Dáil Éireann debate -
Tuesday, 30 Apr 1940

Vol. 79 No. 16

Committee on Finance. - Public Hospitals (Amendment) (No. 2) Bill, 1940—Second Stage.

Minister for Local Government and Public Health (Mr. Ruttledge)

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.

Dr. O'Higgins

How long was your predecessor away in the course of the two years?

Mr. Ruttledge

Certain agreements have, from time to time, to be brought about between the hospitals and the Department. I assume that the hospitals are standing on their rights, or what they conceive to be their rights, but I know that, in the case of one particular hospital, I have been striving since I went into the Department to secure agreement, and I have not been able to secure it. I am as far away from it now as I ever was. The agreement I sought was quite acceptable to the other hospitals. It may be said that these moneys are not the moneys of the taxpayers. They were originally State-sanctioned moneys and, under the Act of 1933, certain duties were imposed on the Minister in order to protect the interests of the poor and facilitate their medical treatment. I am not setting out here to attack any hospital. They have done admirable work and are doing admirable work, and the intention is to have as little interference on the part of the Department with them as possible. Whatever powers have been taken in this Bill relate to duties imposed upon me, and are considered necessary. I think that the hospitals have nothing to fear from these powers. I have seen a number of letters in the Press, and the writers seemed to be under the impression that much wider powers were being taken than it is the intention to take in this Bill. I believe that, when the Bill becomes law and when this organisation is set up, it will be more a protection to the hospitals against frivolous complaints than anything else. It will protect the hospitals against unfounded and frivolous charges. There is no desire to interfere with the hospitals more than is considered absolutely necessary.

Mr. Cosgrave

Generally speaking, the Minister's statement might be regarded as a fair statement, but we have to consider it in relation to the provisions of the Bill. Scarcely any measure introduced in this House in recent years has given rise to so much misgiving and so much regret—I shall not say condemnation, though that may have been expressed—as this Bill. Reading the Bill carefully, one comes to the conclusion that if only small powers are required and are to be exercised, it would have been difficult to put the provisions in a more exhaustive form than they are set out in this Bill. The Minister relieves the mind of the Dáil to some extent regarding the respect due to contracts by saying that the retrospective clauses of the Bill are not going to be imposed. I should have preferred the Minister to say that an agreement once entered into would not be altered eight or ten years afterwards by an Act of this Legislature without the consent of both parties.

In sub-section 1 of the first section of the Bill there is a clause which would bring in a hospital in the City of Dublin getting a subscription from a local authority. I have no authority to speak on behalf of that hospital, nor have I been asked to do so. I understand, however, that there is one hospital in the city which does not participate in the Sweepstakes, and does not intend to do so. Surely, it is not the Minister's intention to bring that hospital within the scope of his examination, or that of the Hospitals Commission. The Minister probably intended to mention that, but he omitted to do so.

Mr. Ruttledge

The Deputy can take that as so now.

Mr. Cosgrave

So far as Section 1 is concerned, no outstanding matter falls to be settled if these two matters receive attention. I now come to what the Minister calls the principal section of the measure. What the operative section of the Bill is depends very much on the standpoint from which one regards the Bill. Taking this particular section, the Minister mentioned that it had taken his predecessor two years to get accommodation with the four voluntary hospitals in the City of Dublin. If my recollection is correct that agreement was entered into in 1938. It may have taken two years to get it, but it has not been put into operation yet.

Surely, if ever there was a case in which the active and cordial co-operation of the bodies concerned is required it is in this case? Looking over the history of this city and county, for a lifetime, it will be seen that there has been no addition to the bed accommodation of the hospitals during that period. I think the Minister would require a microscope to find a vacant bed in any one of these hospitals. However, during that period the population of the city has increased. It has practically doubled while the bed accommodation of the hospitals remains the same as it was 40 or 50 years ago. We are seeking now to find out where the vacant beds are in the hospitals. It is seven years since the 1933 Bill was passed. If we were in a critical frame of mind we could say: "Well, the contribution of the Ministry towards providing extra beds has not been distinguished by any great success during those seven years." If, however, this bureau is to be a success, it requires the active and cordial co-operation of the hospitals. To my mind, a condition necessary to secure that end would be that whatever body would be set up would be the principal body in connection with this business. I would suggest to the Minister that he should amend the Bill so as to let the committee of management be the bureau. Let the committee make its own regulations subject to the concurrence or approval of the Minister. Put the responsibility, as far as possible, on those who are finding the accommodation.

Perhaps I should have prefaced my remarks on this measure by saying that there is a difference of opinion between the Minister and, I think, most Deputies on this side of the House regarding policy in this matter. The Minister wants to have inspection and control, to some extent at any rate, of hospital accommodation in the country. Our view, for what it is worth, is that it would be better to leave that in the hands of those who have been accustomed to the manage ment and control of hospitals for a long period of years and without whom hospital accommodation in this country would have been very meagre. It was they, or their predecessors in title, who provided whatever accommodation or treatment there is. This system has worked, I am glad to hear the Minister say, in a satisfactory manner for a long period. Unfortunately, by reason of the change in the value of money it was impossible to continue that system without some help, and the Legislature agreed to afford means of help to those hospitals. To our mind, it would have been better if they had been given an opportunity of doing it. Certainly it would appear from what the Minister said that these seven, eight or ten years have not been distinguished by any big advance in the accommodation that is available. We appear now to be concerning ourselves more with the regulation of what there is than with the major problem of increasing accommodation.

There is an uneasy feeling that this measure, in respect to Sections 2 and 3, divorces the hospitals from the control they exercised and the administration they practised during that long period. Section 3, to my mind, is about as ambiguous a section as it would be possible to introduce into a Bill. The Minister, in the course of his statement, said that it was the intention to allow hospitals to select the personnel of the advisory committee. Would the Minister consider, in that connection, that while he takes steps to ensure that whatever duties devolve upon him are implemented in the legislation, the duties or obligations he imposes upon others are of much less dynamic character? They are advisory. After all, they are to be the people who will work the Bill. The more help one would give them in carrying out their duties, the more authority one would give them, the less need for examining how they will do their work. In this case, surely the Minister had not in mind the possibility that he has got to examine the names of each of the persons nominated by each of the hospitals, approve of six, and send back three and say: "Let us have other nominations in respect of them"? Surely that is not his intention? When he says, "subject to the approval of the Minister," he surely means that the approval will come as a matter of course?

Mr. Ruttledge

That is the intention.

Mr. Cosgrave

I thought it was. I thought the word "approval" was there rather more by accident than by design.

Mr. Ruttledge

In practice that will be the procedure.

Mr. Cosgrave

I think it would be unfortunate if objection were taken to any of the names submitted. Whatever may be said in respect to the medical profession, I think there is a certain esprit de corps amongst the members of the profession. In all professions there is an esprit de corps, but in no profession will it be found to exist to such a high degree as in the medical profession. If doctors or even members of the board of management were nominated, I think it would be a mistake to have any power in the hands of the Minister to reject that nomination. Assuming that the Minister was going to operate the section in the case of the City of Dublin, and that each of the clinical hospitals is to have a nomination, there would be nine or ten nominations coming from them, together with probably three from the maternity hospitals and three from the children's hospitals. That would be 15 in all. If the Minister were to nominate five, there would be a total of 20—a very large committee—one would say, almost too large. We would have no objection, ordinarily speaking, to the Minister putting in five of his own nominations, but somebody ought to consider whether it is advisable, even if they take the power to add five, that he should add them at all, and whether he would not put the responsibility entirely on the representatives of the hospitals to find the means of getting the information required and of operating to the satisfaction of everybody.

There is a clause there in sub-section (3) of Section 3 in which the term of office of the members of the committee appointed under the section may be reviewed.

"The Minister may revoke at any time the appointment of such committee or any member thereof, or alter the constitution of such a committee."

It may be that, taking the long view, a situation might happen in which such a power would be required. I would suggest to the Minister that he ought to have more confidence in the committee at the start and not press that particular power. Much depends upon the bona fides of everybody in connection with this matter. We have evidence of the bona fides of these boards of hospital management— governing bodies, or the bodies that are covered by that particular term. After all it is they who have, with their surgical and medical efforts, been able to provide whatever accommodation we have had and which the people have enjoyed and which the hospitals generally, from the modest employee to the most distinguished surgeon or physician, have always taken pleasure in being able to give to help the sick poor.

Section 4, as it is drawn, is an objectionable section, and the impression that has grown generally through the various persons or bodies who have considered it is that there is a desire on the part of the Department here to place these hospitals in the same position as the hospitals administered under the Minister's Department under the Medical Charities Act. My own impression is that that is not the intention, but we are not concerned here with the intention so much as with the words before us, as these are going to stand after we have passed away. As that section stands, one would come to the conclusion that the Minister will sit in his office awaiting the receipt of complaints and that he will make up his mind about having sworn inquiries into all the complaints one after another. It would be well to have that section considered in the light of the responsibility that is going to be placed on the advisory committee which will be responsible for the bureau. That committee, in my opinion, ought to hear the complaint in the first instance and ought to investigate it. If it is satisfied that a cause for complaint does lie—presumably the cause of complaint would not be a single individual one, or the committee would be kept busy—there would be no objection on the part of any hospital to having a matter of that sort investigated. As the section is drawn now, however, there is scarcely a governing body in Dublin which would not be under the impression that any cause of complaint is likely to occasion a sworn inquiry.

Going along down the section, one finds in sub-section (4):—

If any person—

(a) being duly summoned to attend as a witness at an inquiry under this section, fails to attend, or,

(b) being in attendance as a witness at such inquiry, refuses to take an oath, produce a document, or answer a question where required so to do by the holder of such inquiry,

such person shall be guilty of an offence under this section and shall be liable on summary conviction thereof to a fine not exceeding five pounds.

I wonder if that is necessary at all. Under another Act that the Minister has introduced here in connection with the Saint Laurence O'Toole Hospital, we have provision for the holding of an inquiry into the value of land and in that case there is no penalty for not answering, nor is it contemplated that there would be a refusal to answer. No matter how generously one might view it, there is implied in this section a suspicion on the part of the Department that complaints will be made and that action must be taken in connection with them.

The Minister has the power of the purse in these cases. Although he has that power, even that must be exercised with some restraint. After all, if he withholds money from a hospital, it is those who are going to take advantage of whatever treatment and accommodation is provided who will ultimately be the sufferers. One is faced, then, with the problem as to whether it is likely that there should be such contumacy on the part of those who would attend an inquiry of that sort, and as to whether they would be so objectionable or difficult.

As regards Section 5, it should not be in the measure at all. If the Minister were to come in and say that it was necessary, and necessary in a hurry, there would be no objection. One would imagine that Section 5 would have been placed either at the beginning or at the end, but it has been sandwiched in between the bureau on the one hand, and the power the Minister is going to take for himself on the other hand. It looks as if it should be after that. I am sure that such an able man as the Minister—and I will pay him the compliment of saying that there is no more able member of the Government than he—would agree that it is inconceivable that it should be sandwiched. It is quite true that the Act of 1933 put certain disadvantages on the Minister. The Minister took these duties on, and it has taken seven years to discover that he has no means of carrying them out. Although there is a Hospitals Commission, empowered and authorised to do certain things, they have not done them. I put it to the Minister as a business proposition that, so far as these hospitals are concerned, they have two masters—the Hospitals Commission on the one hand, and the Minister on the other hand—and that that is an unsatisfactory procedure. It ought to be either one or the other. I suggest to the Minister that it would be an easy way out for himself if he divested himself of the duties that he so lightly imposed on himself seven years ago. He should leave them to the Hospitals Commission, and let him have a body which will be empowered under the Act to do its duties. Its personnel, and so on, can be arranged.

This is a Bill which should not be received nor dealt with in this House in a controversial spirit. Unfortunately, as drawn, it has excited the suspicions of very large numbers of people. It is a Bill which is regarded with suspicion by practically everybody who has had any experience of hospitals management, or of duties in a hospital, or of anything of that sort. That is an unfortunate beginning. It would be a matter of very great satisfaction to all those who have so well served the public in this country for so long, that a situation of this kind be resolved with good will and good faith and that there should not linger in anybody's mind the impression that, year after year, an effort is being made to bring more and more under control a big organisation such as that.

Examining it from the point of view of what is at the disposal of the Minister and his Department, surely we must admit that if this Bill were to be carried out from its beginning to its end in accordance with the tone that distinguishes the measure and the tone that distinguishes the potential father of this measure—that is the Act of 1933—the Minister would require to set up a far bigger section to do that sort of work. That is not the intention, I am sure, but as the matter stands there is a possibility that, sooner or later, it may happen. I think that, at any rate, something should be done in this direction if any more satisfactory results are to be achieved than have been achieved up to this. If there is one thing to which people object, I think it is this business of too much examination, too much inspection, too much investigation, and all that sort of thing. I can imagine these hospitals being examined, inspected, and so on, by officials, just when very important work was in hand, and I can quite imagine how unreasonable it would be to expect these people to answer such questions in the midst of such important work. I think that if that section is put in, every member of this House would get at least five or six complaints of one kind or another every day, or at least every week, from various people who have some cause of complaint, or think they have a cause of complaint, about these hospitals. Surely, in view of what the Minister told us in his opening statement, to the effect that it is not intended to put this thing through in its present form, he is setting up difficulties for himself and for his successors, as well as for his Department and the administration of his Department.

The Minister mentioned, in the course of his statement, that he had had difficulties with regard to one hospital. Well, in my experience of over 20 years, I can say that there is hardly a Department of State with which I did not have difficulties, and very great difficulties—both in and out of office. Naturally, in any such case there would be difficulties, and in this connection there are very great difficulties, one of which, and perhaps the greatest of which, is brought about, I think, by the fact that the hospitals concerned have not been able to balance their accounts, and since they have not been able to balance their accounts, have not been able to bring their equipment up to the standard to which they would like to bring it. Is it not inevitable, therefore, in the circumstances, that those deficits of which the Minister complained—arising from the Minister's and his predecessor's apprehension as to the rising cost—would be gradually rising even as the costs rise? It might be said that certain economies could be arrived at. That would be all right if economies could be achieved, but I think that I might be permitted to say that if any economies were to be achieved, they should be achieved in the case of the Ministry itself.

It is certainly not to be wondered at that with rising prices of equipment and with equipment not being at all up to the proper standard, the balance sheets of the hospitals concerned should not have been right. On that point, also, we have never had any statement from the Minister as to the policy of the Government in this connection. One might almost sense an objection on the part of those responsible for distributing this, as to saying whether the Ministry or the Hospitals' Commission is responsible for the spending of this money. Whether or not the information we get is entirely different from that which the Minister and his Department get, I think it must be admitted that the cost of the equipment of these hospitals has increased, and also that there is a greater variety of such equipment necessary.

Nothing would give me greater pleasure than to see a measure of this sort receiving the unanimous support of a House such as this. It is rather unfortunate that there should be a difference of opinion as to the matter of the administration of hospitals generally. Our view is that the more these hospitals are kept in a voluntary or self-supporting and autonomous position, the better. The other Bill that we had—although this is a successor of the Bill of 1856—showed a desire on the part of the Ministry to get and to keep control, but control of this kind is going to mean practically 25 per cent. of an increase in the cost of local government, without increasing in any way the efficiency or usefulness of the hospitals. I suggest to the Minister an entire recasting of Sections 2 and 3, and an alteration of Section 4, which would make it less objectionable than it is in its present form. I should also suggest that, in so far as Section 6 is concerned, the Minister should reconsider the proposal there with regard to hospitals, and that the major responsibility should be put, in the case of any obstruction or interference, on the hospital immediately concerned. I think that the Minister should reconsider his view in regard to the regulations, to the effect that they should be made subject to his concurrence, and I think that the Minister would have the cordial co-operation of the hospitals and their staffs in the working out of this problem, difficult as it is, if he would give attention to these particular points that I have mentioned. I am sure we all realise that the problem requires the co-operation of everybody, if it is to be made a success.

Dr. O'Higgins

I do not know whether to address my remarks to the Bill or to the Minister's statement, because the Minister's statement is very different from the Bill; but I think that, in the interests of harmony, I should deal with the Minister's statement. If I were to deal with the Bill, as it stands, I think that parliamentary regulations would very soon force me to sit down, but I think that that would be merely giving expression to the ordinary views of the normal doctor, even of the normal doctor who has given a certain percentage of his time gratuitously.

Fortunately, we had the Minister's statement which was, to say the least, reassuring. If we were to read the Bill or to be presented with the Bill as it stands, without any reassurance, we would understand why we have lived through as hectic a week in medical circles as any of us ever experienced. It is only 48 hours ago since some of us believed that we were within a few days of seeing the medical and surgical staffs having to walk out of their hospitals. Words must be read and understood according to the dictionary meaning, and if the words in this Bill meant anything they meant that within the Bill there was a serious attempt by the Department of Local Government to take all the voluntary hospitals under their control and supervision to the same extent as the rate-aided hospitals and to make the surgeons and physicians and other doctors of those hospitals as much subordinates under the control and direction of the Minister's officers as are the salaried medical officers throughout the country. That is the clear and the simple meaning of the Bill as it stands.

Fortunately, this Bill was introduced here on the Second Reading by the Minister, who has beyond measure the gift of disarming people who are before him and, possibly, has the gift of understanding to a very great degree the genuine anxiety of others. I must say, whether he has information or whether he has merely sensed the position, that, if not all certainly very many of the objectionable features in the Bill as it stands, which were the subject of discussion and which gave rise to such disquiet in the past week, have been dealt with by the Minister in his opening statement, and if he puts into print for the Committee Stage the assurances which he has given here to-day, then I think the Bill will be, on the whole, acceptable, certainly far more acceptable than it is at the moment.

Everybody is put in a difficulty over this Bill. There are two things in the Bill which, I think, everyone wants, namely, a bureau or some machinery for providing facilities for the expeditious entry of the genuine case into hospital and, secondly, the provision of facilities for the re-establishment of the Sweep. The old doctors, centuries ago, discovered the trick of putting distasteful things inside a very palatable coating. It looks as if the modern lawyers have tumbled to the trick but have reversed the procedure. They supply palatable things that everyone of us wants in the most distasteful and objectionable coating. The Minister's speech went a very long way towards stripping off that distasteful coating. I would ask the Minister to remember this, that assurances given across the floor of this House are very acceptable and when we secure assurances of that kind they are appreciated by us.

If we were carrying out a Bill such as this in contact with the Minister opposite in the future, we would be satisfied with the assurances given without having it in black and white, but, remember, the assurances matter only to us. It is the written word that is going to matter afterwards and, actually, the implementation of the Bill will not be carried out by any Minister; it will be carried out by hordes of civil servants to whom the written word is the gospel. Nothing else matters. Whatever assurances the Minister is prepared to give, he should devise ways and means of putting them into print for the Committee Stage.

This Bill deals with hospitals that began centuries ago as encampments on the side of the Liffey, where good women and skilled men took in those that were sick and ailing in order to treat them gratuitously and prevent their illnesses from spreading to the general body of the community. They had no grand buildings and no sweepstake funds behind them. They had no facilities for training, merely the desire to do good. Not only had the patients to be treated, but the institution had to be managed, the moneys to keep the institution going had to be collected, and all the work had to be done by the same staff. That was the beginning of our Dublin hospitals. They grew and grew down through the ages and they reached a degree of efficiency that they attracted from all over the world people who were anxious to absorb medical knowledge and to go back to their own countries to treat their own people in the way that Irish doctors were treating their people. They came here to learn and they went back trained and perfected. And all the time the work was done voluntarily, gratuitously, inspired by the desire to serve. Conditions and circumstances came about when, with the increasing cost of commodities, those staffs and managerial boards were unable to keep going out of their own resources and they had to look elsewhere for financial help. Even the Government and the State were unable to come to their financial aid. Even the taxpayer, with his millions, could not face the task that had been faced and borne by the hospitals themselves and, perhaps the greatest God-send that any of us has ever seen coming into this country, in the form of the Hospitals' Trust, the sweepstake came along to solve the difficulty and to meet the burden. Later on it was considered wise that a Government Department should take control and act as middlemen for the moneys and, as trustees, to have certain supervisory control. There should be no confusion between hospitals benefiting out of such funds and hospitals benefiting out of the rates and the taxes. These hospitals, after the sweepstake funds came to their assistance, are just as much voluntary hospitals, staffed by voluntary staffs, as they were ten or 15 years ago.

It may be that every one of us has his own peculiarities, that some of us are unnecessarily "touchy" on some points and others on other points; but still, if we have to live together in the same house, each of us has to make allowances for the peculiarities of the other. What we all want to see, as a result of this Bill, is greater efficiency and increased harmony. There must be trust, not only between the hospitals' staffs and the Government Department, but between the Government Department and the hospitals' staffs. It cannot be all give one way and all take the other way. The Minister is entitled to come here and complain that it took him two years to reach an agreement with one hospital. The representative of the hospital is equally entitled to complain that it took him two years to reach agreement with the Minister, and every one of us could be left to judge on which side the fault lay.

The Minister is going to implement this Bill, presumably, through a committee representative of the hospitals. If he is, the representatives should be elected or appointed by the hospitals. If they are elected by the hospitals, then that is either going to be a committee or it is not, and if the elected representatives of the hospitals are to be a committee, then waive the right of approval, because the right of approval includes the right of disapproval, and there would be nothing but a deadlock if the Minister were going to say: "Although you elected such-and-such a person, I will not have him." If that were to be the position, the right of election means nothing. I would be able to support this Bill with a certain amount of enthusiasm, and certainly with a great degree of hope, if incorporated in the Bill were all the assurances given to us by the Minister to-day, and I hope that when we approach the Committee Stage, the Bill will be drastically altered so as to include those assurances.

Mr. Everett

Personally, I am very glad the Minister has agreed to meet some of the objections raised. I have personal experience, as a patient and as a visitor, of various hospitals in Dublin, and I can certainly say for the constituency I represent that we have no difficulty whatever. The poorest patient from the county, at the latest hour at night, can get all the skill that medical science can give him. We were never refused a bed at any hour of the day or night for any of our urgent cases. The Minister has pointed out that this is only a temporary Bill.

I am in favour of it because I believe it is required in the City of Dublin, but I notice that the Minister is giving authority for a continuation of the sweepstakes, which I understood was matter for the Minister for Justice. Deputy O'Higgins mentioned that that was a pleasure to everybody. It may be a pleasure to those in receipt of the fabulous salaries, including Deputies and Senators, but it is not a pleasure to those who were in receipt of salaries of 30/- a week, who, if they worked overtime for six days and also on Sundays, received £3 10s. 0d. a week, and whose letters complaining of these wages are censored in the Press. The Press were threatened by the Hospitals Commission that if these letters were published all advertisements would be withdrawn from the daily papers.

An Ceann Comhairle

What section of the Bill is the Deputy referring to?

Mr. Everett

Section 12 of the Hospitals' Sweepstakes Act, which we are going to change, so that the Trust will be empowered to receive more in respect of expenses and to give less to the hospitals.

An Ceann Comhairle

What section of this Bill?

Professor O'Sullivan

Section 5.

Mr. Everett

I am not suggesting that the Minister, or any official of his Department, or friends of the Minister, or of anybody in his Department, are receiving emoluments, but I am suggesting that such is so in the case of Deputies of all Parties, and of Senators, and that, therefore, there is no word of protest against the treatment of the 30/- a week employees. We have the spectacle at Ballsbridge——

An Ceann Comhairle

This House has no control over the administration of the Hospitals' Trust.

Mr. Everett

We are going to introduce fresh legislation so that we may drive to Ballsbridge in our motor-cars with £10 or £15 a week, while the unfortunate girls on temporary work have to go by tram or bus. The spectacle is there for anyone to see. It is no wonder that there is discontent in the country and in the City of Dublin, when we see well-off people in the Government service, friends of the directors and friends of the promoters, receiving fabulous salaries for excuses of jobs, while those who have to do all the work have to travel either by bus or tram and work like slaves all day Saturday and Sunday for £3 10s. 0d.

An Ceann Comhairle

The Minister has no control over that matter.

Mr. Everett

I am suggesting——

An Ceann Comhairle

The Deputy is criticising the administration of the Hospitals' Trust.

Mr. Everett

I suggest that before the Minister gives his sanction he should make some arrangement to stop this scandal, and that instead of giving out these fabulous sums, if there is to be only £3 10s. a week for the employee, a lesser percentage should go to the directors and the larger sum to the hospital. I think I am in order in raising my voice in protest against the continuation of this scandal. I am sure the Minister knows about the complaints, and I am sure that if he has the power he will try to remedy the situation. Probably with the ventilation which the matter has got, those things which happened in the past may not happen in the future.

The Minister came to an agreement as to certain conditions which he wanted in regard to inquiries into frivolous complaints about the hospitals. I am sure that an hospital would prefer to have the frivolous complaints than to have the Minister's Department holding inquiries. There is no confidence reposed by public men in the medical section of the Minister's Department in respect of the holding of inquiries into complaints. In the time of the Minister's predecessor a medical member of his staff held an inquiry into a complaint made by a poor man as to ill-treatment of his two children as a result of which ill-treatment the children died. While the ill-treatment was admitted, and while evidence was given by the staff that the children were taken out of their beds and, while suffering from diphtheria, beaten and marched into a room, the Minister's medical section held that that was not one of the reasons for their deaths. It is no wonder that religious orders and others in Dublin object to the Minister having the right of holding an inquiry into complaints about an institution. We have had bitter experience of his so-called inquiries. I ask the Minister to use the power he is being given in this Bill to remove the scandal that I suggest exists in relation to the Sweepstakes employees in Dublin. If he does that, he will have done a good day's work not alone for his Department but for the Sweeps in general.

Professor O'Sullivan

I listened to what I might call the two speeches of the Minister, one, the official description of the Bill—and that I will deal with afterwards—and the other, the opinions of the Minister, and the two were completely different. It is to the Minister I would like to address myself in what I am going to say, not to his Department through the Minister. This Bill as it stands is an outrage. Although, like Deputy Cosgrave and Deputy O'Higgins, I was relieved by the Minister's personal statement, I cannot get away from the necessity of asking myself why this Bill was ever put before the House. We are to have another Bill, but I must say a few words on this Bill, because it betrays the spirit behind the policy of the Department, and the type of mind that is to operate the new Bill. For that reason when asking the Minister to implement—and I have not the slightest doubt that he will—all that he has promised on the Committee Stage, I would also ask him to put down definitely what is meant, because, as I gather, the Bill in all the sections that he mentioned does not at all say what the Minister means. If I were asked what I would disagree and agree with in the Bill, I would disagree with Sections 1, 2, 3 and 4; so far as I understand Section 5, I have nothing against it; I would disagree with Section 6; I do not know precisely what Section 7 means—it is a line and a half—and I have not the slightest objection to the definition clause at the end.

We are in a difficulty. We have two Bills before the House, or, at least, what should have been put into two Bills. If there was any urgency it might have been about Section 5, in connection with the Sweeps. The Minister must know perfectly well that had he come to the House, as was pointed out by the Leader of the Opposition, and asked us in the space of a couple of parliamentary days to give him a one-clause Bill, such as we have in Section 5, he would have got it without any discussion. Instead of that particular thing about which there might have been universal agreement, barring a certain amount of criticism such as we have heard before from Deputy Everett, what do we find? In with that we have, not a Bill that affects politics in the slightest, but a Bill that I regard as one of the most controversial and the most objectionable that could have been brought before this House.

The Minister pleads urgency. Perhaps the Minister does not remember, but sitting beside him is a Parliamentary Secretary who may remember that there was a Hospitals Bill, of which this is an amendment, introduced in 1933, and the plea was urgency. Urgency for what? To allow the Hospitals Sweep money to be spent on the hospitals. That was in 1933. We perceive the remarkable urgency that followed that measure! What has happened the spending? Where are the beds in Dublin that were to be provided as the result of the Sweep money? What has become of the urgency about which we heard so much in 1933? I would like to point out to the Minister, as I felt it incumbent on me to point out in 1933, that this is not public money. It never was public money. It was the money of the hospitals, always intended by this House for the hospitals, and very unwisely, I think, in the 1933 Act there was an incursion made quite unnecessarily into the whole principle of voluntarism so far as hospitals are concerned. So much was that the case that one of the supporters of the Minister, whom we are glad to see back from foreign parts, got up and said that the voluntary principle is dead. That was the excuse for the Act of 1933.

You will inevitably have in any Government Department a certain tendency. I am not now referring to the particular individuals who run the Local Government Department, but I say it is the tendency of any bureaucracy to increase its grip more and more on every possible institution in the State. I hope that the Bill, as we are going to see it on the Committee Stage, will not permit that to happen as much as this Bill threatens. I suggest that the Minister should exercise some care in regard to the way in which this legislation is going to be administered. It is not what the Minister tells us is intended that matters. I put it to him that this Bill is a warning to him, and that he should be most careful to put in black and white what precisely his intentions are and what the limits of these intentions are.

Here we have a Bill that was introduced a couple of days ago, and we are now debating the Second Reading. What was the intention before this Bill was drafted? Am I right in saying that it is to apply to Dublin for the moment? I gather that that is so. Before the Bill was drafted and put before the House, was there a consultation with the various parties interested, with the people vitally interested in the voluntary principle— the ecclesiastical authorities, the managements and staffs of hospitals and the general practitioners? Was there any conference with them before the Bill was launched on the House? Apparently not. If not, I have grave fears with regard to the operation of this measure, because you have the gripping hand of bureaucracy that will increase more and more, and paralyse the voluntary efforts of any institution once the opportunity is offered.

That is not applied particularly to the Local Government Department. That Department may or may not be worse than other Departments. It does not apply to this country alone. I say that is the general modern tendency of Government Departments as a whole, and it ought to be our duty to try to limit that. I know the immediate advantages that may be pointed out. You will have accounts more neatly kept; you will have more frequent reports. That reminds me that there once was a business house in Dublin. A man with a tremendous knowledge of keeping accounts was brought in to manage it, and ultimately the staff were so busy keeping accounts that they had not time to sell their wares. That is what you will have if you allow the Local Government Department to interfere too much with the doctors.

I suggest that you are going to inflict real hardship on the patients in order to keep control of these institutions and to see that everything is worked out according to the desire, not of those who have personal experience of the running of hospitals and who are interested in the work and anxious to advance their science, but in accordance with the ideas of those who are accustomed to run civil service institutions and to account for practically every halfpenny, and spend days in doing so.

It is because I fear that is the spirit behind the whole thing that I cannot look on this proposal with any confidence. I have been consulted by nobody, I am giving my personal views, views that I expressed even on the 1933 Act. It is because I fear the spirit that will operate whatever Bill we pass that I have not looked forward with the same confidence to the important— and I admit they are important— amendments that have been promised us by the Minister. This is largely an experiment, and in order to allow the Government to make up their minds on this matter—to experiment—they caused an intense anxiety, apparently an unnecessary anxiety, because the Minister is prepared to water down the most objectionable sections in this particular Bill, and when I say that, that means practically every section except Section 5. Still, for the sake of that experiment and in order to have the power, on paper at any rate, to deal with complaints that would be very rare, he has introduced here what causes the most intense anxiety to everybody who has the welfare of the hospitals at heart. The Minister himself said that these complaints would be undoubtedly very rare. Now the Department that we are asked to trust is the Department that put the original Bill up to the Minister. Therefore we must ask him to put things down rigidly in black and white. We dealt with Clause 1. The Minister said something else was meant by that than what we have before us. I gather that that section is not going to be retrospective in any respect. Therefore Section 1 should be remodelled.

Mr. McGilligan

He said that any hospital could contract out from this Bill.

Mr. Ruttledge

Yes, not to continue taking the grants.

Mr. McGilligan

The fact that they have taken grants already does not matter?

Mr. Ruttledge

That is so.

Professor O'Sullivan

I will deal with Section 2 afterwards on the question of consultation and so on. On Section 3, perhaps the Minister would be good enough to tell us how many members he expects to have on the committee? Has he any idea? We are discussing here something in the air. We have no information as to whether it is to be a committee of 30, ten or 15. Is every hospital in Dublin to have a representative or must a number of hospitals combine to have one representative so as to secure a small committee?

Mr. Ruttledge

The intention is that every general hospital will have a representative if they want one. That is a matter for themselves. It is not the intention that the Minister will nominate any particular number.

Professor O'Sullivan

Has the Minister any idea as to how many will be on the committee?

Mr. Ruttledge

About 20.

Professor O'Sullivan

It is not the intention of the Minister to nominate anyone and yet he takes power to do so.

Mr. Ruttledge

Deputy Cosgrave raised the question that I am to appoint additional members and I say that it is not the intention to appoint additional members.

Professor O'Sullivan

Well, at any rate that will be changed, not as radically as I would like, but an important change is promised by the Minister. Section 4 will be remodelled. Then what is left of the original intention of the Department, except, as displayed in this Bill, the desire to interfere with the voluntary system? That is a desire that has been expressed on several occasions in this House. When last speaking on this subject six or seven years ago, the then Minister for Local Government and Public Health who is now elevated to a more important position, said he did not know what I was talking about when I spoke of the voluntary principle. I was asked by Deputies what was I talking about and one Deputy said that "voluntary" only applied to national schools, another Deputy said the voluntary principle is dead.

Mr. Briscoe

From the point of view of public spirit.

Professor O'Sullivan

The Department, as far as it can, is killing the voluntary system. That is my objection to the spirit displayed in the original Bill. Regulations seem to be the main thing. When are beds to be provided? The poor of Dublin, of which we have heard a lot from the Minister, have paramount needs, and when they ask for beds they get local government regulations. If there was an urgency in 1933, why has no headway been made in the City of Dublin between that day and this? The reason is the intolerable interference on every possible occasion by governmental Departments. I am not now voicing my own opinion merely. There was recently circulated to members of this House a letter which enclosed a letter from the late Archbishop of Dublin. I propose to read out merely the first sentence of that letter as showing the anxiety felt as late as last May by a man who was intensely interested in this particular matter. Writing to the Mother Superior-General of one of the great nursing orders in this city he says:—"It has struck me that it is essential that the Sisters of Charity should not begin to build their new hospital until the question of inspection and control is satisfactorily settled."

That is the way in which the Local Government Department is regarded, and that is the confidence the high authorities have in the attitude of that Department towards voluntary hospitalisation. I would put that before the Minister and ask him, as Minister, to consider the vital importance of that voluntary principle. It is because I saw in this original Bill no appreciation of this voluntary principle, but a decided effort to kill this voluntary principle, that I am speaking as I am now speaking. When we come to the Committee Stage I want everything clear, and the limitations of the Minister and his Department circumscribed and as clearly stated as possible. Do not put into the Bill certain things that you do not want to use. You are dealing with the voluntary principle, and it is a delicate plant, though it is not quite as delicate apparently as Deputy Briscoe thinks. Remember you are not dealing with public money. You are merely called in as trustee to see that it is properly administered. I am not sure that there has been any great addition to the hospitalisation of the City of Dublin as a result of that trusteeship. I do not know how many millions are at the disposal of the Hospitals Committee. Who does? I cannot discuss that at all—it would be out of order to do so—but where is it? Is that sound administration? Is that the result of the principle of the Bill which we are discussing? Do you think you have made any advance for the hospital situation in the city to provide beds or anything else for the poor?

It is regulations that are the main thing, getting a grip on the hospitals and not building hospitals. I was glad to hear the tribute paid by the Minister to the voluntary hospitals. Perhaps his Parliamentary Secretary will remember the debate on the principal Bill, when the hospitals first got a brick thrown at them and then got a bouquet thrown at them, so that in the end they did not know precisely whether they were in the dock or whether they were getting rewards. That is one of the disadvantages of the Minister's Parliamentary Secretary: that he is a bit blunter than the Minister or than even the Minister's predecessor in this particular matter. Certainly, as many bricks as bouquets were thrown at the voluntary hospitals on that particular occasion. Why cannot the drawing up of regulations be left in the hands of those who have practical experience, namely, of the committee? Why must the Local Government Department put its finger in? Again, with the desire to get control, that absurd desire for uniformity, possibly, that every Government Department has. The older I grow the more I dislike bureaucracy, and I confess I like to check it, wherever possible.

Why cannot the making of these regulations be left to the committee? The Minister says he is willing to meet the hospitals in every possible way. I admit he has done so to a considerable extent. Why cannot that be left to the committee? Why put in sections in the Bill that, apparently, are not necessary? Does the Minister think that, in a matter of this kind, he has better advisers amongst the civil servants, excellent as they may be in the Department of Local Government, than are to be found in the staffs of the hospitals in Dublin dealing with purely hospital matters? I put it to the Minister that this is one more indication of the way in which this thing is looked at—from the point of view of a Government Department and not from the point of view of the hospitals or their management.

In Section 4 the complaints, we are told by the Minister, will be rare indeed. Why all the pother then? Why have all this regulation and all this unrest with regard to complaints which the Minister confesses will be very rare? Is it worth it, or does the Minister really believe that the complaints will be rare? On which leg is the Minister standing? I do not think that civil servants are the proper people to run things of this kind. I believe that in any country where bureaucracy has grown and got the upper hand it has ultimately been to the disadvantage of that country, no matter what sphere of occupation one thinks of, whether it be medical science, running hospitals or anything else. I quite recognise that as civil servants they can do their work remarkably well, but bureaucracy is the last thing that you should allow to creep in to every possible institution in the country.

We were considerably relieved with what I may call the second portion of the Minister's speech. I myself was very much afraid that, when he had finished reading the typescript before him, he was going to sit down. I think I can congratulate the Minister and the House that he did not sit down when he had finished reading the typescript, because he then gave us some indication of the amendments which he was prepared to introduce into this Bill. The amendments sketched out by the Minister will undoubtedly relieve, to a considerable extent, the anxiety felt. I think that everybody will willingly pay that tribute to the Minister. In conclusion, I would ask him to make a real effort to try to check that spirit of getting everything more and more into the hands of Government Departments. If he did that, I think he would be doing a good work not merely for the hospitals, but for the running of government in this country.

Mr. Briscoe

I want to refer to this Bill from probably a different angle to that dealt with by the previous speaker. Perhaps I may be almost in agreement with him on some of the matters that he referred to. First of all, I would like to remind the House that this country has benefited from the Hospitals Sweeps in a way that no other country in the world ever has. An opportunity came to this country which, when availed of, turned out to be beyond the wildest dreams of anybody from the point of view of financial success. Nobody could have imagined that, as a result of the success of the Sweepstakes, such great benefits would accrue to those of our people who most needed them. Deputy O'Sullivan reminded the House of a remark that I made in it seven years ago in connection with our hospitals.

It is quite true that I said the voluntary system was dead. I did not use that phrase in the sense that Deputy O'Sullivan has given to it, and he knows quite well what I meant. I stated then that previously the hospitals had been supported mainly by voluntary subscriptions, and that because of the sweepstakes they would no longer benefit by those subscriptions. There was, at that time, a large accumulation of funds available for the benefit of the hospitals generally, and it was expected that, apart from the carrying out of improvements in the hospitals and the paying off of overdrafts, there would be sufficient to endow and maintain the hospitals in the future and thereby make them independent. I stated that because of all that it would be very hard to get back to the old position under which the hospitals were supported by the voluntary system.

I want to say quite frankly that, to a certain extent I am somewhat disappointed with the Bill. I had hoped that, because of the extreme urgency and need in our bigger cities, particularly in Dublin, for extended hospital treatment, there would be in this Bill some reference to the establishment of a municipal hospital. The Bill proposes, by means of the control of beds and so forth, to try to bring about something of that nature, but I do not think that is going to work out. The last speaker spoke of the responsibility which the State has to what are termed the voluntary hospitals. My view is that the State has a much larger responsibility to the people who should be the beneficiaries from the large funds which have been accumulated, and which are now available, to provide better medical treatment and hospital treatment for the general body of our people. I was also hoping, because I think the matter was discussed on a previous occasion, that there would be, in connection with the establishment of a municipal hospital, a large general hospital in which an opportunity would be afforded for the employment of very eminent medical people.

The possibilities at the moment of providing those people with employment in this country are very limited. I had hoped that some portion of the funds available would be set aside for research work in medical science here. This Bill may do a certain amount of good. It may meet certain complaints made at the moment, but, at the same time, I do not think it is going as far as it should in the direction of fulfilling the hopes of the people generally. I have met, in countries abroad, a number of medical people who either studied in this country or did post-graduate courses here, and I was pleased to learn that in certain branches of medical science they have been very successful. But I do believe that if we did take the responsibility in the proper manner and if we met the situation as we should, instead of dealing with this matter as it is before us now in the Bill, there would be an opportunity of seeing how far the funds available would permit of the establishment in the City of Dublin of a large municipal hospital.

I want to repeat again, in view of the fact that Deputy O'Sullivan referred to it and was trying to make out that it was in connection with another aspect altogether that I used the phrase, that I did say that the voluntary system is dead in so far as it concerns the voluntary support of the hospitals. I do not think it would be fair to attempt by any legislation to put back the hospitals which have benefited from the Sweepstakes into a position where they would again have to appeal for voluntary support. We now have the responsibility of utilising these funds in a way that will leave no room for future criticism of this Government or the previous Government, who, to their credit, made it possible for the Sweepstakes to be started, and in a way that will be of lasting benefit both to this and future generations. I think the Minister might consider not rushing this Bill; he might consider holding it back and probably having a consultation not only with the voluntary hospitals as they are described, but, as I would call them, the private hospitals, but with the medical profession generally, with a view to seeing in what better way can this money now be employed so as to assure the maximum benefit to our generation and also to the future generations that will follow us.

Mr. McGilligan

The last contribution was a welcome one. I think the Deputy spoke thoughtlessly. The Deputy must have realised, when speaking about the great benefit that came to the hospitals of this country from the Hospitals' Trust, and deploring, as he did, the absence of the voluntary contributions which used to come in, that there were two circumstances each of which had its impact on the situation which developed. One was that there was the advent of a new source of supply for the hospitals, and the second was that the country was going through a hard time in the last seven or eight years, and that people generally had not a great deal of money to give in voluntary contributions to the hospitals. But there were a favoured few gilt-edged industrialists, and if the Deputy wanted the voluntary system re-established, he might well have taken the lead.

Mr. Briscoe

I do not believe it will ever happen.

Mr. McGilligan

The Deputy might have given a lead. The Greeks of long ago had a custom that when men came in for a fortune they threw away something in order to prevent Nemesis overtaking them. It would be a welcome addition to any hospital to have a contribution from the Naas delicatessen factory, or from the Roscrea dead meat factory.

Mr. Briscoe

Or the Wicklow gold mine.

Mr. McGilligan

Or the Wicklow gold mine, from which, if it had not been stopped in mid-course, profits might have been made.

Mr. Briscoe

The voluntary system stopped long before the economic war.

Mr. McGilligan

I will admit that. Instead of talking about the resurrection of the voluntary system, it might have been brought about by the gilt-edged industrialists of his type.

Mr. Briscoe

I am not a gilt-edged industrialist.

Mr. McGilligan

Some return might be given to the State for the chances made available to the Deputy. I came to the House this evening to face up to my duty under this Bill with two contrasting pieces of information in my possession in connection with bed bureau schemes.

Mr. Briscoe

Then the personal end is finished?

Mr. McGilligan

Unless you like to start it.

Mr. Briscoe

I shall listen with interest to a decent contribution if the personal side is finished.

Mr. McGilligan

I have such a fund of personal anecdotes about the Deputy that I could go on for quite a long time.

Mr. Briscoe

I could indulge in personal stuff also.

Mr. McGilligan

I do not think the Deputy would receive the anecdotes very enthusiastically.

Mr. Briscoe

We can exchange them.

Mr. McGilligan

I came into the House in possession of two items of information which were in sharp contrast. One was the information conveyed to me, and I think it has not been gainsaid in the House yet, that the main hospitals in Dublin—they were described as four hospitals, but in fact there are six—had, with the aid of the Minister's advisers, evolved a co-operative scheme for the establishment of a bed bureau without any State interference of a compulsory type, such as we have under this measure, and that the agreement had been presented to the Minister's predecessor in the late part of the year 1938. We are presented now with what is an urgent problem, after the Minister's predecessor drooped and slumbered over what these people gave him in 1938. I saw no criticism of that scheme. Nobody knows yet what is in the scheme. We do know that it was a co-operative form of voluntary business arranged by the main hospitals in this city and that, as in the First Stage of this Bill, it was to apply to the city alone. This was arranged in a voluntary way. There was no hint of criticism with regard to that. It was locked in the fastnesses of the Department until this Bill emerged.

In any event, there was a scheme which was contrary to that which we get in this Bill, which is State interference of the most radical type. There is a growing tendency towards that. The Ministry in recent years have gone in for all sorts of things. They interfered in the flour business and thrust 6,000,000 loaves off the tables of the people. They interfered with bacon and put 250,000 cwts. of bacon off the breakfast tables of the people. They went into the bogs in Kildare and sunk a lot of State money there. They went in for the slaughter of calves all over the country, and for the slaughter of dead meat in Roscrea.

Mr. Briscoe

They did not slaughter dead meat—they slaughtered live cows.

Mr. McGilligan

The Deputy was the livest thing about the dead meat factory at Roscrea.

Mr. Briscoe

We hear very little about it to-day.

Mr. McGilligan

That is the tendency revealed here. What is there in this measure but the crudest form of State interference? Deputy O'Sullivan said he would give the Minister certain sections of the Bill, and we would all give him certain sections. We will give him Section 5 and the long Title. I understand that Section 5 is the urgent matter. That could be carried through this House inside a week. But in every other respect— in Sections 1, 2, 4 and 6—this Bill is riddled with Government interference. Section 1 is worse even than State interference—it is deceitful. It brings in hospitals as a matter of compulsion because they have got certain subventions from the Hospitals Commission, although at the time the subventions were given there was no condition attached to them. After what we have been told by the Minister, I hope his promises will be implemented in full. I was rather amazed to hear the breadth of the disclaimers the Minister made. The Bill is not going to be retrospective in any degree. In fact, as from the date of the introduction of the Bill, the hospitals are to have an option whether they will come in or go out. That was, in fact, what the Minister stated. By way of an interruption I got his assent to it. Section 1 had the other provision— that hospitals were to be brought into this willy-nilly because they took funds, although when they took these funds no condition was attached.

Section 2 provides for the establishment of a bureau. The first sub-section opens smoothly enough. There was to be a bureau established by the Hospitals Commission with the consent of the Minister. The Minister was there, but he was only lurking in the background. Then you come to sub-section (2) which is radical and ruthless. It provides that the Minister may by regulations prescribe the manner in which any bureau established shall be carried on, and such regulations may impose-duties on the governing body or on any person taking part in the management of any of the hospitals concerned, including certain things. But the general phrase which comes first is limited by the narrow words which follow:

"Impose duties on the governing body or on any person taking part in the management of any of the hospitals concerned."

Simply because there was a bureau established, the Minister, by regulations, can impose duties on the management of the hospitals. There is reference to the establishment of committees. That whole scheme for the establishment of committees shows distinctly the grip of the Civil Service.

"Where a bureau is established under this Act in relation to two or more assisted hospitals, the Minister may appoint an advisory committee in respect of such bureau and such committee shall, as regards the governing body of each of the said hospitals, contain at least one person who in the opinion of the Minister is representative of such governing body."

The Minister was to appoint an advisory committee, and even though the hospitals might think it proper to put upon it someone as their representative, the Minister alone was to say whether that person should or should not be their representative on the governing body. As if that was not enough, the Minister was to fix the tenure of office of the committee:

"and may at any time revoke the appointment of such committee or any member thereof or alter the constitution of such committee".

If someone came to the committee who, the Minister thought, might be depended on at the beginning but turned out a little bit reluctant later, then the Minister could remove him because he has not obeyed orders sufficiently or to his liking, or he could abolish the whole committee and set up a new one. Section 4 deals with matters of complaint, but there was a statement to-night that what was in the Bill was not intended. Bills on presentation are supposed to contain what is meant and we are entitled to discuss this Bill as presented to us. Arrangements as to the hearing of complaints are made but are not limited to the representative body. A complaint is made to the Minister. It has to beat two tests, that a person is refused admission or that the treatment is unreasonably delayed. Suppose a complaint is made and the Minister operates that section—

"the Minister may, if in his discretion he so thinks proper, cause an inquiry to be held in relation to such complaint and may appoint a person to hold such inquiry."

That is the centre of the measure. Provision for complaint is made and the person to receive the complaint is the Minister. When the Minister gets a complaint, it is in his sole discretion to decide whether it is a proper complaint and to appoint a person to hold an inquiry. When he thinks it proper, he appoints a person to hold an inquiry. These are powers given the person who holds the inquiry:—

"If any person—

(a) being duly summoned to attend as a witness at an inquiry, fails to attend, ..."

That can only have reference to members of the hospital staff, to people concerned somewhere in or about the subject-matter of the complaint in relation to unreasonable delay or nonadmission. If they do not come along or if, having come along, they refuse to take the oath, to produce documents or to answer questions, then they are guilty of an offence and may be fined £5.

To take the most odious comparison that occurs to me at the moment, you are putting the management committees of the hospitals in the same position as some recalcitrant member of the I.R.A. who is brought before the Military Tribunal under the Offences Against the State Act, and refuses to recognise the court. It is thought that that is the proper attitude in connection with hospitals committees in this State, six of which had already presented some sort of scheme to the Minister as far back as 1938. I pass over Section 5, which I consider is one that should be granted at once. Section 6 (2) tells us:—

"For the purposes of the performance of the duties of the Minister and of the Hospitals Commission under the Public Hospitals Acts, 1933 to 1939, and this Act, any officer of the Minister duly authorised in that behalf by the Minister or any officer of the Hospitals Commission duly authorised in that behalf by the Hospitals Commission may exercise in relation to every assisted hospital all or any of the powers specified in the principal sub-section."

The reason for that has still to be explained to me. As I understood, under the old Act every member of the Hospitals Commission was entitled to visit, to inspect and report. Every member of the Hospitals Commission has duties thrown upon him, including the collection of, and digesting of information with regard to the facilities for hospital and nursing treatment provided. There is a further clause—I cannot say which one—which gives the Minister power to decide who goes as representative of the Hospitals Commission into any of the hospitals. Those authorised to inspect must get the approval of the Minister. I would have considered that, as under the old Act, if the Minister required inspection, he could get it through the people delegated by the members of the commission. Here we get the Minister brought in again. The Minister may authorise any officer to exercise in relation to every assisted hospital the powers in Section 14 (6) of the Act of 1933. It is more or less narrowed down compared with the old Act, but we have the same obnoxious business that anyone who interferes with the exercise of the powers is liable to be fined £5.

Here there is a reduction to a very low level, indeed, of the staffs of the hospitals. In the background there is lurking this question: Has a case for the establishment of that rigid way been made? The Minister to-day was facile on that. He said that everyone admits the necessity, and there is a feeling that there ought to be a bed bureau set up.

The feeling is based on the contention that the hospitals are not doing their duty. Accepting, so to speak, justification for certain complaints as the test, I believe the Minister's statement would not be taken as a statement of fact. The desire of the hospitals to have a bed bureau scheme established may be due to their present good position, so that they do not care about any of these inquiries. They may feel that they are strong enough to face the public on any matters alleged against them, and I think it is a welcome sign from the hospitals as to how they are carrying out their duties that they are ready to have an investigation as to how they stand. No case has been made for that. The only concrete point the Minister made was that at some recent inquest the coroner made some remarks; on these remarks the Minister stands. On that, somewhere in the Department, this particular measure was thought out.

This Bill has State interference written all over it. It is State control that is going to be imposed on the hospitals. This State control is going to be imposed on them whether or not they accept certain funds. There was some sort of State control before, but this is an appallingly bad measure. As far as I am concerned, I want to see Section 5 going through. I do not think there is any principle in the measure. The Bill contains a series of bad clauses. The principle of State control is inherent in it. How far it goes we will not have any idea until we see the amendments. Until I see the amendments, I have to suspend judgment as to what in the end I will do about this measure. It will get permission as far as I am concerned to go another stage, but it is only going that length, until I see what is in the Minister's mind. When we came to the House this evening, the noose of the Department of Local Government was around the necks of the hospitals. They are now, more or less, in a state of suspended animation. Let them be suspended. It may not be a comfortable position, but they can get their feet on the ground again. If there is going to be anything in the nature of State control—no matter how little it may be—unless the hospitals have the fullest freedom to get out of it, I shall be against the Bill at a later stage.

Dr. Hannigan

There are one or two remarks that I want to make on this Bill, but I am not quite sure if they are strictly relevant. It seemed to me that the Minister's statement was not only in conflict with certain clauses in the Bill, but actually in conflict with the spirit of the Bill. When I read the Bill first I was very favourably impressed, because I took the view that the Government had at last become alive to its responsibilities to the public which had for so long been dissatisfied with the control and the running of the hospitals in Dublin. The principal cause of the dissatisfaction has been the difficulty of securing the admission of non-paying patients and patients who could only make a microscopic contribution towards their maintenance in hospitals supported by what are regarded as public funds, namely, the accumulation of the Hospitals Trust funds. It was quite apparent that considerably organised opposition would have been directed against this Bill in its original form. To my mind, that opposition could have been effectively answered by putting the question. "What improvement has taken place in the hospital system in the past ten years to justify its retention?" I refer to the haphazard and unorganised system of admissions to these hospitals. The Minister apparently preferred to take another course, to yield on certain vital matters which destroyed the whole effect of the Bill and which will produce a bed-bureau scheme which will not be effective. The Government has shown great patience in delaying so long in the setting up of a hospital bed-bureau scheme. It has, to my mind, displayed patience to a criminal degree in allowing this matter to be delayed so long. For years the voluntary hospitals had been alternately coaxed and threatened to produce an organised scheme for the admission of patients, but so great was individual jealousy and rivalry, and indifference to the real point at issue, that no scheme was forthcoming. The provisions in this Bill undoubtedly fulfil the requirements of a good bed-bureau scheme on paper.

I had hoped, foolishly enough, that the passage of this Bill in its original state would be secured and that, when it became an Act, it would be properly operated. I mean by that that the provisions of the Bill would be interpreted not in the letter but in the spirit. I have heard this evening the voluntary hospital system extolled to the skies. I should like the members of this House to hear the views of some of the dispensary medical officers and some of the humble practitioners who spend their lives working amongst the sick poor and the working classes. They would find that their views were much at variance with some of the views expressed here to-night. From time to time, as many of us recollect, references have been made at coroners' courts to the death of some unfortunate whose life might have been saved if immediate admission to a hospital had been obtainable. I am sorry that the Minister is not more impressed by public references such as these than by vested interests, organised opposition and the tremendous pressure which, undoubtedly, has been brought to bear on him to change his mind on this Bill.

Mr. Costello

Deputy McGilligan has so completely explained the attitude which I should propose to take on this Bill that I intervene only for the purpose of underlining and pointing the moral to be drawn from the circumstances attending the introduction of this measure. I spent three hours in the House this evening waiting for an opportunity to speak. I was largely prevented from speaking by a speech of a colleague of the Minister who is introducing this Bill in which he denounced Deputy O'Higgins, following upon another colleague—the Minister for Defence—who had previously denounced Deputy O'Higgins. Being forced to leave the House for the purpose of receiving some sustenance before dealing with this Bill, I returned, having missed the statement of the Minister in charge of this Bill and, to my surprise——

Mr. MacEntee

Is this in order?

Mr. Costello

To my surprise, I discovered that Deputy O'Higgins was handing out bouquets to the Minister for Local Government. The spectacle of Deputy O'Higgins handing out a bouquet to any Fianna Fáil Minister was so unusual that it rather startled me, and I wondered what had been the change of attitude on this Bill, not having heard the Minister's promises. Having read the Bill for the first time, it appeared to me that there would be two public reactions to it. In the first place I thought it would lead to what I believed would be the newest revolution in this country. The I.R.A. are under the impression that they are to cause the next revolution. I think they are wrong. There is going to be a bloodless revolution by the ordinary, decent person against bureaucracy. That is going to be the first revolution. When the implications of this Bill were understood I was of opinion that it would assist in the forthcoming revolution to which I have referred. The second reaction which, I thought, would come from this Bill, if persisted in, was a reaction against the sweepstakes themselves. I thought that the Bill would probably bring about the early and complete closing down of the sweepstakes. I had intended, because of the principles enshrined in the Bill —so far as there are any principles enshrined in it—to vote against the Bill. I left the House with that intention and returned to achieve that object. I gather now that the Minister has given way on a considerable number of points. I, like Deputy McGilligan, suspend judgment until I see these changes in black and white, and can bring my judgment and professional skill to bear on the amendments dealing with the principles of bureaucracy and State-control underlying the measure.

Why was the Bill introduced in this form? That is the point which I wish to underline. We had a separate Bill introduced by the Government to enable the sweepstakes to be carried on in the manner in which they are intended to be carried on under Section 5 of this Bill. That Bill was withdrawn and a Bill for the establishment of a hospital bureau was mixed up with a Bill for the carrying on of the sweepstakes. It appears to me that that was purely a trick on the part of the Government. They intended to put those people who are anxious that the sweepstake authorities who want to carry on particular types of sweepstakes should get the authority proposed to be given them under Section 5, in the position that the Government could say to them: "If you do not give us this Bill, including the bureau and bureaucratic power over the bureau, the sweepstake authorities will not get what they want."

There could be no other explanation of the extraordinary character of this Bill, looked at from the point of view of drafting or scientific preparation. Apparently, the Minister has now given way on most of the obnoxious clauses in this Bill but he has given no explanation as to why he has mixed up the two proposals. I am not satisfied that he has given way or that he intends to give way on the principles that appeal to me. Section 6 of the Bill comprises a very obnoxious principle, but I am told that that is a matter to be fought out subsequently.

So far as this Bill has any principle in it, it is the principle of establishing a bureau. As far as I understand, the provisions in reference to the bureau were submitted to the Minister's Department a long time ago by the hospitals concerned. There was no necessity, therefore, to bring in this Bill unless the Department intended to attach to it a system of State control, and to set up a bureaucracy to administer it. The fact that the Minister has only now granted the concessions he has indicated is clear proof that the Department of Local Government has given way to the pressure of public opinion as disclosed in the last few days. My purpose in speaking here to-night is to underline the moral, that if public opinion is sufficiently militant, sufficiently vocal, it will force the Government to give way to the wishes of the public as so made vocal. I am quite satisfied that were it not for that vocal public opinion, expressed in the Press by doctors and hospital authorities, were it not for the vocal public opinion expressed on behalf of religious communities engaged in the carrying on of hospitals, we would have the Minister standing over every line and clause of the Bill as introduced. That is the principle I wish to underline here to-night so that the public may understand that if public opinion becomes sufficiently vocal, the Government will have to bow before the storm of such opinion and that it is well worth while to organise public opinion against a measure of this kind. We have the Minister giving us certain undertakings, but not a single clause of the Bill with the exception of Clause 5 is necessary. The question of the provision of a bureau could be dealt with by agreement. The fact that it was introduced in the present form is capable of only one answer, that this Bill represents the Minister's original intentions but that the Government have had to bow before the storm of vocal public opinion in the last few days.

Mr. Ruttledge

This Bill on one side has been given perhaps the widest possible interpretation. An atmosphere of suspicion in regard to it has been created for the last week or so. Arising out of that suspicion—unfounded and unnecessary suspicion— there has been an attempt to give it the widest possible interpretation rather than keep to the strict meaning of the provisions of the Bill. I am sorry that the debate concluded on the note struck by Deputy Costello. On any measure I have introduced to this House I have been at all times ready to concede any amendments or to make any concessions that I felt I could safely concede, and what I have conceded in this Bill does not in the slightest degree prejudice the effectiveness of the Hospitals Bureau. If I thought for one moment that any of the alterations or amendments, as I have already indicated in my opening statement, were going in the slightest way to render the purpose of the Bill nugatory, or that they would in the slightest degree prejudice its effectiveness, I would not agree to such amendments. Let us be clear on that.

It is not a question of pressure of what Deputy Costello calls public opinion. The opinion we have heard expressed is the opinion of people whose opinions anybody must respect, people who have given their service and their time to the advancement of medical science in this country. The Minister, however, is chiefly concerned with the position that has arisen in regard to the treatment of the sick poor, with devising some reasonable method of meeting this position and of alleviating the sufferings of these poor people. That is the only concern he has. The Bill, as introduced, may have got, and may be entitled in some respects to get, the wide interpretation that has been given to it. I believed in considering this matter that I could get the desired effect by amending the measure, and, as I have already indicated to the House, I am prepared to make such amendments. It is not a question of pressure of public opinion. We have always been anxious, so far as we could, to get that co-operation which is essential for the successful operation of a measure of this sort.

Reference has been made by Deputy McGilligan to the agreement that was reached between the hospitals. I understood that that agreement was reached between four of the principal hospitals and that the others had not come in. Suppose there was agreement between six, that bureau is not applicable to the present position. At that time it was intended that the bureau would operate when it had 600 beds available and that the Dublin Corporation and the Dublin County Council would have representatives on the bureau because patients from St. Kevin's would be sent to the hospitals through the bureau. At no time was it stated in these negotiations or in that agreement that the bureau as then contemplated could work unless and until these new hospitals were built and 600 new beds were provided.

Deputy McGilligan referred to the fact that I only gave one concrete example and that was a reference to a coroner's inquiry. I said that I understood that it was accepted on all sides that the necessity for a hospitals bureau existed. I have not heard anybody in this House, nor have I seen any articles in the Press in the last few days since this controversy arose, stating that a bureau was not required. In fact all the statements were to the contrary. I referred in my opening statement to the reports of the Hospitals Commission. Time after time, they pointed out the difficulties that have arisen through the fact that a hospital bureau was not in existence. I know that people connected with social organisations who are constantly in touch with the poor have frequently pointed out the crying need for a hospital bureau. We have, therefore, to face the position which these representations indicate. We know that hospital accommodation is limited. Reference has been made to the number of beds in this city and it has been asked where are the extra beds provided. That question has been raised with a cloak of suspicion thrown round it so that I think it worth while to refer to the matter in some detail.

This is a table showing the number of beds in hospitals in Dublin City in 1929, and in February, 1940. I shall read the increase in each case. From 1929, as compared with 1940, the increase was: Sir Patrick Dun's Hospital, 12; Mater Misericordiae Hospital, 50; Meath Hospital and County Dublin Infirmary, 7; Richmond, Whitworth and Hardwicke Hospitals, 7; Royal City of Dublin Hospital, 25; Dr. Steevens' Hospital, 17; St. Kevin's Hospital, 174. That makes, for the general hospitals, a total increase in the number of beds in 1940, as compared with 1929, of 292. In the special hospitals, the increase was as follows: Maternity hospitals—National Maternity Hospital, Holles Street, 95 beds; Coombe Lying-In Hospital, 20; Rotunda Maternity Hospital, 16. In other hospitals the increase was: Children's Hospital, Temple Street, 58; National Children's Hospital, Harcourt Street, 17; Teach Ultain, 30; St. Patrick's Infant Hospital, 12; City of Dublin Cancer Hospital, 8; Royal Victoria Eye and Ear Hospital, 32; Catholic Institution for the Deaf and Dumb, 20; St. Vincent's Home for the Mentally Defective Children, 195. This makes the net increase in beds in the special hospitals 503. In Dublin County the increases were as follows: St. Michael's, Dun Laoghaire, 41; Orthopaedic Hospital, Cappagh, 40; Our Lady of Lourdes Hospital for Tuberculosis, Dun Laoghaire, 32; Peamount Sanatorium, 89; Convalescent Home, Cheeverstown, 18; Linden Convalescent Home, 87; St. Augustine's Colony for Mental Defectives, 120. That made a grand total increase in the number of beds of 1,188. I give those particulars now as I have been questioned here on a number of occasions as to where those beds were. We know that we have not a sufficient number of beds available to operate a bureau in the way it was hoped that it could be operated when that agreement was arrived at between my predecessor and the hospitals.

Dr. Hannigan

If there were sufficient beds, there would be no need for the bureau.

Mr. Ruttledge

It would be very useful if patients were coming in from hospitals in the country. You might have one hospital full and another not, and, while there might be no very great necessity, the bureau would be in a position to fulfil a very useful service. Some reference has been made to complaints. I would not like to see penalties imposed on anybody in a Bill of this kind, any more than anybody else would. It may not seem to be a proper thing, if it could be avoided, and I will look into the matter. So far as complaints are concerned, the very same thing inserted in this Bill was accepted in that agreement, that is, with regard to the delay in admission for treatment or the delay in treatment after admission. I have met some people, and I understand that the sole objection they would have would be to any inspection with regard to the treatment, medical or surgical. This provision for a bureau—which was agreed on between these hospitals—set out that it was:

"... to investigate complaints in regard to admission to, or refusal to admit any poor person to, or delay after admission in giving medical attention to any poor person in any of the hospitals concerned, and to report thereon to the Minister if so requested by him. (The right of the committee to inspect and investigate complaints would not empower them to interfere between a medical practitioner and a patient in regard to the nature of the treatment afforded or to be afforded by him to the patient)."

That has been followed in the Bill. That is the only sort of inspection we want. We do not want to inquire into the treatment by a doctor of his patient. There have been cases from time to time, however, in the Department—I only know of one or two since I went there, but I have been informed that there were cases before that—and no matter how well-conducted an institution may be there will be cases from time to time where very serious results have arisen from delay in treatment. I do not wish to suggest in any way that the hospitals are not well and properly run, but cases may occur where a hospital may not have control over itself or could not be regarded as having actual knowledge that may be brought to our attention and on which we may be able to take action to make that hospital more careful in the future. Whether merely bringing it to their notice would have the same effect as the claborate procedure outlined here, I do not know. It is felt that it would not. Again, when I say that there may be cases of delay in admission or of delay in treatment, I must add that these are very rare.

A good deal has been said about the regulations. They will be made in consultation with this committee. The committee should know their own business and, certainly, their advice in regard to the drafting of these regulations ought to put those regulations, in the ordinary way, in such a position that the Minister or his Department would find nothing to disagree with in them. The committee which will make these regulations will be elected by the hospitals themselves. I do not know whether I can simply say: "Let the hospitals elect them, and do not leave them subject to sanction." There may be some difficulty about that, but the hospitals certainly will, in their own organisation, nominate their own members. I am not going, as Minister, to criticise or interfere with those appointments. Whether or not I should tie, for all time, a Department to such a procedure, I do not know. It may be found necessary to specify a certain period. That might be a matter on which the hospitals themselves might be able to give some assistance, in suggesting whether there should be a change of board from time to time. I do not propose to nominate anybody or to appoint anybody on that board. This advisory committee will be composed entirely and completely of the representatives of the general and special hospitals. I again repeat that I do not want to interfere with the nominations in any way. They can nominate whomsoever they like and I will accept that, in the ordinary way.

There is a suggestion that we are interfering, that this is in the nature of bureaucracy, and that we are bringing the Local Government Department into the matter too much. I do not like to be hearing, every time that anything such as this takes place, something in the nature of an attack on civil servants. After all, the person to be attacked in connection with a Bill such as this is the Minister concerned, and not the civil servant, who is not in a position to defend himself. If the Minister concerned is doing his job, he should be responsible for whatever comes into this House in connection with any Bill that he is bringing in, and he should stand over that Bill. If there are faults in this particular Bill, I am sure that we shall do our best to correct them on the Committee Stage, but I think it is not fair that any Minister should try to fall back on the civil servants, and I, personally, certainly would not do so. If it is suggested that some of the provisions in this Bill are too wide, that may be so, and we can correct such matters on the Committee Stage. When we come to see the effect of this bed bureau system, if it can be made better by altering it or making provisions that would make it more palatable, then it does not matter, at least, so far as I am concerned, because all I want is to make the Bill as good and effective as possible. It has been suggested that Section 6 here might be divested of the powers given in Section 14 (6) of the Public Hospitals Act, 1933. This had reference to the duties assigned to the Minister under Section 14 (6) of the Act of 1933.

Mr. Cosgrave

I think it is really in sub-sections (4) and (5) that this matter arises, and I think that, under sub-section (4), of that section, the Minister is given certain powers, such as to remove any member of the Hospitals Commission, and so on.

Mr. Ruttledge

Yes, I know.

Mr. Cosgrave

Except for that, the Minister did not take any power for himself under that sub-section, but I think that he has power to interfere under another sub-section.

Mr. Ruttledge

Yes, I think that is so, but it must be remembered that you had, in the reports of the Hospitals Commission, various recommendations made to the Department.

Mr. Cosgrave

To the Minister?

Mr. Ruttledge

Well, yes, to the Minister; but in this report of the Hospitals Commission, of 1933-34, certain headings are set down as to the agreements to be entered into by the Minister and the hospitals concerned. I suppose it is not quite fair to refer to anybody outside this House, but I think I should be permitted to say that there is a body of medical opinion in this city which, time after time, has lauded the report of the Hospitals Commission. I imagine that their appreciation should carry some weight, but in any case I think that everybody else lauds that report and, in my opinion, quite rightly so. However, after going into the details of the various hospitals, the commission suggested various headings of conditions, in their 1933-34 report, and the headings are as follows:—

"(a) That the institution shall continue to be used as a hospital and that no section of it shall be devoted to any other purpose than that contemplated at the time the grant is made except with the concurrence of the Minister.

"(b) That the hospital shall continue to be run as a charitable institution and that no portion of its income shall be utilised for purposes other than those affecting the essential services of the hospital.

"(c) That an appropriate number of the patients accommodated annually in the hospital shall be treated free-of-charge.

"(d) That the hospital shall be run in such a manner as to be as nearly self-supporting as possible, without detriment to the fundamental principles of providing, as far as possible, efficient medical treatment and attention for all classes, or the charitable purpose of providing free hospital treatment for the poor, which is the primary object for which voluntary hospitals have come into being.

"(e) That the hospital shall be subject to inspection at all reasonable times by authorised representatives of the Minister."

And so on. Now, the position is that agreements have been entered into with certain hospitals and have been accepted, and, under these agreements, provision is made to the effect that the Minister's representative may, at all reasonable times, inspect the hospitals concerned, with regard to seeing whether the provisions imposed on the Minister by the Act are being carried out.

Mr. Cosgrave

Perhaps I might be permitted to refer the Minister to Section 24 and 25 of the Act of 1933, which have to do with the making of the grants out of the Hospitals' Trust Fund. I think that the Minister is being put now into the position of being the judge, which I think he ought to be, but also into the position of being the advocate. I put it to the Minister that if he is going in, and not an official, according to what he has just told us, he is now imposing upon himself two offices: firstly the office of an advocate and, secondly, the office of judge.

Mr. Ruttledge

No, I do not think so. The Minister, or his representative goes in only for a certain object.

Mr. Cosgrave

Yes, and on which the Hospitals Commission have reported. However, would the Minister consider that point?

Mr. Ruttledge

Yes, I shall, but I do not think there is the slightest ground for alarm, so far as the hospitals are concerned.

Mr. Cosgrave

It seems to me that there is, at least, a prima facie case there, at any rate.

Mr. Ruttledge

Well, it is a thing that is in operation in several ways in the hospitals, and, so far as I understand, the medical view is that the only objection is to inspection with regard to treatment of patients, from medical and surgical angles.

Mr. Cosgrave

Yes, and probably inadvisable from the same angles. However, I think that the Minister would be better advised not to allow himself to be put in the position of being both advocate and judge.

Mr. Ruttledge

Very well; I shall look into the matter.

Mr. Cosgrave

The Minister is either a Minister or a civil servant, but he cannot be both.

Mr. Ruttledge

Yes. At any rate, I shall look into the matter. I do not think, Sir, that there is anything more to be said here. So far as I understand, the Bill has been accepted by the House, and whatever can be done in the way of improving the Bill, we shall endeavour to do on the Committee Stage, and I shall certainly bring in amendments to cover the points that have been raised.

Mr. Cosgrave

How soon can we expect to have these amendments? When does the Minister want the next stage of the Bill?

Mr. Ruttledge

I should like to have the next stage to-morrow week, if possible.

Mr. Cosgrave

Yes, but when may we expect to have the Minister's proposed amendments?

Mr. Ruttledge

I shall try to get them out as soon as possible. I may have them by Friday, but I am not sure.

Mr. Cosgrave

In the event of the Minister's amendments being available on Friday, how long will we be given to put in our amendments?

Mr. Ruttledge

Would Monday be all right?

Mr. Cosgrave

Yes, if we have the Minister's amendments by Friday that would be all right.

An Ceann Comhairle

Very well; Monday will do.

Mr. Cosgrave

Monday would be all right. It would give members opposite time for the post.

Question put, and agreed to.

Committee Stage provisionally arranged for Wednesday, 8th May, 1940.