Saint Laurence O'Toole Hospital Bill, 1940—Second Stage.

Dr. Ward

I move that this Bill be now read a Second Time. The purpose of this Bill is to provide legislation for the establishment of a new general hospital in or near the City of Dublin in place of the House of Industry Hospitals. The House of Industry Hospitals are a group of hospitals which were established on premises in North Brunswick Street, Dublin, in connection with a House of Industry. Houses of industry were first provided for by an Act passed by the Parliament of Ireland in the year 1771-2 entitled:—

An Act for badging such poor as shall be found unable to support themselves by labour, and otherwise providing for them, and for restraining such as shall be found unable to support themselves by labour or industry from begging.

The Act provided for the creation of a corporation in every county and city to be known by the name of "the president and assistants instituted for the relief of the poor and for punishing vagabonds and sturdy beggars." These corporations were empowered to build hospitals to be called workhouses or houses of industry for the relief of the poor in their respective counties.

In pursuance of this Act a corporation for the relief of the poor in the City of Dublin was constituted in the year 1773. That corporation established and maintained the Dublin House of Industry. Subsequently various buildings in the nature of hospitals as they are known to-day grew up in connection with the House of Industry. In the year 1774 two wards were set apart for medical and surgical cases. In the year 1803 a hospital for the accommodation of cases of infectious and contagious diseases was opened. Premises were purchased in the year 1811 and converted into a surgical hospital block. A medical hospital block was opened in the year 1817.

The Irish Poor Relief Act of 1838 introduced a new code of law for the relief of the poor. By that Act the administration of the relief of the poor was entrusted to a central authority known as the Poor Law Commission. For the purpose of administration the country was to be divided into areas to be known as poor law unions. In each union a workhouse for the relief of the poor was to be established and, if and when the Poor Law Commission. so directed, every house of industry was to be the workhouse for the poor law union in which it was situated.

After the passing of the Act of 1838 the portion of the Dublin House of Industry which had been used merely for the relief of the poor was converted into a workhouse and became the workhouse of North Dublin Union. The medical, surgical and fever hospitals already mentioned continued to function separately as hospitals and to be known as the House of Industry Hospitals.

Special provision was made for the regulation of the House of Industry Hospitals by the Dublin Hospitals Regulation Act, 1856. That Act provided that so much of the House of Industry Hospitals and lands as were not appropriated to the purposes of a workhouse under the provisions of the Act of 1838 should vest in the Commissioners of Public Works in Ireland in trust for and to the use of the hospitals.

The Act of 1856 empowered the Lord Lieutenant, with the approval of the Treasury Commissioners, to regulate as he thought fit the number and description of officers and servants to be kept in the hospitals and the salaries to be paid to them and from time to time to appoint and remove such officers or servants and upon the occurrence of a vacancy to make an appointment or otherwise as he thought fit.

The Lord Lieutenant was empowered, when he deemed it expedient so to do, to direct that the management of the hospitals should be vested in a board of governors to be partly nominated by him and partly elected by the subscribers to the hospitals in such proportions as he determined from time to time, and to fix from time to time the number of members of which such board should consist and the qualification necessary for the members to be elected by subscribers. By an order dated the 9th May, 1857, the Lord Lieutenant fixed the number of members to constitute the board at eleven. Later the number was increased to seventeen. As there were no subscribers to the hospitals all the members of the board of governors were appointed by the Lord Lieutenant.

The Act of 1856 sets out the powers in relation to officers and servants of the hospitals which should vest in a board of governors if and when appointed by the Lord Lieutenant. The board, subject to the approval of the Lord Lieutenant and the Treasury Commissioners and subject to the orders made by the Lord Lieutenant, could regulate and determine the number and description of officers and servants to be kept in the hospitals, and the salaries to be paid to them, and they might from time to time remove such officers and servants and at their discretion make appointments to vacancies. The Lord Lieutenant might from time to time alter the constitution and limit and define the powers of the board of governors and he might delegate to the board or to any officer of the hospitals all or any of the powers vested in him in relation thereto.

The Act also gave the Lord Lieutenant power, at his discretion and subject to the consent and approval of the Treasury Commissioners, to grant a superannuation allowance to any officer or servant of the hospitals who became incapable of discharging his duties by reason of confirmed sickness, age or infirmity.

After the establishment of the Irish Free State the powers and functions of the Lord Lieutenant under the Act of 1856 were transferred to the Minister for Local Government and Public Health and the powers of the Treasury Commissioners to the Minister for Finance.

Before going on to deal with the provisions of the Bill under consideration it might be well to give the reasons which have rendered it necessary. The Hospitals Commission in their First General Report recommended a scheme of hospitals for Dublin which would entail the development of four large general hospitals each with a complement of 550 beds. One of the hospitals recommended to be developed was the House of Industry Hospitals. These hospitals contained a total of 325 beds, but deducting 78 beds for fever cases there remained 247 beds for general medical and surgical cases. To increase the accommodation from 247 to 550 beds would necessitate considerable additional buildings. The board of governors of the existing hospitals have no power to erect new buildings. Their powers were limited by the Act of 1856 to the management of the hospitals.

The site of the existing hospitals is rather restricted and for a large modern hospital it would be well to have considerably more space. Proposals of the Dublin Town Planning Authorities for the replanning of the neighbourhood would have the effect of cutting off portions of the lands. This would further restrict the site and leave it inadequate for a large hospital. It would, therefore, be necessary to seek a new site. At present neither the hospital authority nor the Minister has power to acquire land for the purposes of these hospitals, and it is now proposed to make the necessary legal provision.

Though the provisions of the Bill are expressed in very clear terms, and largely explain themselves, I think it well to refer here to some of the principal points in the Bill. The Minister for Local Government and Public Health is given power in the Bill to acquire land for the purposes of the new hospital. He may acquire the land either by agreement or compulsorily, and for the purposes of compulsory acquisition the usual provisions of the Acquisition of Land (Assessment of Compensation) Act and of the Lands Clauses Acts may be applied. All land so acquired shall be held by the Minister in trust for and to the use of the hospital. The expenses incurred by the Minister in connection with the acquisition of the land shall be defrayed out of the Hospitals Trust Fund.

When the Minister has acquired a site he shall proceed to the establishment of a board of governors for the new hospital. He shall by order provide for the number of members of the board, the method of appointment and terms of office of members and other matters such as resignation, disqualification and the filling of casual vacancies. The Bill contains the provisions of a usual nature in regard to the meetings and proceedings of the board when established.

As regards appointment, salaries and removal of officers and servants of the board of governors, the Minister may by order declare in relation to any office that the power to appoint, remove, abolish and fix remuneration or any of such powers may be exercised by the board without his consent, and where such order is in force the board may exercise any of the powers permitted by the order in relation to officers. The board of governors are required by the Bill to prepare and submit to the Minister a scheme with the object of providing pensions and gratuities for or in respect of officers and servants of the board. In this connection I might mention that it will be necessary to move an amendment on the Committee Stage to distinguish between paid officers and unpaid officers. It is not intended to submit a scheme of superannuation for the unpaid officers of the board.

The Bill contains the usual clauses as regards accounts and contracts. The board will be empowered to invest funds in trustee securities, to accept any real and personal property as an endowment, to hold land and to borrow by means of bank overdraft or otherwise.

After the board has held its first meeting it is required with all convenient speed to prepare and submit to the Minister a scheme for the erection and equipment of a new hospital on the site acquired for that purpose by the Minister. The Minister may approve of the scheme without modification, or modify it whether by addition, omission or variation, or he may require the board to submit a new scheme. After the scheme has been approved by the Minister the board shall proceed to erect and equip the new hospital.

There is provision in the Bill for payment by the existing governing body to the board of governors of the new hospital of the unexpended balance of any moneys received by that body under the Public Charitable Hospitals Act, 1930 to 1932, and any accumulations of such moneys. These moneys are to be applied by the board of governors towards defraying the expenses incurred by the board in the preparation of the scheme and in the erection and equipment of the new hospital. The balance of the expenses will be met by the Minister, so far as in his opinion they have been reasonably incurred, out of the Hospitals Trust Fund.

The board of governors will be given power, with the consent of the Minister, to extend, alter, enlarge or otherwise improve the new hospital. The hospital shall be controlled and managed by the board and they may do all such things as the governing body of a hospital are usually authorised to do in relation to a hospital controlled by such governing body.

As soon as the new hospital is erected and equipped and is, in the opinion of the Minister, ready for the reception of patients, the governing body of the existing hospitals shall be dissolved and cease to exist and all their property, debts and liabilities shall be transferred to the board of governors of the new hospital. Where any property transferred is held upon trust for the endowment of a bed, or medical prize, or medal fund, or upon other special trusts, such property shall be held by the board of governors upon such trusts as may be declared by the board but which shall, in the opinion of the board, correspond so far as circumstances allow to the trusts affecting the property before the transfer.

Officers and servants of the existing governing body will also be transferred to the board of governors on the completion of the new hospital and there is provision in the Bill for the preservation of their status and remuneration.

The board of governors of the new hospital are required to close the existing hospitals as soon as may be after the completion of the new hospital. There is provision in the Bill which will enable the board to provide and continue an out-patients' department to the new hospital on the premises of the existing hospitals after they are closed.

The Minister is empowered by the Bill to dispose of the lands on which the existing hospitals are situated or any portion of them. The net proceeds of any such disposal are to be paid by the Minister into the Hospitals Trust Fund. It will be necessary on the Committee Stage to submit some amendments in relation to the provision regarding the closing of the existing hospitals. It may not be possible or desirable to close the existing hospitals on the completion of the new hospital. I propose to submit amendments providing for the closing in whole or part of the existing hospitals in such manner as the circumstances may require.

Mr. Cosgrave

The Parliamentary Secretary's speech has certainly not been very illuminating. Most of what he told us could be gathered from the Bill, and some of what he told us does not appear to be borne out by facts. If I understood him correctly he said it was proposed to acquire a site in or near the City of Dublin, but not the present site.

Mr. Norton

He has it already.

Mr. Cosgrave

We were not told, but we were given to infer from what he said, that it is not proposed to build a new hospital on the site of the present hospital. Will the Parliamentary Secretary say if that is so?

Dr. Ward

It is not considered possible to build a new hospital on the present site, for the reason, with the information before me, that it appears there is not sufficient room available on the site. If property adjacent to the present site can be procured, it does not follow that the existing site will not be used, in conjunction with whatever additional property may be secured, but the position appears to be, as far as I could examine it, that the existing site, as it stands, does not provide adequate accommodation for the proposed new hospital.

Mr. Cosgrave

In the course of his observations the Parliamentary Secretary made some reference to the Hospitals Commission that was set up by the Government, and that has Government nominees on it. I think there is no one else on it except Government nominees, and when I say that I mean persons agreeable politically to the Government. From an examination of the reports of this commission for the last few years, since 1933, when this body was set up by the Government, it does not appear to have been ever intended by the Hospitals Commission to put this hospital on any other site than the present one. There are reasons for that. There is a rumour to the effect that the Minister had acquired, or was about to acquire, a site at Cabra. That would be two or three miles away from the site of the present three hospitals. In the course of the report of the Hospitals Commission the desirability of having some agreement between the people who control the Morning Star and the Grangegorman Institution is mentioned. The reasons given for having an accommodation with the Grangegorman Institution are probably better known to the Parliamentary Secretary than to any other layman in the House. It is a matter with which the Parliamentary Secretary, as a professional man, should have acquainted himself. Why he never mentioned that in the course of his opening speech is rather mystifying if not puzzling.

It is quite true that this is an old surgical and mental hospital, with accommodation for fever patients. Generally speaking up to seven or eight years ago it was looked upon as a Government hospital. That is a peculiar sort of name, Government hospital, but it was given for some reason. There was a Government contribution towards this hospital from about the middle of the last century until 1932, of from £5,000 to £7,000. The Minister called the three hospitals the House of Industry Hospitals. Very few people in the City of Dublin know them by such names. They are commonly known as the Richmond Hospital. Sometimes one hears them referred to as the Hardwicke, or the Whitworth hospitals, but the Richmond is a name that stretches back over two centuries. In so far as interference by the Government was concerned it was warranted and justified by the Government contribution, but since the date mentioned it is entirely independent of the Government. Not only has the hospital no income from the State or from Government funds but it has repaid, along with the other hospitals, every penny it ever got from the Government. Therefore, so far as interference is concerned, it is unjustified interference, and the Minister's position is that of an officer of the Gárda out on point duty. He is in a position to regulate the traffic but not to control it, not to do as he pleases, but rather to enter into possession of authority that has come down to him to control the hospitals for the purpose intended.

It was intended for the relief of the sick. Is it going to relieve the sick in Cabra? If the hospital is to be two or three miles out, will patients go to it? This institution has had the distinction of being a teaching hospital for over two centuries. Has the Parliamentary Secretary looked up the evidence given before the commission which sat in 1854 to deal with this matter? He will hear from many of his confreres in the city about Dominick Corrigan. Even as a student, he must have heard that name. Dominick Corrigan gave evidence before this commission and he referred to "the mischief that would be done if these hospitals were closed". He was referring to the site. Are we to have in the year 1940 a perpetration of the mischief that was abhorred by Dominick Corrigan in 1854? I hope not.

It is quite possible that the site on which these hospitals are at present is not sufficient for a 550-bed hospital. But it is probable that you could put such a hospital, or a series of hospitals to provide that accommodation, on the site. In what the Ministry has called "hospitalisation," generally, ornate, magnificent, architectural buildings are not required. What is required is such accommodation as will enable suitable treatment to be provided for the patients. The Minister cannot have reached his present position in his profession without knowing that there are such hospitals in some of the most highly hospitalised countries in the world. He can obtain information about the hospitals of Baltimore, the Mayo Clinic and so on. Why did they adopt these methods in dealing with these hospitals? They adopted them to suit the convenience of those who would use the hospitals. It may be urged that the site in this case is not sufficiently stylish and it may be that the people who go into the hospital are not sufficiently stylish, but they have gone in there for two and a half centuries. The hospital is well known and popular, and it has served a public need. Distinguished members of the medical profession have attended there and it is a teaching hospital.

Members may not be familiar with the meaning of that simple term—a "teaching hospital". It means that students attend there in the mornings. About 100 years ago they used to attend at 8 o'clock in the morning. Now, they attend at 9 o'clock and spend an hour and a half or an hour and three quarters there. After that, they attend one of the colleges—the National, Trinity or the College of Surgeons—for their lectures. The students say that this hospital is sufficiently far from the lecture colleges as it is and, if it were any greater distance, that they would not attend. The hospital is not attached to any of the three colleges and it has students from all three. Is it the intention of the Parliamentary Secretary that this hospital should be a teaching hospital? The matter was referred to during the inquiry of 1854 and it was thought to be of great advantage that it should be a teaching hospital. That was the opinion both of the commission and of those who gave evidence before it. In the course of the evidence, it was mentioned that one of the surgeons visiting the hospital some years before considered the matter of such importance that he set up a fund of a couple of thousand pounds to establish a museum of surgical and medical information. Subsequently, he left £8,000 or £10,000 for the same purpose. His name was Mr. Carmichael. That is the inheritance and the Parliamentary Secretary has no right to alter the site of the hospital to such an extent as to endanger the possibility of its use to the people for whom it was built or to endanger it as a teaching hospital. If it be a teaching hospital, it is more than likely that the patients will get better attention than if it were not a teaching hospital.

I do not suppose it is necessary to read for the House the various references by the Hospitals Commission to this hospital or to say that, right through their whole series of recommendations, it was their intention that this hospital should be built upon the present site, using that term in the way in which the Parliamentary Secretary used it in one of the few remarks he made on the Bill—that is, that the site is capable of extension. My information is that the Ministry has full particulars regarding the cost of extending the hospital site in the present area. The figure is not very considerable, and the site will have to be acquired within the next few years. The purpose is not yet settled—whether it will be for a housing scheme, for town planning or for an extension of this hospital. That is the first objection I have to this Bill as drafted. A site "in or near the city" could be at Nelson Pillar or it could be at Cabra. It could be on the south side, although I think it is not intended to be on the south side. No information has been given to the House to show that it would be desirable to change the location of these hospitals from the populous areas in which they are situated. They have served the people who had recourse to them for two centuries very well.

My second point is in connection with the constitution of the board. The members of the present board were appointed about 1919 or 1920 and have continued on from that period. About that time, the then Government—the British Government—refused to recognise this hospital as a Government hospital and the board of governors were not satisfied to administer anything else than the charity which they had been accustomed to administer. The then surgical and medical staff—and the word "staff" does not appear in any part of this Bill—came together and, although their accounts were closed in various directions and they could not get any overdraft, they put up whatever money was needed to keep the hospital going until they submitted a number of schemes to the lord lieutenant of the time. The constitution of the board then included six members of the staff, that is, six professional men, surgeons, physicians and others; there were approximately ten in all.

I should like to know if it is the intention, in connection with the board that is to be appointed by the Minister to function after the establishment date, to associate the staff in the same way as they have been associated. I do not mind one more or less, although I think six should be the minimum. Is it intended to have the association which has gone on for something like 30 years? It has been a happy association and it has functioned well. I should say that during the period that has since elapsed the quality character of this hospital has been very well maintained.

There are, it would appear, to be two boards. It is unfortunate the way this Bill has been drafted. One board will be the existing governing body. That it should be designated by small letters in the course of the whole Bill is somewhat surprising, because the new board has a capital "B" all through. You might not have walked in that fashion on people who have done their work as they have done it during the last 30 years; you might have let them go out with some good grace. If the sensible thing were done. the intention might be to appoint the old board as the new board. The old board will continue as long as the old hospital is in existence. The day when the new hospital is to be opened and the old hospital closed, the old board goes out of existence.

It is quite possible, in the case of a hospital like this, where they have been accustomed to a fund of £5,000 or £7,000, that they had not spent much money on a clerical staff or that they had not got much accommodation. As the Bill is drawn, it would appear that the existing governing body, the present board, must supply office accommodation and clerical assistance to the new board. I think it is fairly clear—it ought to be—that the chairman of the old board will be the chairman of the new board. It may be awkward for him at a precise moment during the proceedings. We will say that a board meeting is called for 11 o'clock and the meeting is over at 12 o'clock. The second board meets at 12 o'clock and the chairman has to nod to one gentleman going out and to another coming in. I think the Minister should make some effort to bring a little harmony into that part of the Bill. I think he would find it possible to get agreement with the board in regard to anything in reason.

That is practically all I have to say in regard to this measure. I think it is unfortunate, not only in the interests of this hospital but of the patients who are either in the hospital or about to go into it, that it should be in contemplation to put the hospital on any other site. I think it would not be in the interests of the sufferers that this hospital should be away from the location of the Grangegorman institution. It would be a great pity that this hospital would be at a distance from the Morning Star and the Regina Coeli. It is inconceivable that three bodies such as those could not arrive at some agreement and, with the powers the Minister proposes to take, that they could not acquire land in that district. It seems almost unbelievable that those three institutions and the persons in control of them and responsible for conducting them cannot come to an agreement to give each other what is required there in the way of space, to harmonise relations and to put up a hospital in that district which will meet the needs of the district and which will be capable of working in conjunction with the Grangegorman institution, the Morning Star and the Regina Coeli. It is in the hope that such accommodation can be found and in the belief that it should be possible to harmonise relations between the new board that is going to be appointed and the existing governing body, that I do not intend to vote against this measure.

Mr. Norton

We can hardly consider this Bill without adverting to the rumours that abound to-day to the effect that the site of the new hospital will be somewhere in or around the Cabra area. What the House is being asked to do is to agree to a Bill to change the Richmond Hospital to a place about four or five miles from the centre of the City of Dublin. If rumour be correct it is understood that the Department have already acquired a site, or that a site has already been acquired in Cabra and will be transferred to and vested in the Minister on the enactment of this Bill. No sane man outside the Custom House would suggest to this House or to the citizens of Dublin that the Richmond Hospital should be moved from its present location to a place in Cabra. This whole Bill is designed to change the Richmond Hospital to a place four or five miles from the centre of the city. The Richmond Hospital is probably the most popular hospital in Dublin. It was originally erected to provide free hospital treatment for the working-class people of the city. It maintained that very honourable tradition until 1919, when the British Government insisted on putting wounded soldiers into it.

Mr. Cosgrave

They would not give any more money and the hospital had to take in patients in order to balance its accounts.

Mr. Norton

The hospital authorities then felt that they were being compelled to depart from the terms of their original charter, namely, that the hospital was one in which free treatment would be provided for the poorer citizens of Dublin. Anybody who knows the hospital and knows the surroundings knows that the area is probably the most densely populated portion of the City of Dublin. Anybody who knows the hospital knows that at present it supplies a very essential need to the thousands of people who occupy that portion of the city.

It is true and, of course, the fact is evident to anybody who has ever visited the hospital, that it is in need of modernisation and extension. But it is also true and evident to anybody who knows the area that there is plenty of space adjoining it which would facilitate the extension and modernisation of the hospital. There is adjoining it a very substantial building known as the Morning Star. There is not much difficulty in acquiring the Morning Star and extending the hospital to the Morning Star grounds. But this Bill seems to be a Bill to transfer the Richmond Hospital to the Morning Star, whereas it ought to be a Bill to transfer the site of the Morning Star to the Richmond Hospital and to transfer the Morning Star to some other site in this city where it can quite easily fulfil the functions which it fulfils to-day. If the rumour be correct that it is intended to erect a new hospital out at Cabra, I would like to ask the Parliamentary Secretary how he imagines that the poor people who have to attend the hospital can manage to get there from Queen Street, Church Street, Capel Street or North King Street to the City Hospital. That difficulty will be accentuated when it is pointed out that the sick person cannot go to the hospital alone. Such a person has to bring a friend with him and sometimes they have to use some king of conveyance. These poor people will have to go to the new hospital at Cabra if the site is to be there.

All along the discussions which related to the hospital had to do with the extent of its accommodation. These discussions proceeded on the basis of leaving the hospital at its present site. All the reports have indicated that there was no question of an alternative site to the existing Richmond Hospital site until very recently. Somebody apparently hit upon the idea that the best place for the hospital was as far away from the City of Dublin as it was possible to locate that hospital. The idea apparently was to remove it as far away as possible from the residences of the people who mostly use that hospital. What is the insuperable difficulty in acquiring land adjacent to the existing site of the Richmond? The land there is available. It is not very expensive land, and there is no difficulty whatever in accommodating elsewhere those who now use the land. It would be easy enough to give those reasonable accommodation elsewhere.

It may be difficult for the Parliamentary Secretary in reading through memoranda, sent by interested parties, to appreciate the value of the Richmond Hospital to the poor who live in the neighbourhood of that hospital. I took the trouble of ascertaining what provision was made for and treatment given to the poor in that hospital during the year 1939. In that year there were 33,500 bed days provided free of charge for persons who found it necessary to use the hospital. The out-patients' department has been a very valuable institution to the poor people in the area. In the year 1939 there were 50,000 persons treated in the out-patients' department attached to the hospital. In future, if the poor are to have bed days at all they must manage to get to Cabra with all the inconvenience associated with getting there and with all the inconvenience associated with their relatives visiting them there. If these people are to get attended to at the out-patients' department provided at Cabra for them it would be a very real hardship on them.

The Parliamentary Secretary said there was power to provide an out-patients' department on the site of the present hospital. Well certainly it is not a satisfactory position to have the hospital located at Cabra four or five miles away and to have the out-patients' department located in the present hospital. I never heard of that kind of a hospital scheme up to this. This is the first time it has been suggested that we are to have an out-patients' department situated four or five miles from the hospital. Moreover, there is no guarantee even that an out-patients' department will be provided on the site of the present hospital. The extent to which the hospital has been used by the poor people who obtain treatment free of charge, the number who attend as out-patients and the number who have attended the hospital clearly indicate that the hospital has been generally appreciated and its services utilised so far as the poor in the area are concerned. I think the proposal to change the site of the hospital from its present location to Cabra is one that cannot be recommended on any reasonable grounds. The effect of the change will be to inflict great hardship on the poor of a very densely populated part of the city. The Minister has not given any reason to indicate what in his opinion justifies this change. Nobody has come forward to say that this change is essential. Nobody can say—unless a person is looking for difficulties and hoping to find them—that it is impossible to secure additional accommodation for this hospital. It is evident that there is no difficulty in finding the space necessary within the immediate vicinity of the present hospital.

There is another rather strange feature in this Bill and that is that under it the Minister has power to appoint the governing body of the hospital. I think the present governing body is a self-appointed body. If vacancies occur they are filled by certain members of the body. But in this Bill we are being offered a scheme of control by which the Minister will appoint all the nominees of the governing body. We were not told by the Parliamentary Secretary in what way that power will be exercised. We may find that the Bill will work this way, that the Minister will appoint a number of people whom he considers suitable to be governors. There is no reason to believe that these people will have any representative standing. For instance, the entire staff of the hospital may be left out. The local authorities may find that they will have no representation whatever and those who represent the workers of the city may find that they will have nobody there to represent them; that section of the community which is forced by economic necessity to avail of the services provided by the hospital, may have nobody to represent them on the governing body. The Parliamentary Secretary should tell us about these things and he should make suitable amendments in the Bill, amendments that will provide that there shall be reasonable democratic control of the new hospital, that those who will be appointed to constitute the governing body of the hospital will be persons in a representative position, that efforts will be made to ensure that the hospital is democratically controlled and that the persons who utilise the hospital and who are personally concerned will be represented on the governing body.

One serious omission in the Bill is that though we are really providing a new Richmond Hospital under another name we are doing nothing to perpetuate the purpose that was behind the inspiration to build the original hospital. The present hospital was built to provide free treatment for the poor. There is no assurance whatever in this Bill that there will be free treatment in the hospital, and there is no guarantees whatever that the poor will get in this hospital the treatment they are getting in the present Richmond Hospital. There is no provision in the Bill to ensure that, expressed as a percentage, there will be a minimum percentage of free beds made available in this new hospital for people who are unable to pay for beds.

My fear on the whole matter is that, if this hospital is changed from its present site to Cabra, it will be regarded largely as a suburban show-house into which wealthy patients, possibly the bulk of them from places outside the City of Dublin, will go for treatment, so that they can live in a kind of spa while the poor people who now rely on the Richmond Hospital to provide them with treatment will have to fend for themselves elsewhere, and that at a time when it is harder than ever for a poor person to get into a hospital. It may, of course, be said that the Mater Hospital is not very far from the existing Richmond Hospital, and that the Mater Hospital really serves, to some extent, the needs of the area, but the poor people do not go to the Mater Hospital. I am not too sure that poor people are wanted in the Mater Hospital if they cannot pay. It is all very well, of course, to say that the Mater Hospital is there, but you might as well say to an unemployed labourer in Gardiner Street that the Gresham Hotel serves meals to non-residents as to tell him that the Mater Hospital is there.

The Parliamentary Secretary has made no real case for this Bill. What he omitted to say was much more important than what he did say. I suggest to him that he should give us more details as regards what is contemplated, so that we may know exactly what is really behind the move to rebuild the Richmond Hospital in some other place in the city. So far as I am concerned, I am opposed to the Bill if it is for the purpose of transferring the existing Richmond Hospital from its present site to a site four or five miles away from the masses of the population which it at present serves. The Parliamentary Secretary took very good care to conceal from the House the real location of the site of the new hospital. We ought to have that information now, so that the House will definitely know what exactly it is voting for when it votes for a Bill of this kind.

Mr. Childers

I rise on the Second Reading of this Bill not with any intention of criticising the terms of the Bill but simply to try to elucidate, on behalf of a great number of people who are interested in it, certain matters. I think one can say, without exaggeration, that the eyes of the medical world of Ireland have been focussed on this Bill. Quite a number of the men in the medical world have read all its provisions, and while many of them see no ipso facto objection to any single clause they feel that certain passages in the Bill contain a certain vagueness. I, like other Deputies, rise for the purpose of seeking further clarification of its provisions. I think that clarification is required if the fears of those medical men are to be allayed.

One of the great things in this country has been the devotion of our teaching hospitals. On account of our history we have not been able to do very much that is of great distinction in our own country, but one of the things that we have been able to do is to develop teaching hospitals, making them an example to the world. Associated with the ideal of teaching hospitals is the principle of voluntary hospitals, hospitals in which doctors work without remuneration, and very often for excessive hours. The average person who takes an interest in medical development in this country, when he reads this Bill, sees one great danger before his mind which I would like to mention in the interests of Irish medicine in general, and so as to make the position perfectly clear. If, as may be supposed, a hospital is built on a site at some distance from the present hospital; if it is equally found that it is not possible to close the present hospital, and if the board of both hospitals more or less represents the interests of the old board, including most of the members of the old board as I understand will be the case, you will have developing two sorts of hospitals. There will be the old Richmond Hospital worked on the voluntary principle of an unpaid staff. There may be a hospital built at Cabra with a large number of beds which it will be quite impossible to operate on the voluntary principle. The staff there will have to be paid out of some fund or other. In that situation the fundamental principle which lies behind the teaching hospitals, worked on the voluntary principle, will be changed. It is that, principally, which is causing a great deal of concern to people in the medical world who are interested in maintaining the principle of teaching hospitals on the voluntary system.

I am not saying that with a view to criticising the Bill. There is nothing further from my mind, but what I do say is that the matter requires further clarification. If the recommendation of the Hospitals Commission that there should be a sectional development of the Mater and Richmond Hospitals is carried out, then you will have a certain number of beds added to the existing Richmond Hospital. The extra beds can be carried on with the aid of a voluntary medical staff. You will have the same practitioners as before giving attention to the needy sick in the same manner as before, teaching the new students who come along and maintaining the old principle, so long in operation amongst the medical profession in the country. But once you change the site of the hospital, or go to an area where students cannot be taught with ease, to one in which the doctors will be unable to give their voluntary services, then the whole principle behind the recommendations of the Hospitals Commission will be changed.

I would like to read for the House an extract from the report of the Hospitals Commission of 1933-34. At page 80 in their report, in the last paragraph they say:—

"The Mater and Richmond Hospitals, Dublin, the development of which is contemplated, on their existing sites, are examples of hospitals where sectional development could be allowed to proceed without putting too great a strain on the Hospitals Trust Fund. Should the final scheme for these hospitals prove impossible of attainment, through lack of funds, this sectional development would not result in wastage, as under any circumstances the improvements are urgently required, and improved hospital facilities would be secured. In the case of hospitals whose schemes of development involve the erection of their buildings on new sites, it would of course be inadvisable to allow such schemes to proceed immediately.”

There you have a clear recommendation from the Hospitals Commission. I understand also from the people in the medical world that it is envisaged as being possible to build section by section a new hospital on the present Richmond site with about 550 beds, if an arrangement could be come to between the Grangegorman Hospital and the Morning Star. I understand that it is very possible that such an arrangement could be come to. If that is the case, the Parliamentary Secretary would be carrying out the recommendations of the Hospitals Commission in so doing. He would be preserving the voluntary system of teaching hospitals, one that has a great tradition in this country, and at the same time he would be going far to relieve the minds of people in the medical world. I again want to say that I am not in the least criticising the Bill. I am simply asking for a clarification of the position. If the Parliamentary Secretary desires to create a large new hospital in an entirely new area, far from any institution in which teaching is undertaken, and with a staff that has to be paid from funds of one kind or another, it is obvious that that should be done in an entirely separate Bill. It is a separate principle that should be developed for a specific purpose. It is the ambiguity that has arisen in connection with this Bill that has caused all this worry. I want, in conclusion, to ask the Parliamentary Secretary if he can assure the House that the voluntary principle will be maintained, and the board will not be asked to carry out such responsibilities as will entail their looking after and paying for a staff.

General Mulcahy

The Parliamentary Secretary has succeeded in establishing a record in this House. It is obvious that he has left everybody very much befuddled as to what exactly they are going to vote on here and what is going to be the result of our discussions. Deputy Norton said the Parliamentary Secretary did not make a case for the Bill. He did not. If his case does not reflect what is in the Bill, his Bill apparently does not reflect what he is going to do. That is why there is so much demand for clarification. The Parliamentary Secretary spoke for a long time about the history of the institution we are discussing. Deputy Cosgrave talked about some of the difficulties in passing through the transition stage. I should like to keep my eye on the future when all this fog has passed and when the Minister's actions have taken place. If the future is to be related to this Bill, then on the surface we are going to get a very astonishing thing.

The Minister is going to take a hospital organism that exists at present, that has long established roots, and that has a very definite connection with the life of the city and with medical development and service in more ways than one. He is taking power to procure a site and then to say to the people in charge of the present hospitals' scheme: "Go and build your hospital on that site and the money will be provided from the Hospitals Trust Fund. I am going to issue orders of my own as to the type of board that is going to control that hospital in the future." That is, that you are going to have a Ministerial decision as to a site and then you are going to have a Ministerial line of policy; he is the person who, by order, may say what kind of board is going to run that hospital, and he is going to select that board in his own way. On the face of the Bill the Minister and the Minister's sweet will count for everything. I take it from what Deputy Cosgrave said in his opposition to this Bill that what is purposed is not what is here. At any rate, what is in the Bill is that the Minister can do anything he likes.

I think it would be a very disastrous thing at this particular stage for the House to pass a Bill without knowing what exactly is in the Bill. When we consider all the various things that must have been considered before the Bill was framed; the various discussions that must have taken place in relation to the medical staffs there and the ordinary medical work they are carrying out, in relation to the teaching side, and in relation to the side of this hospital's work that impinges on the treatment of the poor in the City of Dublin; and the discussions that, I take it, were carefully, fully and thoroughly gone on with, then the Parliamentary Secretary has given the House very little information. In dealing with this matter I think we ought to have more information. We do not want detailed information so much as a line on the principles that will guide him in bringing about the development of this hospital as a new hospital, or an extension of the old hospital, and the principles upon which the control of that hospital and the carrying on of its work in future will be carried out.

To put the Bill before this House in its present state is absurd. It is asking the House not only to discuss a local matter, but you might also say an individual matter; a matter dealing with an individual institution without stating the principles upon which the matter is going to be run. I do not say that it is not an important thing. I think it is as important a thing from the point of view of principle as might come before the House. When you take the general line of thought at present, here in Dublin we are appointing a manager who is going to be in charge of the City and County of Dublin. Then the political atmosphere is reeking with suggestions of vocationalism as a general scheme that is going to cure a lot of things that cannot be cured by mere politicians or democratically-elected institutions. We talk about planning. In the middle of all this talk about the importance of the control of everything in the City and County of Dublin by municipal machinery assisted or controlled by a manager, on the one hand, and planning in all directions on the other, as well as planning in the vocational line, here we get the Minister stepping into a very complicated and intricate situation and saying, "This is a Bill to give the Minister power to do everything that he likes."

This Bill ought to be held up and not proceeded with in this House, at any rate, until the Parliamentary Secretary feels that he can take us more into his confidence as to what is going to happen. If this hospital is going to be brought to Cabra, then a new situation is being developed here. It is a case of the Minister taking, for what reasons nobody can tell, the matter entirely into his own hands and working on lines dictated by his own mind. It is ignoring some of the vital interests of the City of Dublin as far as the treatment of the poor is concerned. It is ignoring vital interests as far as medical education in the city is concerned. It has been suggested that, if the hospital is taken to Cabra, the students will not go there. The reactions are going to be wider than that. At present the teaching hospitals have a difficulty in catering for the number of students attending them. If the Richmond Hospital is going to be removed, then not only is the Richmond Hospital going to be deprived of the status of a teaching hospital, and the students of the additional facilities given there, but the other hospitals in the teaching group are going to have their teaching work made even more difficult than at present. In the interests of the students, and particularly of the senior students, it would be a disastrous thing if the difficulties of the teaching hospitals in regard to overcrowding were to be increased. Then, on the purely medical side, there are difficulties no doubt that would be created by the removing of the hospital.

In regard to these matters I think we ought to get some more information as to what is the Minister's intention. Is he going to ignore the facilities provided by the Richmond Hospital for the treatment of the poor in the City of Dublin? Is he going to ignore the reactions on medical education in the city if the hospital is going to be removed outside the city? Is he going to ignore the reactions on the medical practitioners who will be carrying on their work in that hospital? I think the Parliamentary Secretary will agree that it is not overstating the position so far as this House is concerned when I say that this is a Bill, on the superficial proposals in it, for which no case has been made; that it is setting up a hospital that will be a purely Government hospital, controlled by the Minister, and, on the other hand, it is a Bill that does not really disclose what its intentions are. In a matter that reacts in such an important way on Dublin City, and on various interests in the city, he should explain why his proposals are being presented in this way, and give the House some idea what his plans are.

Those who know how difficult it is to get a person into the incurable hospital on the south side of Dublin, consider that there is urgent need for another incurable home, and the Cabra area should be suitable for that purpose. I wish to correct a statement that was made by Deputy Norton. In drawing attention to a reference to Cabra, and the residents there being catered for by the Mater Hospital, he said it would be just like telling an unemployed person that the Gresham Hotel provided meals for non-residents. I do not think Deputy Norton meant that reference to apply to the Mater Hospital, because that hospital is doing glorious work, and has more than its share of non-paying patients. As Deputy Childers pointed out the medical and nursing staffs there are on duty at all hours of the day and night, attending without fee or reward to the very large number of patients that attend there. I visit the Mater Hospital very often and I see people there who are not able to pay. There are patients in the Mater Hospital who are not expected to pay. I want to say of the Mater Hospital that the poor and unemployed who cannot pay get the best of attention there.

What would happen in the area in which the Richmond is now situate if the hospital were removed? What is to become of the very large number of dispensary patients who visit it every morning? The Richmond Hospital is full at present. I am in touch with the hospital and it is only a few days since I got a patient in there. The authorities in the Richmond Hospital have been most kind and attentive to the people of the city. I know of instances where the Richmond Hospital, although over-crowded, removed some patients to certain hotels in the vicinity, in order to make room for others who required immediate attention. Patients who attend the dispensary daily are repeatedly advised to go into hospital for a few days' treatment. If the hospital is removed to Cabra what would happen to these people? It would be impossible for them to attend the proposed new hospital. Very often relatives object to going a distance to visit their friends. We all know that relatives of patients influence them regarding the hospitals to which they should go for treatment Patients will be inclined to say: "I do not want to go so far away. I will not be able to see my friends there, and it will be lonesome." Dublin is in need of a hospital similar to the Mater, Sir Patrick Dun's or Mercer's, but it is wanted in that part of the city where the Richmond is at present doing such splendid work.

I appeal to the Parliamentary Secretary to change his mind about the provision regarding the present Richmond Hospital. I understand that there is plenty of room for development in that district. If the hospital is removed I do not know what will happen patients who now attend there.

Mr. P.S. Doyle

The Minister gave a very interesting review of the work of what is known as the Richmond Hospital. I think if the Richmond Hospital has excelled in the work it has done for the sick poor of the city it is principally in connection with the expert medical treatment it has provided for many centuries. It is a pity now to change it if the intention is to join up the three hospitals. If the additional ground necessary to enlarge the hospital can be secured it should be secured in the heart of the city, and around such a populous district as the one in which the present hospital is situate. It would be a calamity to transfer the work of that hospital to the outskirts of the city. That has been impressed upon the Parliamentary Secretary by previous speakers and I trust he will take some notice of their criticism. In his statement the Parliamentary Secretary did not refer to the number of free beds that will be available when the addition to this hospital is made. I wish to draw the Parliamentary Secretary's attention to the fact that there are many chronic cases in hospitals in the city which very often have to be transferred to St. Kevin's. Some extra provision should be made for such cases in any modernising of the hospital system that takes place.

I appreciate the amount of hospital-extension work done in the past few years, but I am not at all satisfied that sufficient attention has been devoted to the question of the provision of hospitals in the cities. I do not say that merely for the purpose of criticising, but because I think it is wrong to remove the hospitals outside the cities as, I think, is the intention in this case. The same applies to other cities. I think the hospitals ought to be in the hearts of the cities, save in an exceptional case. I know of the good work done throughout the country in building new hospitals. Everybody must admire that work, but I think that the policy of having the hospitals removed from the populous areas is a mistaken policy. It involves also a certain amount of extra expense and thus imposes a burden on the State or the local authority. References have been made to the constitution of the board. I do not know what the Minister's intention is as regards the number to be appointed on the board, but I think that some recognition ought to be given to those who have carried on this work for years. With many of them it has been a tradition and I do not think that they should be cast aside or prevented from continuing that good work by a mere stroke of the pen. If the Minister elucidates some of the points I have mentioned, it is not my intention to oppose the Bill.

Mr. McGilligan

Quite a number of interesting points, calling more for investigation than for critical comment, arise on this stage of the Bill. In the first place, I should like to deal with the question of the site. It is understood that the proposal is that the hospital itself should be removed to a site at Cabra. As I read the Bill, I can see no provision for having in any other area an out-patients' department. The only provision for acquisition or retention of land by the Minister is in respect of an area adjacent to the site of the new hospital. If the site of the new hospital is to be in Cabra, it seems to me that the phrase used in the Bill rules out the possibility of what was regarded as almost a certainty—that the out-patients' department, catering for those who at present attend the dispensary attached to the Richmond, would remain as it is. If the whole outfit—intern accommodation and the out-patients' department—is to be removed to Cabra, a certain amount of hardship will be created for those who visit the out-patients' department of the Richmond. Those in number are a considerable body of the citizens. The Hospitals Commission, which reported in 1933, indicated that the attendances at the out-patients' department of the Richmond totalled 25,000. That does not mean 25,000 individuals. The same persons might attend over and over again but 25,000 attendances were registered. If that means only 5,000 or 6,000 persons attending at the out-patients' department, there will be a hardship if they have to travel to Cabra—which they will hardly do—or if they have to resort to some other out-patients' department in the neighbourhood. That resort will not be to Jervis Street, because the out-patients' department there is overcrowded. At the time that there were 25,000 attendances at the out-patients' department at the Richmond, the attendances at Jervis Street ran to over 40,000. If the idea be, as at one time it was understood to be, that the hospital proper be removed to Cabra but that facilities for out-patients still remain somewhere about the site of the present Richmond, in the main the objection to the site would disappear. Undoubtedly, some further accommodation would be required in connection with the teaching institutions. If students have to walk the new hospital and attend lectures at any of the three teaching institutions, some facilities will have to be provided. With the new means of transport—even if it costs the student something extra—accommodation can be provided. Some change may be required in the hours of the lectures at the different colleges, but that can be arranged if the new hospital attracts a sufficient body of students as a teaching hospital.

The Bill is, of course, completely away from the recommendations of the commission. The commission recommended the rebuilding of the Richmond Hospital on its present site. Some other proposals were put to them which they did not favour. Finally, a proposal similar to that in the Bill was put to them, with the distinction that the out-patients' department was to remain where it is, and they flatly and decisively turned it down. They gave reasons for so doing and these reasons should be attended to by the Parliamentary Secretary in his reply. A body which was supposed to have specialised qualifications, and which was set up to report upon this matter, amongst other matters, reported decisively against this proposal.

The next matter that arises is that of costs and funds. Nothing is causing so much curiosity and, possibly, disquiet as the question of where the moneys are that were supposed to be accumulated through the Hospitals Sweepstakes and lodged in certain accounts for future paying-out to these hospitals. Questions were asked in this House about these matters and they only met with evasions. There is considerable curiosity and a fair amount of anxiety in the city as to where, in fact, the £8,500,000 supposed to be available for better hospital accommodation is, whether it is there at all or, if it is there, whether it is in such a form that it can easily be loosened as and when required. It is quite obvious to anybody who knows the situation of the country that, if £8,500,000 were invested in any of the ordinary securities of this country, an attempt to cash out even £500,000 of this sum would probably prove disastrous. It would cause a considerable fluctuation in the value of the particular holdings to others who had to hold on to them. The Parliamentary Secretary and the Minister were, from time to time, given an opportunity to say not exactly where all these funds are but to mention the main places where they are held. Up to date, all we have had is a certain number of evasive answers such as: that it was not considered good policy to give information in connection with matters in control of an outside body. The Parliamentary Secretary was asked if he would privately give such information and he gave an assurance that he would do that. I have not heard that that has been done. Possibly, the Parliamentary Secretary will now fulfil the promise he gave a Deputy that he would inquire and let him know as a private individual where these funds at present reside. Let us assume that there are moneys in hands and that these moneys can be loosened up without causing any great disruption of the country's finances.

There is, to me, one overshadowing feature in connection with this Bill. It is only the extension of a policy which we have seen proceeding apace since the present Government came into office. The Government have gone into all sorts of things, not always with the greatest success. They were dealing with bogs or peat at Ticknevin; they had dealings in dead meat also. Perhaps no useful purpose would be served by going through the whole list of their failures. They were in all sorts of things that Governments would be better off not to have any connection with. They are now going to deal with hospitals. We have three measures running their course through the House which indicate the advancement of this particular type of mind. For instance, we have a Bill about advanced studies. That is going to be a matter in which the Executive Council are going to interfere at every turn. We are going to have county management; the work is going to be done through county managers, but it seems clear that it is definitely going to be a matter for the Government and for a particular Minister. Now we have this proposal in regard to the hospitals.

As far as this Bill goes, it may work out in either of two ways. It may give complete freedom to the hospital authorities—and that would be as I desire. On the other hand, the Bill undoubtedly affords an easy opportunity of interference by the Government, or an officious Minister could intervene at every hand's turn. Throughout the Bill phrases are numerous indicating that the board, once appointed, may not do various things without the consent or the concurrence of the Minister, or a couple of Ministers. So long as there are phrases in the Bill there is the possibility of the fullest Government control being exercised.

The Minister will arrange for the appointment of the board. He can decide the whole scheme of organisation of the new board, the number to be on it, and the method of appointment. I should not have minded the Government starting the institution and then letting it sail along under conditions that would be set down; but there is a sub-paragraph to the effect that whatever the Minister does by an order he can next day withdraw or amend, and he can put a series of fresh proposals for the building up of the board. In fact, he can call upon the members of the board for their resignation at any moment. That power may not be used in the way in which the phrase sets it out, but it is possible it may be used in the way I have suggested.

There is clearly one thing which is taken out of the board's hands altogether, and that is the appointment and dismissal of officers and servants. Neither an appointment nor a dismissal can be achieved without the consent of the Minister. I wonder how far does that term carry? So far as servants, in the sense that they are porters or gatekeepers or persons of that type are concerned, one can understand the proposal; but the point is, does it go to the extent of including nurses, resident surgeons, resident medical people, honorary visiting physicians and surgeons? How far does the phrase extend? If it goes very widely, and if it is intended to include the appointment or dismissal of any member of the staff, then I think it is the most unwholesome and undesirable type of procedure that could possibly be established.

I expect the answer to this objection will be that at the moment the appointment of some of the staff of the Richmond Hospital requires the assent of the Minister for Local Government. That comes down from olden times. It comes from the time when the hospital, to a great extent, depended upon Parliamentary moneys. There was a view held that where money was provided by public grants to any institution of this type, then something in the nature of control of the institution should be effected by public representatives. It is a long time since the Richmond and the Hardwicke Hospitals were founded. Even though we can trace back to a period when there was possible a particular form of Government control, the fact is that that Government control was rarely used and was almost obsolete. As a matter of fact, it has become obsolete and it is rather anomalous that, in the year 1940, we should start off in circumstances under which this hospital is not going to get what in the ordinary way would be called public moneys and put it, as far as legislation can put it, under the control of a Government Department. Even if that answer be given, I suggest that the passage of time has rendered the analogy that may be founded on the old situation, when the hospital was constructed, completely out of date.

The modern situation with regard to hospitals and educational institutions is, broadly, that if the Government give anything of the taxpayers' money, they may intervene in relation to the formation of the lines upon which the hospital or other institution ought to proceed, directing it in its first years and, having launched it, then letting it swing along for itself afterwards. That is not what is set out in this Bill. It may be what is intended. There have been countless examples where pieces of legislation were brought in here containing powers capable of being used in two ways, in a way that would commend itself to those prepared to support the proposal, or in the opposite way. Those who expressed some fears were generally lulled into a false sense of security. They were told that, so far as the phrases were concerned, the intention was that the legislation would be operated in a particular way. In a few years changes of government may occur and people with totally different ideas may operate along the lines in regard to which fears were originally expressed. It is not much use if the Parliamentary Secretary tells us what his intentions are. If he gets those intentions agreed to by the House the Bill should be moulded so that the matter cannot be arranged in any other way than along those lines and in accordance with the intentions that are expressed.

Before we vote even on the principle of this Bill we require an explanation of some things. Have the Government appreciated the difficulties, which apparently the Hospitals Commission did, of removing this institution from its present area? If they have appreciated the difficulties, how is it proposed to have them met? Has there been consultation with those who are primarily concerned? Is there a proposal to split the hospital, as it were, and have the out-patient department left where it is, with better accommodation, and the in-patient department removed to Cabra? If that is the situation, has any special provision been made? Will there be any special ambulance provision for the removal of patients to the outskirts of the city? From the point of view of the students and the staff, and their association with the teaching institution, has there been any consultation in order to ascertain whether or not this matter is going to cause trouble? It seems to me that it will cause some trouble. Has this matter been investigated by the people concerned; has it been ascertained what their opinion is, and if there is going to be any trouble arising out of the present proposal?

With regard to finance, is the money there? I am not speaking of the money for this particular measure. Is the £8,500,000 there and is the money in such a way that it can easily, from time to time, say in drafts of £250,000 or so, be freed so as to be available for those who are to interest themselves in these proposals?

The overshadowing thing in this Bill is the position in regard to control. Will the hospital be under the control of the Government and is this the position, that the Government will exercise some supervision and control over the board and will insist on the board following some lines of development that may be set out? How far does this phrase about officers and servants carry? Even if the board is to be under the control of the Government, how far are the members of the board, irrespective of any fundamental changes that may be imposed on them by a Government dissatisfied with their progress, going to have control of the nursing and the medical staffs?

Mr. Byrne (Junior)

I fail to see any justification for taking the Richmond Hospital out of the present densely-populated area which it has served so faithfully for many years and sending poor people miles away to a place which, if they are unable to walk to it, they cannot reach without spending a small fortune on bus fares. As Deputy Norton very correctly pointed out, when the patient has to be taken to the hospital a very expensive form of transport has to be used, that is a taxi as a rule.

The present hospital is very convenient for no less than 75,000 of our Dublin citizens in the immediate vicinity. According to the 1936 census the areas immediately surrounding the Richmond Hospital, without trespassing on outside areas at all which are catered for by other hospitals, had a population of approximately 60,000. There are probably now 70,000 to 75,000 people in that area and those people are to be deprived of the Richmond Hospital; if the rumours are correct they will have to go elsewhere. That is most unjust. I personally protest very vigorously here against the removal of the Richmond Hospital. We are told that it would be difficult to build a new hospital in the site of the present one. We are told that it would be necessary to build a 550-bed hospital and that it would not be possible to extend the present hospital to that number of beds. I have been told on reliable authority and several Deputies have already mentioned it that plans are available for the erection of a 550-bed hospital on the present site. I appeal to the Parliamentary Secretary and to the Government to withdraw their plans and to erect the new hospital on the-old-site.

Mr. Dockrell

I only wish to make one point. This point has already been made by many of the previous speakers and that is the advisability of keeping the hospital on its present site. Apparently there is some doubt as to whether a hospital could be erected on the ground available. But there is no doubt in the mind of anybody who looks into it that there is sufficient space available in the neighbourhood to erect an ideal hospital. I think we ought to hear from the Minister if a final decision has been reached on that point, because to my mind that is the essence of the whole Bill. I would like the Minister or the Parliamentary Secretary when replying to deal specifically with that point.

Dr. Ward

Most of the debate on this Bill has been based on the assumption that the Ministry had already reached a decision that the new hospital would be built in Cabra or in the Cabra district, and that in no circumstances would the new hospital be built anywhere else. Various Deputies have stated that there are rumours afloat that a site has actually been acquired in the Cabra district. There is no foundation whatever for any such rumours. The Cabra district as a desirable district in which the new hospital might be situated has been discussed, but it is entirely misleading to suggest that a decision has been arrived at and that the hospital must be built in that area. There are various objections. Most of these objections have been raised by some one or other of the Deputies. Some of the objections have been raised by Deputies who spoke of the new hospital being on the outskirts of the city. The attitude of the Ministry has been from the beginning and it still is that if a suitable site can be provided in or near the centre of the city they will not insist on the hospital being built out in the suburbs. Deputy Norton spoke about the difficulties that might be experienced by the poor in finding their way out to the hospital in Cabra and the additional difficulties in the case of relatives who wanted to visit them. He dealt with the difficulty that would be created by the hospital being located outside the centre of the city. But it is well to bear in mind that the present density of population in the district in which the constituent hospitals are at present located may not continue in the future. That area will in all probability be cleared. Buildings and houses will have to be provided in other areas for the people who are now living in these congested streets in the neighbourhood immediately surrounding the present hospitals. Taking the long view it might be wiser to go outside the congested districts when securing a site for the new hospital. For example, the city may develop and develop rapidly and extensively in the Cabra district, and the people who are now so anxious to remain near the present site may find that the density of population has moved out to a different part of the city altogether and that it would have been wiser to take the long view now when considering sites for the hospital.

Mr. A. Byrne

Why not use the old city? Why remove everything to the outskirts of the city?

Dr. Ward

Deputy Childers suggested the possibility of sectional development, building a portion of the new hospital now and moving on by degrees over a long period of years until the entire building had been erected. That, undoubtedly, is a possibility, but whether the hospital is to be built in sections, or whether the whole undertaking in connection with it is to be embarked upon at the one time, the Bill is still necessary in order to provide the necessary machinery: to set up a board with statutory authority to build the hospital and giving the Minister power to acquire land for the purpose. As to the possibility mentioned by various Deputies of agreement being reached between the authorities of Grangegorman Mental Hospital, the Morning Star and the present board of governors of the Richmond, Whitworth and Hardwicke Hospitals, I have no doubt that if they reach agreement as to a site and present the Minister with such an agreement, and if the site appears to be reasonably satisfactory, the Minister will be glad to see a suitable site provided in or near the centre of the city as the title of the Bill suggests.

Mr. Cosgrave

Is that an evasion or an undertaking?

Dr. Ward

It is neither.

Dr. Ward

I am not inclined to give a smart answer to Deputy McGilligan or to withhold information from the House. All I can tell the House is that the funds are invested in trustee securities, and that the trustees do not desire to publish to the world the securities in which these moneys are invested.

Dáil Éireann debate - Wednesday, 24 Apr 1940

Saint Laurence O'Toole Hospital Bill, 1940—Second Stage.

Mr. Byrne

Mr. Byrne

Mr. Byrne

Mr. Byrne

Mr. A. Byrne

A Deputy

Mr. Byrne

Mr. Byrne

Mr. Byrne

Dáil Éireann debate -
Wednesday, 24 Apr 1940