluntary hospitals at the moment—as we know there are— in Cork—can the Minister insist that they be transferred, even though they never asked the Hospitals Committee for a contribution?

I wish to call the Parliamentary Secretary's attention to the case of the voluntary hospital in Valentia Island, County Kerry. I appeal to him to consider that case, because the governing body have carried on under great difficulties; they have performed great work for a number of years. Recently they made representations with a view to gaining whatever facilities will be available from this measure. I submit that, in view of the limited funds at their disposal, and the fact that they have been operating in an island, they should get every consideration. Voluntary hospitals in Dublin and Cork and such centres are surrounded by very influential bodies and by people who are anxious to assist on every occasion. Funds are available from various sources for them, but in the case of Valentia Island it is quite different. In the event of the governing body there applying for permission to avail of these services or concessions, I should like to know what would be the attitude of the Parliamentary Secretary. Would he give them the privileges they seek or the advantages that would accrue to larger centres, such as Dublin or Cork? Knowing the circumstances and the justice of their case, I earnestly make that plea to the Parliamentary Secretary.

Mr. Brennan

In so far as the Bill is making provision for adequate hospital accommodation, it is certainly a very welcome gesture, because adequate hospital accommodation has been a very long-felt want. Of course, the saving feature of the whole Bill— and I think it ought to ease even the mind of Deputy Flynn and the Deputy from Cork—is that agreement has to be reached, or rather that the board in charge of the voluntary hospital must of themselves, in fact, ask for the establishment order before it is granted. I should like to know where exactly the local authority fits in. Are the local authorities to be consulted in the making of the establishment order or are they to be pushed in? What I am really anxious about is the burden that is already on local authorities for hospitalisation. That burden is very heavy, and I do not think it would make for better hospitalisation if that burden is going to be increased in any way. Right through the Bill, however, we have that spirit of agreement which the Parliamentary Secretary says is necessary, and on that account I feel that it will not be really a controversial matter at all and that, possibly, and very probably, very good work is going to flow as a result of this Bill. I hope it will, and I hope the Minister will give some time to considering the implications of the Bill, because I do not think we understand very well at the moment what these implications may be as far as local authorities are concerned. I am sure, however, from the spirit in which this has been introduced, that it is really a matter of finding the best way to provide adequate hospitalisation, and to that extent we all welcome the Bill.

The Deputy from Cork raised the point of the Minister insisting on the committee of management of a voluntary hospital seeking an Establishment Order. As Deputy Brennan has pointed out, the Minister has no power whatever in this Bill to insist on any local authority taking advantage of this. The initiative must come from the committee of management. Regarding Deputy Flynn's point, so far at any rate I have not had any representations on the matter from any voluntary committee in County Kerry, but if, as Deputy Flynn suggests, there is a committee of a voluntary hospital in Kerry that wishes to avail of the terms of this Bill, and who have merged their interests with the local authority to seek an Establishment Order, the Bill is intended to provide the necessary machinery to have that desirable and accom plished. Deputy Brennan need not have any anxiety—I do not think he really has any—as to the position of the local authorities under this Bill. There will be no compulsion on the local authority any more than on the committee of management. Before an Order is sought, or even subsequent to amendment by the Minister, there must be complete local agreement; and unless there is complete local agreement to the Minister's amendment—even to Establishment Orders, the draft of which might have been submitted to me—the Order will not become effective or operative.

Mr. Brennan

Is that in the Bill?

Mr. Brennan

I know that it is there with regard to the committee of management, but is it there in regard to the local authority?

There is no compulsion on the management committee or the local authority. It is merely in order to facilitate the dissolving of existing committees and the setting up of new joint boards. As I have pointed out, in the cases of the Cork and Dublin Fever Hospitals, special legislation had to be introduced to meet the situation there. There the governing body of the hospitals concerned were anxious to merge with the local authority and hand over their assets to a new governing body, partly representative of the local authority in the area and partly representative of the committee of management. Two or three similar instances have arisen where voluntary institutions are anxious to be dissolved and to hand over their assets to a new governing body on these representative lines.

Is there any possibility of compensation to the governing bodies in such cases?

With regard to the question of compensation, I think it would be found that most of these institutions are voluntary institutions to begin with, and that their main concern as such is to provide the most up-to-date hospital facilities that can be provided. By merging their interests with the local authority, and by subsequently getting, I presume, substantial grants from the Hospitals Trust Funds, they will probably be able to secure the establishment of a new up-to-date and properly equipped institution, and that, I take it, is their primary object as members of a committee of management.

Is it open to voluntary hospitals to appeal under this?

Yes, it is open to anybody, under this.

Question put and agreed to.
Committee Stage ordered for 30th November.