I move: That the Bill be now read a Second Time. The main object of the Bill is to provide for the establishment and maintenance of hospital bureaus for the purpose of facilitating the admission to hospitals of persons who require hospital treatment. The Bill is of general application, but it may be assumed that the establishment of a hospital bureau will be confined to Dublin where the public voluntary hospitals provide general and special treatment. The provision of a hospital bureau for the Dublin centre first arose when the hospitalisation scheme recommended by the Hospitals Commission was under consideration. That scheme contemplates provision for the treatment of poor persons in four major general hospitals with an increase of approximately 600 beds.
The arrangements for the establishment of a bureau for that purpose were fully discussed with the representatives of the hospitals. Agreement was reached in regard to the functions and duties of the bureau and the management thereof. The representatives of the hospitals considered that it would not function in advance of the additional accommodation which would be necessary in the four hospitals for the treatment of poor persons.
It was intended that the bureau then contemplated would be under the control of a body composed of representatives of the hospitals and of certain local bodies in the City and County of Dublin. As the bed complement of the voluntary hospitals would not permit of hospital treatment for the large number of poor persons who receive hospital treatment in St. Kevin's Hospital, which is under the control of the Dublin Board of Assistance, it is not considered expedient at present to establish a bureau controlled by representatives of the voluntary hospitals and local authorities.
It is generally agreed that difficulties are encountered by the medical profession in Dublin in getting hospital treatment for some emergency or acute cases. A hospital bureau would serve a very useful purpose if it helped to facilitate the admission of such cases. Its activities should operate to the mutual advantage of the voluntary hospitals, the medical profession and people requiring hospital treatment.
A good deal of consideration has been given to the form which a hospital bureau should take. It might have been desirable to locate it in one of the large voluntary hospitals but there is scarcely sufficient co-operation on matters affecting hospital management amongst the hospitals in Dublin to warrant such a course. The course suggested in the Bill was decided upon as being the most likely to afford the facilities in connection with admissions to hospitals that are so necessary at present and at the same time involve little additional annual expenditure.
A considerable proportion of the patients in the Dublin general hospitals for years past has received free treatment. The Bill does not propose to interfere in any way with the manner of admission of free patients to these hospitals. It is evident, however, that there are many persons who are in urgent need of treatment in a hospital who cannot secure admission under present conditions, and have to rely upon medical care given under unsuitable conditions in the home. In such cases it is hoped a hospital bureau will be an advantage.
I need not enter at this stage into the detailed working of a hospital bureau. The present arrangement is in the nature of an experiment and its success will depend largely on the co-operation afforded by the representatives of the voluntary hospitals. Regulations governing the administration of a bureau will be made in pursuance of Section 2 of the Bill after consultation with the Advisory Committee. Hospital bureaus are in operation in a few large centres of population in other countries where the voluntary hospitals provide the main hospital service for the public, and have proved to be advantageous for the hospitals and for patients as well as the medical profession.
Section 4 of the Bill makes provision for the investigation of complaints arising out of the refusal to admit persons on whose behalf arrangements for hospital treatment have been made by the hospitals bureau, or on the ground that treatment was unreasonably delayed. It is not expected that such complaints will often arise, but the powers conferred are regarded as essential in the public interest, and they will, it is believed, moreover prove to be a useful protection of the voluntary hospitals. Such a measure of general supervision as is contemplated need not, and is not intended to, interfere with the ordinary rights of the hospitals to control their internal management.
There is one other matter of importance which is concerned with the extension of the exercise of powers of inspection of hospitals and the furnishing of information bearing on their financial position. The Public Hospitals Act, 1933, gave certain powers in this respect to the Hospitals Commission, but during the consideration of that Bill it was never contemplated that there would be made such heavy demands on the Hospitals Trust Fund as have been made by the voluntary hospitals to meet expenditure in excess of income in the past couple of years.
As the extent of the hospital deficits still continues to show an upward trend, the present position must be regarded as serious. There should, therefore, be close co-operation between the voluntary hospitals and the Hospitals Commission in matter affecting the internal economy of the hospitals. As regards the position of the Minister in relation to voluntary hospitals, the Act of 1933 imposes definite obligations on him with the object of securing that grants are properly applied. The exercise of such powers by the Minister is distinct from the duties to be discharged under the Act by the Hospitals Commission, and the experience gained since the passing of the Act of 1933 shows that it is necessary to have the powers sought in Section 6 of the Bill.
It is also proposed to amend Section 12 of the Act of 1933 which governs the application of the proportion of the proceeds of the sale of tickets in a sweepstake towards meeting expenses of promoting the sweepstake. In present conditions it must be assumed that any future sweepstakes would not receive support outside the country to the extent that has prevailed in the past. In that event a specified proportion of the proceeds which would be payable to the promoter would be difficult to determine. It has accordingly been decided to remove the limit of 7 per centum in the Act of 1933, and to rely upon the maximum percentage of 30 per centum of the proceeds of the sale of tickets in a sweepstake which can be made applicable to meeting expenses generally, other than tickets, commissions, prizes, or other remuneration given in relation to the sale of tickets. There will be power to fix a lesser percentage if the Minister for Justice so decides.
There is also an amendment of the Act passed here last year, that made provision for a reserve fund to be built up. That reserve fund was created for the purpose of meeting the emergency, and it is not considered that it will apply any longer.
In the first instance, I do not think it is necessary to make any case for the setting up of the hospital bureau. That necessity is admitted on all sides. The Hospitals Commission in their reports from time to time have stressed the necessity for such a bureau. We had petitions from social organisations in the city, stressing the necessity for a bureau, and recently some reference was made to it at an inquest, by the coroner, when he hoped that such a thing could not happen if there was such an organisation there as the bureau. This is intended as a temporary arrangement. At the time the agreement was arrived at between the four principal voluntary hospitals in the city, it was believed that such a bureau as we had in mind could not operate until the increased beds were provided. I admit that the Bill in its provisions is rather wide, and on the Committee Stage we can get it down to narrower limits, and to more specified terms. It was also brought to my notice that the retrospective provisions in this Bill do not give the hospitals the opportunity, so to speak, to contract out. That may be a fair position to put forward, and I am quite prepared to concede that, so far as the retrospective provisions in the Bill are concerned, they can be changed on the Committee Stage, to give the hospitals the opportunity of saying whether or not they will come into the bureau system.
Reference has been made to the regulations that may be made by the Minister under the Bill. I do not know if it will be possible on the Committee Stage to set out anything like the exact regulations that are in mind, but it may be possible to give some general indication of the lines these regulations are to follow. However, the regulations will be made after consultation with the Advisory Committee. If the words "impose duties" in Section 2 are considered as some sort of dictation, we can get some other words and set forth what they should be.
In Section 3 it is not intended that the Minister shall appoint representatives of the hospitals without consultation with anyone. What is intended is, that representatives of the general and special hospitals in the city should be appointed by their own organisations, and by their own hospitals and approved by the Minister. If there is any doubt about that I am quite prepared on the Committee Stage, to make it perfectly clear that the hospitals themselves shall appoint their representatives and submit them for approval. This provision has been construed in some way as an attempt to interfere with the internal organisation of the hospitals in such a way that the Minister will appoint representatives of the hospitals over the heads of the hospitals authorities. That is not the intention.
Under Section 4, which deals with complaints, the intention, which can be made clear on Committee Stage, is that if a complaint be made to the Minister he will refer it to the Hospitals Commission in charge of the bureau. The Hospitals Commission will consult with the advisory committee of the bureau. In the ordinary way, the complaint would be dealt with in this manner. If the case were one of gross seriousness, the Hospitals Commission could refer it to the Minister for the purpose of holding an inquiry, as contemplated by the section. That, again, can be changed to allow the complaints to be made to the Hospitals Commission in the first instance. As it is, if they come through the Minister, he will refer them to the Hospitals Commission. The Hospitals Commission will have to consult with the advisory committee, representing the hospitals, and, if they are satisfied that the complaint is of a serious character, it can be referred to the Minister for the holding of an inquiry, if he considers this course necessary. As I have indicated, those cases will, probably, be very rare indeed. I should have mentioned that the regulations will be laid on the Table of the House.
I know I shall be asked why this arrangement was not got by consultation with the hospital authorities. The setting up of this bureau has been pressed forward as a very urgent matter. My predecessor succeeded in two years in getting agreement with four voluntary hospitals regarding some form of bureau. If I set out to secure agreement with the 27 institutions with which I should have to deal, and if it took my predecessor two years to secure agreement with four voluntary hospitals, how long it would take me is a simple matter of proportion, though it might not apply in that way.