It is proposed to take this Bill on Tuesday next also.
Vol. 100 No. 3
It is proposed to take this Bill on Tuesday next also.
This amendment asks to include on the advisory council which the Parliamentary Secretary proposes to set up members of local authorities and social welfare workers. We were arguing this amendment last night. The Parliamentary Secretary having slept on it, I hoped he might change his mind and not be so sarcastic this morning. There is no use in going back and telling the House what was done 21 years ago. We are living in a different world to-day, and every section of the community is looking forward to better conditions. The problems of public health are not merely medical problems. While it might be advisable for the Minister to have councils composed of medical men to deal with purely medical matters, there are other aspects of life equally important from a preventive point of view, on which men with practical experience of everyday life should be called in an advisory capacity. As the amendment points out, members of local authorities as social welfare workers have knowledge of social and economic problems, and if we look forward to operating this Public Health Bill successfully we must provide machinery to deal with the problems that are there. Listening to the Parliamentary Secretary last night, it appeared to us that he is concerned with the medical aspect, and that the only advice he proposes to seek is advice from medical men on a highly complex scientific problem. That is necessary, but we consider that it is essential that he should set up a consultative council to deal with the economic and social aspects of equally essential problems.
The Parliamentary Secretary cannot deny that a good standard of living is most essential to good health in the family circle and that that is dependent on fair family income. We cannot ignore that aspect of the problem. The Parliamentary Secretary cannot deny the wisdom of providing a council to advise him on social and economic matters. I hope he will reconsider this whole matter. A council drawn from the people suggested in the amendment would be very useful and could give the Minister very valuable advice. It is not enough to say that you are going to look after the medical side and the medical problems. Social and economic problems are there and are contributing in a great measure to the pretty low standard of health in the country at the present time and the high incidence of disease. It is merely waste of time to talk about the provision of councils of scientists to deal with scientific matters if we are going to ignore the other and more pressing problems.
I have been rather amazed at the amount of discussion that this amendment has evoked. I was inclined to think that the amendment was not necessary because the Minister, in the section, has taken power to include the type of people referred to specifically in the amendment, but the tone of the Parliamentary Secretary, and the manner in which he has met the amendment, indicate how necessary it has been to have the amendment in specific terms. One would have thought, reading the section, that the Minister, in the exercise of his power and knowledge in connection with the administration of this Bill, would take the necessary steps to consult all those who would be specially qualified in the particular aspect of the public health problem that this section adverts to. It would appear now from the attitude adopted by the Parliamentary Secretary that those who have the misfortune of being associated with local authorities or public welfare workers are to be excluded. I thought the amendment unnecessary. I thought that those people, if they had the necessary qualifications, would automatically be included in consultation if and when the particular issues under discussion came within their ambit, but I take it now, from the attitude of the Parliamentary Secretary, that any of these persons is automatically excluded from consideration, that he refuses to give them the right to be included as ordinary citizens because they come into the categories defined in the amendment. I should like the Parliamentary Secretary to make that point clear before the amendment is put to a division. I should like him to indicate whether or not that is really his intention, that he is going to decline to consult welfare workers or members of local authorities, irrespective of the qualifications they may have or how they may be able to advise upon certain aspects of the public health question. If we are to be told that the vendetta is complete against local authorities, we ought to be told it now. I do hope the Parliamentary Secretary will not be satisfied with a smile but will tell us something.
Is the smile objectionable to you?
It makes me smile too. It is infectious.
I think this section would be improved if the Parliamentary Secretary were to accept the amendment. In fact I think he should welcome the amendment and should be glad to invite representatives of the various organisations doing social work in this country to give their advice and the benefit of their experience and their suggestions as to the prevention of disease. There are organisations such as the Catholic Social Service Conference who visit people in their homes and see how they are fed. They have food centres and clothing guilds. If the people were properly clothed and nourished it would go a long way towards relieving the pressure on our sanatoria. There is the Saint Camillus Order that visits the sick in their homes. They know their requirements. Representatives of such an organisation would be very valuable on a council such as is now suggested and could suggest remedies for some of the grievances that they have seen. We all know of the splendid work done by the St. John Ambulance Brigade in their dining halls throughout the city. They realise the need for proper diet for expectant mothers. They and the Catholic Social Service Conference are doing splendid work at the moment. Surely the advice of the chairman of the public health committee of a great city like Dublin, that is up against the difficulties of public health services every day in the week, should be welcomed by the Minister. The Infant Aid Society has 400 voluntary visitors who visit the homes of the people and make reports of conditions in the homes of the unemployed and recommendations in regard to a suitable supply of milk for these people. Surely that is a public health matter. Their visitors see the neglect of the homes; they see the delicate baby, the barefooted children, the ill-nourished children. Surely people like that should be welcomed in the Custom House. The Custom House dictators should not get it into their heads that all the brains in respect of public health matters are in the Custom House. I am satisfied that very valuable information could be obtained from those who visit the sick, the aged and the blind. There is the St. Vincent de Paul Society, which we are always praising for the splendid work they do. Their members do not seek the limelight but are able to write privately to the various people concerned and tell them of the conditions of the poor people in the City of Dublin and elsewhere in Ireland. Surely all those people could give valuable advice to the Minister. I say that he should welcome the suggestion that welfare workers and representatives of the various boards throughout the country should come in and give him their valuable assistance. The attitude of the Parliamentary Secretary since this Bill was printed is to trample on friendly and valuable suggestions from all parts of the House —Labour, Clann na Talmhan, Fine Gael, a few of us on the back benches. We are as much interested in public health as he or anybody associated with him and we put forward with all seriousness, all honesty and sincerity, views that we think will help the Parliamentary Secretary. Yet we are trampled on. I go further, I say that Parliamentary representation has been trampled on by the Parliamentary Secretary.
Will the Deputy deal with the amendment?
One time, last night, when you were not in the Chair——
I have nothing to do with when I am not in the Chair.
The Parliamentary Secretary practically sneered and laughed at suggestions. He openly laughed at the Deputies.
Last night I heard at least three or four Deputies telling the Parliamentary Secretary of his alleged offences against this House. We might now deal with the amendment.
I agree. I am not going to deal with that matter this morning, but personally I was inclined to resent his attitude generally. This Bill is going to take up a lot of time and, as one Deputy said, he hoped that having slept on the things that were said yesterday, the Parliamentary Secretary would come in this morning in a more friendly frame of mind towards those who are putting up suggestions. I put forward a few suggestions to him now as to how I think the Bill could be improved. All these voluntary organisations outside know what is required. The lay visitors who attend the sick and dress their wounds—I have known members of the St. Camillus's Order to dress the wounds of tuberculosis victims—and who know all these things ought to be welcomed and I think the Parliamentary Secretary should welcome them.
I would be sorry if any of the Parties in the House or any of the individual Deputies would feel that there is an element of personal enmity entering into this matter as between their views on this measure and mine. For that matter, there is not any political consideration entering into it from my point of view. I am concerned now, as I was concerned when the Bill was drafted, and as I have been concerned for the years in which I have been exercising Ministerial functions, with the problems that this Bill is intended to deal with. I am concerned with nothing else. I would wholeheartedly welcome the co-operation of any and every Party in this House in making the Bill a better Bill if it could be made a better Bill. But it is asking a lot of me when Deputies ask me to accept as an improvement on the Bill amendments that undoubtedly will not be an improvement and, in very many instances, will operate to restrict the proper application of the measure.
Now, I realise the difficulty of the Fine Gael Party. I am perfectly frank about this. I think they made a mistake. I think they read into the original measure quite a lot of things that were certainly not intended. I think they ought to concede that, in the amendments which I have circulated, I have gone a tremendous distance to meet the point of view expressed on the Second Reading and to allay any genuine fears which may exist as to the scope and purpose of this measure. In fact, is it not true that I have been twitted, for example, in the Irish Times, with having so radically altered my attitude by reason of the amendments I have circulated that I must not have given the Bill proper consideration? An attempt was made to hold me up to public ridicule in that article in the Irish Times because I have attempted to meet the viewpoint expressed on the Second Reading and that has been conveyed to me in the many discussions which I have had since the Second Reading with various sections of the community, with, in fact, almost every element of the community that is intimately concerned with this Bill. I tried to meet that point of view. I think I have succeeded in meeting it reasonably. But, in the meantime, the Fine Gael Party and other Parties, but mainly the Fine Gael Party, have flooded us with 550 or so amendments.
I am accountable, I think, for 126, so that I cannot give you credit for the whole of them. Do not ask anybody to believe that these 550 odd amendments are a constructive effort to produce a better measure. They are not.
What about this one?
I am coming to this one. I am searching for that better atmosphere that Deputy Hughes, Deputy Byrne and Deputy Keyes wish to create. Last night we had Deputy Cogan pleading for a better and more friendly atmosphere. I have the friendliest feeling in the world towards the whole of them, strange to say. That is the way I am constituted.
As the Americans say, you are not succeeding in putting it across.
Even Deputy Morrissey is not half as bad as he pretends.
A fellow feeling makes us wondrous kind.
Deputy Hughes is right—the night's sleep did him good.
There must not have been too much on his conscience or he would not have slept at all. Coming to this particular amendment, as the Ceann Comhairle suggests, I do not believe that it would improve, in fact I do very firmly believe that it would disimprove the Bill substantially. On the question of consultation with representatives of local authorities and social workers and all that, does not every Deputy know that, if there is any section of the community that is in close touch with the Ministry of Local Government and Public Health, it is the representatives of the local authorities? Day after day, we have their viewpoint on public health matters and on social questions. They meet in their local bodies, their views are expressed in the Press, they come up on deputations to the Department, and there are many of them here in the House who avail of the many opportunities afforded to them to express their viewpoint on local government and public health matters.
When we were discussing this matter last night I drew the attention of the House to the fact that the problems upon which we had not the necessary advice in the past, or on which we required further assistance, were mainly problems of a scientific nature. There is no end to the advice to be got from members of local authorities; there is no difficulty whatever in the various public health and ancillary matters relating to public health problems. But scientific problems are in a different category altogether. I need not delay the House. The Deputies do not appear to have paid very much attention to it because they do not appreciate it as keenly as I do. They are so full of this particular amendment of their own that they are not prepared to give due weight to the importance of the policy that I have in mind regarding Section 12.
If this amendment were accepted, sub-section (3) would read:—
"Every consultative council established under this section shall consist of persons, including members of local authorities and social welfare workers having practical experience or special knowledge of the matters in respect of which they are to give advice and assistance."
"Every consultative council established under the section shall consist of persons, including members of local authorities and other social workers...." Do Deputies seriously consider that that would be a workable section, that if I set up an advisory committee to advise me on the desirability of setting up a biological standards laboratory—I do not want to talk a lot of technicalities over the heads of lay Deputies; that is not at all my desire—of setting up a serum institute, of using of penicillin in the treatment of venereal disease, in substitution for some of the older remedies and how far that would be desirable; how far it would be able to change over completely to new methods of treatment not only of that disease but of many other diseases—they are only a few of the many problems we have to deal with of a scientific nature—and if, on every one of these committees we must have members of local authorities, would it work? It would be an absurdity. There are other delicate problems which I need not mention and which would not fit in so well.
No opportunity has been neglected of discussion with social organisations in the City of Dublin and throughout the provinces, and with members of local authorities, and securing their viewpoint on the aspects of these social problems on which they are specially qualified to advise. No opportunity will be missed in the future, but I cannot agree to the principle that members of local authorities are to be members of every advisory consultative council or committee which from time to time may be set up to advise the Minister on a problem concerning which local authorities would not be of any assistance.
Unless there is a change of heart on the part of the Opposition, I feel that it is futile talking to them, because it does not matter how overwhelming, how reasonable the case may be, it will not make the slightest impression. One can only conclude that the Opposition will have their debate and will make their demonstration and that it does not matter how foolish or how disruptive the acceptance of their amendments might be. They apparently propose to continue in that line. I wish they would not. I would welcome their co-operation, and I say that with the greatest sincerity, but, at the same time, in my effort to get them out of the hole into which they have put themselves, I cannot spoil the Bill.
The Parliamentary Secretary cannot spoil the Bill. It is a pity he thought it necessary to spoil the tone of the beginning of his speech. If I had been able to get on my feet 20 seconds earlier, I had intended to congratulate the Parliamentary Secretary on his conversion to reason and on the more reasonable tone of his remarks.
Would it help the Deputy if I withdrew the last 20 seconds?
The Parliamentary Secretary made it perfectly clear in the last 20 seconds what his real mind on the Bill is. He has made it quite clear——
Go ahead. You will get plenty of it.
——that people on this side cannot convince him that they are actuated, in their approach to the Bill, by any motives other than political motives and desiring to score off the Parliamentary Secretary.
And 550 amendments.
The number of amendments depends on the Bill. We have had very important Bills in this House, Bills which probably would cost even more money than this Bill will cost, and there were not 550 amendments to them. Yesterday we dealt with the Committee Stage of a Bill which will cost £4,000,000. It was a Bill of 72 sections and there were 49 amendments, and solely because the Minister in charge not only knew his Bill inside out but appreciated the motives which actuated those who were criticising the Bill, that Bill of 72 sections with 49 amendments and involving £4,000,000 went through the House in two and a half hours.
The Parliamentary Secretary is concerned with what the Irish Times thinks of him. He is concerned with getting Fine Gael, as he says, out of the hole in which they have put themselves. He says that Fine Gael made a mistake on the Second Reading in opposing this Bill at all and that they ought to admit it. If nobody else, either inside or outside the House, has justified to the full the stand taken by Fine Gael on this Bill, the Parliamentary Secretary himself has done so. I do not hold against the Parliamentary Secretary the fact that he has introduced over 100 amendments to the Bill. That is one of the things I hold in his favour, but does he not see any point in that in relation to this amendment— that following consultation with ordinary non-technical people in this House—because that is what it amounts to—having got advice from members of the House and having listened to the contributions which they made on the Second Reading, he felt that he could, by acting on these suggestions and on some suggestions received from people outside, improve his measure to the tune of 100 or 120 amendments which he has introduced himself?
Where was the mistake made there? By whom was the mistake made? Perhaps if the Parliamentary Secretary had had a little more consultation before the Bill was introduced, fewer amendments to it would require to be fathered by him now. Fine Gael did not make any mistake. On the contrary, Fine Gael was apparently the only Party which saw the absolute dangers in the Bill as introduced and it is only now that other people both inside and outside the House are waking up to these dangers. It was only after we had exposed the dangers in the Bill, the danger to the citizen from the point of view of his health, his personal liberty and his pocket, that people both outside and inside the House began to take proper interest in the Bill. The Parliamentary Secretary may go on, for whatever length of time this Bill is before the House, with his little sneers. They are going to have no effect one way or another. If he thinks a pose of that type, a pose of contemptuous unconcern, is going to have any effect on this House, he is making a very big mistake.
It is quite clear that he is approaching all these problem purely from the point of view of a medical man. It is ordinarily of benefit to have at the head of our public health services a properly qualified medical man and the fact that he has medical qualifications could be of tremendous benefit in the administration of the various public health codes. However, if that political head of a Department with professional degrees is going to allow his outlook to be limited and be rigidly confined within—I am sure he will not misunderstand me when I say this— that narrow sphere, and if he is not able to see any class, group or section of people outside the qualified medical men who are in a position to give any beneficial advice in relation to the prevention of disease, then I am afraid, far from it being an advantage to have a medical man at the head of our public health services, it may be better if we had a non-medical man there.
I do not want to go into all the economic questions that some of us believe are the main root and main cause of disease, but I think it is admitted by any person who has any ordinary common sense at all that on the conditions under which people are forced to live depends to a large extent whether they will be healthy or unhealthy. It is a matter of the extent to which they are nourished or can be nourished out of their income. We know that persons suffering from malnutrition—children, in particular—are not able to resist disease. I am not blind at all to the fact that the medical profession, or certain sections of it, and particularly the dispensary doctors, are in close personal touch with the living conditions of the people, especially of the very poor people. I know also that they are concerned about those conditions and that they know that, as long as those conditions obtain, so long will disease continue and increase. Those medical men, and particularly those dispensary doctors, can and are only too willing to give advice to the Department which would be of value; but I find it hard to believe, from the Parliamentary Secretary's attitude, that he is prepared either to seek or to accept such advice.
If he conveys any idea to the House by that attitude, it is that he does not feel he is in any need of advice from anybody. He takes the line that all these amendments of ours are purely obstructive, he talks about our making demonstrations and says that we will go on making demonstrations and that we are trying to restrict in every way his efforts to deal with public health. The Parliamentary Secretary is possessed either of a peculiarly warped mind or he is saying something he does not believe at all. If he is so completely steeped in Party politics that his mind is warped to that extent, then I am afraid the administration of this Bill will be in the hands of a person who will not administer it to the best advantage. He said last night that he was concerned mainly with having his councils constituted of people with scientific knowledge— medical scientists. I do not know whether or not he meant people outside the medical profession. I think that is not wide enough.
There is a disease in this country responsible for confining more people to their beds and certainly for taking them away from their normal work than perhaps any other disease. That is rheumatism, which is responsible for the loss of more work hours or work days than any other disease. I am not a medical man and know nothing at all about medical matters, but I have heard it said as long as I can remember, by various medical authorities, that rheumatism is contracted and allowed to develop mainly through negligence and through ignorance. It is a common thing, particularly in the rural parts, to see comparatively young men so crippled that they are not able to perform their ordinary work. That is due, in the main, I have been told, to heavy wettings disregarded at the time and when they have been going on for a long period they end ultimately in chronic rheumatism. I am concerned as to whether the Parliamentary Secretary has in mind, in connection with this Bill, a properly planned publicity campaign, whether he would consider consulting a publicity expert in the case of rheumatism and other diseases which can be checked by a proper understanding and properly directed publicity. We know that, while one can spend a great sum of money on publicity, it is possible that publicity costing half that amount and properly directed might bring ten times the reward. If this Bill is to be operated purely and solely by medical men we will not get out of it the results we should get. There is no use in talking about putting an end to tuberculosis or to malnutrition while you are faced with the fact that thousands of families are unable to get enough to eat.
That is away from the amendment.
I am not opening up a new line, but I can relate it to the point. First-hand information on that particular aspect can be given to the Minister by social welfare workers and by members of local authorities, in a much fuller and much more practical way than by the members of the medical profession. The Minister is laying all the emphasis, in his refusal to accept this amendment, on the cure of disease.
We are all concerned with the curing of disease, but I think we must all realise that measures to prevent disease are far more important and urgent and, if we confine ourselves solely to the curative aspect and ignore the preventive aspect, which is apparently what is going to happen, if we are to judge from what the Parliamentary Secretary has said and from his attitude, then this Bill will fail, no matter how it may be improved during its passage through the Oireachtas. The Dáil may legislate to its heart's content and produce the best Bill possible, but, if it is not administered in the proper way and in the proper spirit, then it will not bring the results that it should bring.
I do not want to follow the Parliamentary Secretary over the wide ground he has traversed, but he has raised a point to which I should like to refer. He says he has been trying to bring the discussion to what he would regard as a satisfactory basis. I am quite prepared to take him at his own measure. The sole purpose in this amendment, from what one can gather is in the mind of Deputy O'Sullivan, is to provide that where there are problems that are going to be the basis of the activities of consultative councils, then, in relation to these problems, the members of local authorities and social workers, who have certain practical experience and who can make a useful contribution, will not be excluded. The Parliamentary Secretary has stated that if the amendment is accepted every consultative council must include social workers and members of local authorities. That is not so. The object of the amendment is to include people who have practical experience and, because of that, can give helpful advice and assistance.
That is not the legal interpretation.
I will take the Parliamentary Secretary up on that point. The suggestion I am making is that where there is a problem on which the Parliamentary Secretary desires to receive advice and assistance from a consultative council, and that problem is one in which even the Parliamentary Secretary is satisfied that certain members of local authorities and social workers can, because of their practical experience, give good advice and assistance, then their advice and assistance should be sought. Would the Parliamentary Secretary be prepared, on the Report Stage, to amend the section so that they will not be excluded?
They are not excluded.
I think it might be better to have the section indicating clearly that they will be included. At the moment it would seem that the whole purpose of the section is to establish these councils on a rigid and narrow basis.
No. I stated already that if and when we are confronted with a problem upon which social workers or representatives of local authorities have specialised knowledge we shall be quite glad to get their advice and will take the necessary steps to secure that. But I will not accept a statutory obligation to make the members of local authorities members of the consultative councils. The Minister has full discretion, without this amendment, to appoint such persons, if he deems it fit to do so.
I should like to remind the Parliamentary Secretary of a body that has given great help in this country—that is, the Jubilee Nurses. I feel sure that the committee that formed the Jubilee Nurses would be pre-eminently in the minds of Deputy Morrissey, Deputy Larkin and the other contributors to this debate. Members of the association would not go forward for any county council seat. They are great social workers. There are 266 of these associations in Ireland. They subscribed a lot of money since Lady Aberdeen instituted the association and they have done wonderful work. It would be rather a pity to ignore them. Indeed, you might make the Jubilee Nurses' Association the basis of your future schemes. I believe they would give very valuable assistance as members of a consultative council.
Amendment put and negatived.
I move amendment No. 37:—
After sub-section (3) to add a new sub-section as follows:—
The Minister shall on the establishment of a consultative council under this section publish in Iris Oifigiúil the purpose or purposes for which such consultative council has been established and the name and qualifications of the members thereof.
I suggest to the Parliamentary Secretary that it would be a help to us all, and perhaps to himself, to have that done.
There is one particular difficulty about the publication of the names in Iris Oifigiúil and that is in relation to consultative councils. The members of those councils might subsequently act on a selection board. Take, for example, the recent appointments of persons who would undertake a nutritional survey. We had to have prior consultation with certain people who had specialised knowledge, as to the qualifications that we ought to lay down for the persons who would be candidates for undertaking a nutritional survey. The personnel who advised us as to the qualifications acted as the selection board. A somewhat similar position will arise in relation to the staffing of some of our specialised institutions, particularly our sanatoria. Men may have to be selected in advance and perhaps sent abroad to carry out a special line of investigation or a special course of training. The selection of a personnel in such circumstances is, as everybody will agree, rather a delicate matter.
Regardless of the spirit in which such a problem might be met in the House, there is also a certain amount of suspicion outside as to the manner in which these selections are made and it is very difficult so to plan as to ensure that nobody can have any grounds for complaint or suspicion. In such circumstances, if the advisers should form, as they have done in the past, the personnel of the selection board, and if their names were published in advance, I rather think these individuals would find themselves in a difficult position when candidates would get to know who was on the selection board. Otherwise there is no objection to it, but that does constitute a difficulty and that is the one that suggests itself to me.
I earnestly suggest to the Parliamentary Secretary that until our public get to know who are the leaders of thought, the leaders of advice, in our various professions, we will not have any public confidence, on the one hand, or any real public education, on the other. If, under an Act passed here, a consultative council is set up, I think it would be really ludicrous that the public, in a widespread way, not to talk about responsible representatives of the people, should be deprived of knowing who the persons were who were selected to advise the Minister as members of a consultative council.
I will undertake to look into this matter between now and the Report Stage and see if a draft could be devised that will meet the Deputy's viewpoint and at the same time obviate the difficulty regarding selection boards. It probably would be possible to exclude that particular type of advisory committee from the members of the councils whose names would be published. Perhaps that will meet the Deputy's view.
I quite agree. The Parliamentary Secretary seems to have a difficulty in his mind. He seems to consider as consultative councils bodies that we would not normally consider as such. He seems to have in mind the gathering of a few people together to give advice—an ad hoc committee, as it were—as a consultative council.
I think he will find in practice that he will have to differentiate between what can be regarded as a consultative council and what is not. I take it that if we provide for a consultative council occasions will arise when people will be invited to act on them. If they were brought in for other matters, in order to have a preliminary consultation about things on which they would subsequently act as a selection board, that would be different. They might be brought in for consultation but hardly on a consultative council.
I take it that what the Deputy has in mind is more or less a continuing consultative council, one that would remain in being for a substantial period, as distinct from the type of ad hoc committee that might remain in existence only for two or three days, or perhaps for a week. I am prepared to meet the Deputy on that.
The Minister will review the matter for the Report Stage.
I move amendment No. 38:—
Before Section 13 and in Part III of the Bill to insert a new section as follows:—
Every county authority shall appoint an appeal board which shall consist of not less than five and not more than seven members, of whom not less than two members shall be clergymen, one member shall be a registered medical practitioner and one member shall be a solicitor or barrister of not less than ten years' standing. It shall be the duty of the appeal board to hear and decide any complaint made regarding the manner in which the Public Health Acts are administered in the county.
The appeal board may order the release of any person detained under these Acts, or the transfer from one institution to another of such person.
The appeal board may make recommendations to the county authority regarding the administration of the Public Health Acts in the county.
No person employed by the Department of Local Government and Public Health or by the county authority shall be a member of the appeal board.
This seeks to provide an appeal board, by which any citizen who feels that he is seriously aggrieved by the operation of the Act may secure redress. The type of appeal board I have envisaged is one that shall be established in each county and nominated or appointed by the county council. On that point I suggest it is desirable that such a board should be set up in each county. It might be recommended that it would be better to have one board for the entire State. That is a matter upon which it is difficult to express an opinion, without knowing how many appeals are likely to arise. If there is a good deal of work to be submitted to such an appeal board it would be better to have a board for each county. It would be undesirable to have a board which might be compelled to devote a considerable amount of time to the work. If you have an independent board, I believe it would be better to have one composed of individuals engaged in other avocations or occupations, who now and then might be called in to adjudicate on questions that arose between citizens and the authorities. If there was one board for the entire State, that might mean that the board would become more or less a professional body, as it would have to devote too much time to the work. It is not the intention of the amendment that the members of such a board should be paid, should receive remuneration or even expenses of any kind, but would be purely voluntary when acting in the interests of the public. The appeal board, of course, would have one definite power, where a person who was detained under this Act appeals, if the board is satisfied that that person was unjustly treated, it might release him. In addition, if a person desired to transfer from one institution to another, the board would have power to grant the transfer. That is absolutely essential for that type of appeal tribunal.
That is in operation.
That provides for an appeal to the Minister. I do not think an appeal to the Minister is a satisfactory safeguard for the citizen. We are now building up a high health organisation. It is like a vast pyramid on the top of which sits the Minister, and from all branches of that organisation a great deal of work will be directed to the Minister's attention. There is great fear that the Minister would be unable to give proper attention to an appeal that might be made by some humble citizen in a remote part of the State, or perhaps by some patient interned in an institution. A free untrammelled and unrestricted body such as is envisaged would be able to decide such matters on their merits. On the Second Reading, when I made this point, the Minister asked if my suggestion was that an appeal should be made to the farmers' union. I think that was rather a cheap sneer on the Parliamentary Secretary's part, and he may regret it.
It was only a joke.
Maybe. I accept it as such. Even if there was an appeal to farmers it might, in certain cases, constitute a safeguard for ordinary citizens. We know that on a murder charge the tribunal that is called upon to decide whether a person is guilty or not guilty is composed of plain citizens, who might be farmers. A tribunal of citizens could decide questions of this kind with much more impartiality than a Minister. The amendment suggests a tribunal of citizens of high standing. I suggest two clergymen for this reason, that by reason of their vocation they have a deep knowledge of human rights and failings, as well as the necessity of safeguarding individual liberty and the dignity of human personality. I suggest at least two clergymen in order to give representation to the different religious denominations.
There would be more than two, I am afraid.
I do not think the Parliamentary Secretary would seriously suggest that every religious denomination should be represented upon a body of this kind but, at any rate, there should be two. A medical doctor and a member of the legal profession would also be desirable on such a body, the medical man, obviously, because of his knowledge and training in medical matters, and a member of the legal profession because of his training in legal aspects of human rights and liberties. Such a board would be a valuable safeguard to the citizens who might feel that their rights might be seriously endangered by reason of the operation of this Bill. At certain times during the debate the Parliamentary Secretary has said that there was a conspiracy between all Parties against him—I might say.
An unholy alliance.
An unholy alliance, as Deputy O'Donnell has suggested. There has been no alliance, holy or unholy, as far as this Bill is concerned. We have all approached it, perhaps from different angles, with absolutely independent and open minds. The Farmers' Party, weighing the pros and cons of the Bill, consider that its main purpose is desirable inasmuch as it seems to extend compulsory institutional treatment and we consider that such compulsory institutional treatment is necessary at the present time for dealing with certain infectious diseases. At the same time we consider that some safeguard should be grafted into the Bill in order to ensure that no citizen will be wrongfully interned and, perhaps, unjustly treated while so interned. While medical doctors and staffs of the various institutions are persons of very high standing and reputation, there is no use in pretending that they are all infallible and perfect. In every institution you will find the petty tyrant; you will find the person with some little petty spite, who will vent it upon people who are completely at his mercy. It is for the protection of the weakest, the most helpless section of the community, that this tribunal is so essential. We have all read of the terrible things that have happened in other countries as a result of the streamlining and controlling of all human activities. There is a big measure of control being introduced in this Bill over human liberties and we, as a legislative Assembly, should be careful to see that accompanying such control are such safeguards as are embodied in the amendment.
Who are the people that Deputy Cogan visualises as administering this Bill? Following Deputy Cogan's suggestion to its logical conclusion, there would be no need for a Minister dealing with public health. Deputy Cogan has developed a certain fear of the Minister. He would prefer to see anybody at all administering this Bill than the Minister that the people of this State have put into the position of administering it. It is very difficult to understand his outlook. He tells this House that the public must be protected against institutions. If the Deputy has any fears, would he be more explicit and tell the House what those fears are? He makes a point that the liberty of the individual will suffer very severely as a result of this Bill. On the Second Stage of this Bill very fine contributions were made to the debate dealing with the matter of personal liberty. Anything contained in this Bill was inserted for the sole purpose of protecting and safeguarding the people as a whole, not any private individual, and because certain sections are embodied in the Bill for the purpose of safeguarding the health of the people, somebody may come along and say, as Deputy Cogan has said, that he wants a certain body set up that will leave the Minister in the position of being more or less an ornament. I cannot visualise that any Minister in a democratic country will do anything extraordinary or anything other than what is for the benefit of the community as a whole. The House should realise that the healthy people of this country have liberties and rights which can only be protected by the control of persons suffering from infectious diseases. It cannot be imagined that anybody would abuse this Bill to the extent that Deputy Cogan seems to think it will be abused.
I hope the Parliamentary Secretary will not object if I depart from my usual line and speak against the amendment. I will try to get back to line later. There might be some purpose in trying to provide for such a form of appeal in a general form but I do think that the way in which Deputy Cogan has gone about it is not practicable or very helpful.
We are concerned here with a Bill, at least in so far as its new features are concerned, leaving aside for the moment the question of maternity and child welfare, that is dealing in the main with the problem of infectious disease. It is proposed in this amendment that there should be set up in every county authority an appeal board which will have power, inter alia, to deal with any Order issued under the various sections under which a person was required to be isolated in an institution or to take other measures to protect other people against the infectious disease he may be infected with. Is it not quite clear from that point of view that such an appeal board will not be practicable? If we are dealing with infectious disease, to my mind, speaking as a layman, speed is required in isolating that person and securing that he receives proper medical attention. Take it for granted that something has gone wrong under the Act, by the time the appeal board has met to consider the matter, in nine cases out of ten, I would expect the person would have recovered completely from the infectious disease. That is one feature that I think is an argument against its practicability. Secondly, if a person had not got an infectious disease and had been wrongfully isolated, again the appeal board would not operate sufficiently quickly to bring him the immediate redress that is necessary. There is a provision in the section under which an appeal can be made to the Minister. Deputy Burke is very anxious to defend the Minister against us all, but I think he is well able to look after himself. I am not suggesting that in this particular case we are dealing with some of the more objectionable features we have had in the last few hours in this House. In that section, where there is an appeal to the Minister, I think that in itself would be sufficient with, if you like, some improvement in order to provide that the person making the appeal could have immediate recourse and immediate opportunity to make the appeal. I will deal with that when we come to it. In the particular amendment we are now dealing with, I cannot see that the particular type of machinery suggested would be of any great benefit to any person who would desire to appeal in relation to the new features of the Bill that we are dealing with.
Deputy Cogan goes to some pains to set out what should be the personnel of the board. Let us take it for granted that, when a person has been isolated as having an infectious disease, the board meets. I presume there will be a report from the particular medical officer who has made the order and has charge of the particular patient. Is the board, with its lay knowledge, going to decide against the medical expert knowledge of the doctor that this person should or should not be isloated? I have sat on a board and discovered that, outside exceptional cases, the tendency of a lay board is to accept the expert advice given. An appeal board of this character I think would find great difficulty in deciding on the merits of a case unless they had an expert medical inquiry in regard to the case. My experience of most of the medical doctors in charge of institutions is not that they want to keep people in, but, unfortunately, that they do not often take them in quickly enough, either because they have not the accommodation or because they do not realise the urgency of the cases. It is very rarely that they are anxious to keep a person in when he wants to get out. In the case of mental disease, they do not want to keep the patient in if they are satisfied that he can with safety to himself and other people be released. The very fact of a medical practitioner suggesting to a board that they can raise a difficulty may lead to a conflict between the medical practitioner sitting on the board and the medical officer who has dealt with the case and who has to make an expert report. I suggest that if we do want to provide a more speedy and more efficient appeal, we should try to do it on the particular sections as we come to them. This amendment in its present form does not commend itself to me as an acceptable way of dealing with the problem.
I support the views expressed by Deputy Larkin. I think the amendment is unworkable and entirely impracticable. If the appeal board are to meet at all, it would be considerably after the event and any decision they would reach would perhaps have no bearing on the patient's grievance. If they were to meet at all, they would have to meet ad hoc to consider the particular complaint made by a patient. These men would perhaps be residing in different parts of a county and the difficulty of getting them together to consider a grievance of this kind would in itself render the provision unworkable. At the same time, I feel that, having regard to the drastic powers in this Bill, the Bill will be operated in certain cases on police principles, that the treatment is forcible, and that the detention is forcible. There must be some way of enabling an aggrieved patient to ventilate his grievance with a considerable degree of urgency. I think also that there must be some way by which a complaint of that kind can be heard at once and a decision reached without undue delay.
Is not that on the section?
I consider that this amendment really is misplaced, that this should really come on Section 29, if anywhere. What I want to get at is that, if a serious case does arise and a person is forcibly detained under the provisions of the Bill, he has redress in the ordinary courts. I do not see anything in this Bill that will prevent him from seeking a habeas corpus motion to release him from his detention. If I am correct in that view, I believe that a habeas corpus motion will in extreme cases be the quickest way of remedying any grievance and I ask Deputy Cogan not to press the amendment.
Deputy Cogan looks feelingly towards me. Perhaps he would like to have my view put on record. The fact of the matter is that the proposal has been so effectively disposed of by Deputies Larkin, Coogan and Burke that there is not much left for me to say. Deputy Cogan, I think, did not anticipate the acceptance of his amendment. I do not think it is necessary to delay the House very long in dealing with it. It has been pretty well scotched already. If it were accepted, it would present an absolutely unworkable machine. In fact, we would be duplicating our public health authority in every county. We would have the county council in the provinces and the corporation in the cities and we would have superimposed on them this other body which would have certain functions in relation to the administration of public health services. "The appeal board may make recommendations to the county authority regarding the administration of the Public Health Acts in the county." Suppose a public health authority are not discharging their duties, it is necessary that this other body should be superimposed on them to see that they carry out their duties. Complaint is made as to the degree of control which is exercised by the Minister over local authorities. But, if they have two clergymen, a doctor and a lawyer superimposed on them in addition to the weight of the Minister, if these men are anyway near the top of the pyramid, near the Minister, it would be top-heavy, I am afraid. On the matter of recommending the release of a person who was still in an infectious condition in the opinion of the responsible medical authority, these people apparently would be given certain functions of a directive nature. You would have conflict there immediately.
The medical doctor who will be a member of this board that Deputy Cogan suggests should be set up might not necessarily have any public health qualifications at all. The county medical officer of health, who will be the chief medical officer under the Bill, at any rate is an expert in public health. Not only that, but he has statutory obligations regarding the protection of the health of the community. Somebody else, without any particular qualification at all, is to come along and say: "You should not have that man confined at all. I do not agree with you. You must release him". We would have the conflict that Deputy Larkin referred to, and nothing but confusion could emerge from it.
We will have a further discussion on the principles relating to this amendment at a later stage, and I think that the appeal machinery will be sufficient to ensure that such elements as petty tyranny and petty spite, which Deputy Cogan had in mind, will not enter into the equation. The fullest facility for appeal to the Minister on the part of a person detained as a source of infection or as a danger to the community will be afforded. Amendment No. 129 of the second group of amendments makes further provision, if the patient is detained for more than six months, for a special examination and report by an officer sent out by the Minister, although the patient may not take the initiative or move in the matter. However, that is another day's work and we will meet it later on.
The Parliamentary Secretary has talked a good deal on this Bill about an unholy alliance and a conspiracy against him, but here we have now a very unholy alliance and a very closely-knit conspiracy against this amendment. The Labour Party, Fine Gael and the Government Party are all linked up together to defeat the ends of justice which are sought to be furthered by this amendment. The Parliamentary Secretary warmly applauded the statement by Deputy Larkin——
That is the new atmosphere.
It was always present, but the Parliamentary Secretary did not see it.
——that this appeal tribunal is unworkable. What was the ground on which Deputy Larkin stated that it was unworkable? He said that speed was essential. The question of speed does not arise at all, because the main purpose of the amendment is to safeguard a person not against unjust arrest or internment of a very short and temporary nature, but against being interned for a very long period. It is that type of case which this appeal board is mainly designed to meet, and the question of speed does not, therefore, arise at all. The tribunal can meet and consider carefully over a long period the rights or wrongs of any appeal made to them.
It was also suggested that this appeal board might not have the necessary professional or expert qualifications to deal with such an appeal, but neither has a judge on the bench who deals with complex cases submitted to him. He has to hear the expert evidence of both parties in the case and use his own judgment to decide between them. This appeal board, as an impartial and responsible body, can hear the expert evidence of both sides and weigh up as between them, and it is at least as capable of judging as between one body of experts and another as the Minister. The Minister may not always be an absolutely infallible expert on all matters which may be submitted to him.
Deputy Burke, I think, went a little too far in his enthusiasm to support the Parliamentary Secretary and to defeat this amendment. He told us that the Bill seeks to safeguard the health of the people. I agree with that. He says that healthy people have rights. Of course they have, but so, too, have unhealthy people and so, too, have invalids. They, too, have rights which ought to be safeguarded, and it is not just or right that we should trample upon the liberties and rights of even one obscure patient, in order to advance the interests of public health. The end does not justify the means in the matter of public health any more than in any other matter. Justice must be done to every individual citizen, no matter how diseased, how sick or how weak he may be. He has his rights, which ought to be safeguarded. They are not safeguarded in the Bill. I have failed to find any adequate safeguard. An appeal to the Minister, when we have a suspicion as to the type of Minister we will have, is no safeguard whatever and the House is very foolish in lining up behind the Parliamentary Secretary and conspiring with Deputy Larkin in seeking to defeat this amendment.
I agree that this is impracticable and, if Deputy Cogan will think about it, he will have to admit that it is impracticable. The Bill is drastic in many respects and, because of its drastic provisions, I can understand the Deputy's anxiety to bring in safeguards of this sort, but I suggest that this proposal is not helpful in that respect and would not be a safeguard because, so far as the individual is concerned, if he is an infective case or suspected of infection—and right through the whole measure, because of contacts or otherwise, a man may be a suspect, or a probable source of infection, to use the actual words in the Bill—and a medical officer says he is a probable source of infection and he is isolated, surely the question of justice can scarcely arise.
It is really a matter of a man's opinion, and he is entitled to his opinion, and his opinion is not to be questioned. If he says: "I believe this man is a probable source of infection, and, because he is a probable source of infection, he is dangerous to the community," there is no matter there which you can bring before a board. He may be wrong, and another medical man may differ, but if the House agrees to give him the power to say that a man is a probable source of infection, that is an end of it. It cannot be questioned by a board, by the Minister or by anybody else.
In the same way, if a man is detained in an institution for a considerable period, it may appear to his friends to be unreasonable, but if he is a reactor and continues to react to tests, he will not be released, because while the reaction is there he is a probable source of infection. If there is an appeal to a board and the medical officer in charge of the institution comes before the board and says: "This case has reacted for a period. I am annoyed about it, but he has reacted, and while he is a reactor, I cannot release him" there is no appeal on that and nothing can be done about it. The medical man in charge wants to get rid of his patient, but he cannot release him because he is a persistent reactor, and until he is cleared up and proved to be a safe case to discharge, he will be detained. I do not see that a provision of this sort will be helpful in any way.
The one thing about which I am concerned and about which this Party is concerned is to try at all costs to get the co-operation of the individual, rather than to force him into an institution. We should appeal to the individual's sense of what is right and proper in the circumstances. We should have his co-operation and he will be a better patient on the basis of co-operation rather than on a basis of provisions of this sort. If the Deputy considers it, he will realise that this board will not serve any useful purpose. So far as a board of this sort, giving a direction to a health authority, is concerned I think a health authority would resent being given a direction or advice as to their administration. They might feel, as the Parliamentary Secretary says, that it was a reflection on their capacity as administrators. I could not support the amendment.
Many years ago, Charles Reade, the novelist, wrote a book on the matter of detention which led to an inquiry into the running of private asylums. I understand that now the certificates of two medical men are required for the internment of an individual. For reasons of property in the time I speak of, the certificate of one medical man was sufficient. When inquiries were made at that time, they found that many men were detained in these private asylums, and hence the necessity of getting a second certificate. It was a matter of securing property belonging to the so-called insane patient. If any such people were detained now, is there any right of appeal for a patient in such a hospital, even though he is detained on the certificate of two medical men? Has he not the right of appeal after being some years confined in that way?
Deputy Hughes has completely demolished the case against this amendment, and I think all Parties concerned ought to consider a new line. Deputy Hughes says a man could be interned on a medical opinion, and that a board such as envisaged in this amendment could not upset that.
On suspicion, I say—do not misrepresent me—of being a probable source of infection.
Yes, on a medical doctor's opinion that a man is a probable source of infection; but is it not within the power of the board to call in another medical man and set one opinion against the other to see which is correct? That happens in court, where we have conflicting opinions on medical and other matters, and the judge has to weigh them up. Deputy Hughes made what might have appeared to him to be a strong point. He said that our main purpose should be to appeal for the co-operation of the patient.
I think that is absolutely essential. As far as possible we should make the patient feel he is not being persecuted. Persons suffering from various infectious diseases, particularly tuberculosis, are inclined to develop a persecution complex, to feel that they are being persecuted and wronged by every section of the community, and particularly by the medical profession. If there is no appeal to any impartial tribunal, that sense of grievance may grow; but if there is an appeal, and if that independent tribunal on careful investigation decides that the patient is suffering from an infectious disease, then it will be more easy to secure the co-operation of the patient with the authorities in whatever institution the patient is.
The Deputy is making a very hypothetical case.
It is not a hypothetical case. We are going to deal with hundreds and perhaps thousands under this Bill, with all types of people, some of whom will feel they are very grievously wronged, and that the whole machinery of the State is being mobilised against them. This amendment seeks to provide a safeguard which would give them a sense of confidence and security, so that they will not feel they are up against a conspiracy—such as I appear to be up against in this House.
I am not standing firmly for the particular wording of this amendment. If the Parliamentary Secretary or the House—I am not concerned as to what he thinks—decides that an appeal board of some sort is desirable, I am prepared to hear any suggestion for a better type than is envisaged in this amendment, even a type of board which may be constituted on entirely different lines. There has been a suggestion that a person may be unable to bring his case before a tribunal. That suggestion does not carry any weight, as I am sure there will be visiting committees, and so on, who would take up the case of any person who feels he has a grievance and bring it to the notice of the proper authorities. If the Parliamentary Secretary would consider this thing carefully—which I think he has not done—he would find there is urgent need for such a board. It would deal not alone with people who are interned. We have a very drastic section in the Bill later on, which deals with people who are pronounced by the medical profession as being verminous. The word "verminous" has been given some terrifically fine definitions.
They are only ordinary lice.
Now, the Parliamentary Secretary will remember that they are only ordinary lice, but lice with high-sounding Latin or Greek titles and various classifications.
You could not make them respectable that way.
The Parliamentary Secretary will agree with me that, if a citizen is publicly declared to be verminous without just reason, he will feel that he has a very definite grievance and will be anxious to have some kind of a fair tribunal to which he can appeal to justify himself.
He needs a good bath, in a case like that.
I do not think Deputy Burke is helping the Parliamentary Secretary very much, nor have any of those Deputies who have spoken against this amendment given him very much assistance. There is, on the part of Deputy Burke and all other Deputies who have spoken, an inclination to adopt an absolutely intolerant and unthinking attitude towards anybody accused of suffering from an infectious disease or of being verminous. Deputy Burke says there is nothing for such a person but a good bath. If a member of the Deputy's family or if he himself were publicly accused by some crank in the medical profession of being verminous, would he agree that there was nothing for it but a good bath? This matter requires a little more consideration and if the House is wise it will accept the amendment. At the least, there should be an indication from the Parliamentary Secretary that he is prepared to provide some equitable and just form of tribunal.
It is puzzling to me how we come to discuss this particular amendment at this stage, as it seems to be completely out of place. What we are now discussing on this amendment really is Section 29 of the Bill.
And a lot of other sections.
I think the Deputy will agree that that is the main one, the one which he is mainly concerned to safeguard. May I point out to him that, including the amendments dealing with other appeal boards, there are over 80 amendments tabled to Section 29 alone? I do not know how it found itself in this particular position in the list, as it does not seem to have any reference even to the section before it or to the section after it. That makes it a little more difficult for us, as we have to switch over our papers to Section 29 and the amendments thereto. I can assure Deputy Cogan that those of us here are, like himself, anxious to provide all the effective safeguards that can be provided for the citizen who may be concerned in the operation of Section 29 or any other section that would operate in a like way. Even if this amendment were accepted, however, it would not provide the protection which he is anxious to provide. I doubt very much if it would have the effect he wants it to have and I would ask him not to press it, for the sole reason that it is, I think, unworkable.
I do not know if Deputy Cogan is trying deliberately to misunderstand me, but I would give him an example of what I have in mind.
Supposing a doctor is called in to examine a family and he diagnoses that a child has diphtheria and advises and insists on isolation. He takes a swab and sends that off for analysis. Then he is informed that it is not a case of diphtheria. In the meantime the child has been isolated for three or four days while the doctor is waiting for the result of the test. Surely, he cannot be charged with wrongfully isolating that child? It was advisable to do so because his diagnosis was diphtheria and he isolated the case because he did not want the disease to spread through the family and possibly to other contacts.
That is the sort of thing that will be brought before the board. It might be proved later that there was no necessity for isolation and, if the parents were unreasonable and felt the doctor was to blame for insisting on isolation, they might consider adopting a certain course. Any reasonable man will have to admit that that doctor was justified in isolating the case and he should be fully protected by the law because he considered the case was infectious. There would be no grounds for appeal there, no matter what board you provide.
I am rather surprised that Deputy Cogan has adopted the attitude that he has taken up on this amendment. We gave him a way out which he apparently refuses to take. He complains of an unholy or a holy alliance—I was not here when the word was used. We are simply applying the light of common sense and reason to what, to my mind, is a very impracticable amendment, a thing that cannot possibly work.
The Deputy's amendment goes far outside this question of appeal. It gives the appeal board the duty of hearing and deciding any complaint regarding the administration of the Public Health Acts. If that were to be adopted, the appeal board would be a permanent institution, sitting daily almost.
I do not want to prolong the discussion, but I appeal to the Deputy not to press the amendment because it is unworkable. There is a legal remedy. In an extreme case habeas corpus can be resorted to. There is an appeal to the Minister, and whatever we have to say on the question of appeal would best be dealt with on Section 29 rather than here. The views that have been expressed have been spontaneously expressed by Deputies, having heard Deputy Cogan on his amendment.
Amendment put and declared negatived.
I move amendment No. 39:—
Before Section 13 and in Part III of the Bill to insert a new section as follows:—
Every county authority shall appoint one or more visiting committees whose function it shall be to visit health institutions in their area and make such inquiries as may be necessary to ascertain if the public health Acts are being fairly and efficiently administered.
Every visiting committee shall consist of persons having practical experience or special knowledge of social work.
No member of a local authority or person employed by the Department of Local Government and Public Health or by a local authority shall be a member of a visiting committee.
Members of a visiting committee shall be known as visiting officers.
This amendment seeks to extend the authority which a local body has to set up visiting committees to investigate the conditions in various health institutions. The effect of this amendment, as far as existing law is concerned, would be that it would definitely make it mandatory on local authorities to appoint visiting committees. It would also provide for a special type of visiting committee. At present I think it is within the power of any local authority to set up a visiting committee in respect of an entire county or portion of a county, but it is not mandatory to do so and I think it should be in order to safeguard the interests of the patients in view of the wide extension of the health laws.
There is a new provision in the amendment and it is that members of the local authorities and their officials should not be members of those visiting committees. The reason for putting in this provision is obvious. It would be undesirable to have employees of a local authority or of the Department as visiting officers and I think it would be unnecessary and undesirable to have members of the local authority on such committees. The idea behind this amendment is that the committee should approach this question entirely independent of the local authority and, perhaps, with a perfectly open mind in regard to anything they may find, right or wrong, in the institutions. By excluding members of the local authority you will ensure that you will have a different type of visiting committee from what we have at present, and I think that would be desirable.
The Parliamentary Secretary should accept this amendment, perhaps not exactly in the words submitted here, but with some variation which he may think fit to introduce. He will admit that there is a greater need now for closer inspection and vigilance in regard to institutions, having regard to the manner in which the powers of the health authorities have been extended. I think that recently—as a matter of fact, since the amendment was put on the Order Paper—a circular was sent round to local authorities urging them to appoint visiting committees. That would seem to indicate that the Parliamentary Secretary is anxious to have such committees in existence.
At the risk of being taunted again with a break-up of an alliance, I have to say that I cannot see my way to support this amendment. That is all the more firmly implanted in me because I do not want to see any unholy alliance—that is, an unholy alliance between the Parliamentary Secretary and Deputy Cogan —to take one of the very few remaining little powers—if I may use that term—from the local authorities. Deputy Cogan ought to know by now that the Minister does not want assistance from him or from anybody else in his efforts to deprive local authorities of any little rights or privileges that they possess.
This does not deprive them of any rights or privileges.
But it does. It deprives them of acting on visiting committees to various institutions.
They were always entitled to visit institutions.
But they will not be if this amendment is carried. I want to make this point, that it might be desirable to give a local authority the right to put one or two outside persons on a visiting committee, but they should be in the minority. To suggest that a visiting committee should be appointed which would be independent of a local authority would be a mistake. A visiting committee of that kind, with probably the best intentions in the world, but without the necessary practical knowledge of the working of such institutions, if unaccompanied by anybody who knew anything about their working would not be satisfactory. Another part of this amendment would deprive such a committee of whatever assistance or advice they could get from anybody concerned with the running of institutions.
I do not see how the amendment could be accepted. It is quite clear that a local authority has the right to appoint a visiting committee. While I do not think it is mandatory on them to restrict membership to themselves, it is desirable that there should be a majority of members of the local authority on the committee. I acted on visiting committees to local institutions, and my experience is that unless such committees could invite an official or a professional man attached to the institution to accompany them, who would place himself at their disposal and answer questions arising from their observations, then I do not think visits to institutions would have much practical effect.
It would be desirable to clear up the position as to the powers of members of local authorities to visit institutions. Deputy Cogan seems to think that it is an inherent part of their constitution that local authorities should have that power. It would be true, as far as mental hospitals are concerned, but my experience is that the power ceases there. There are other institutions, such as tuberculosis hospitals, and as far as my experience in the city goes, it would be necessary to have the consent of the manager for the time being to visit such places. I do not think members of the committee, as such, have the right to visit, unless they had the consent of the manager. That would appear to cut across. Deputy Cogan's argument regarding the position of public representatives. Perhaps the Parliamentary Secretary would clear up the point.
The power of county councils to appoint advisory committees is set out in Section 58 of the Local Government Act, 1925. Under that section a county council can appoint an advisory committee composed wholly of members of the council or partly of such members and other persons. Under the Public Assistance Act power to appoint corresponding committees will be found in Section 11. Deputy Larkin will probably remember that when the Mental Treatment Act was before the House we dealt with the same type of question, and that amendments were introduced providing for the appointment of visiting committees to these institutions. From the point of view of policy, it is desirable, and the Ministry has always encouraged, the appointment of such committees. But the proposal here, that elected members of a local authority should be excluded from membership, could not be entertained. I do not think there can be any difference of opinion on that.
I would be surprised if Deputy Cogan, on reflection, would not see that it would be an entirely improper position to create. On the point raised by Deputy O'Sullivan I am not clear. Is the institution under the control of a local authority and, if not, is it one for infectious diseases? I cannot understand difficulty arising about members of a local authority visiting. It is understandable that restrictions would have to be applied to the visitation of infectious diseases hospitals. The type of case that Deputy O'Sullivan has raised is one that I am not familiar with. It was not brought to my notice before. If the position is not sufficiently clear, the Deputy should refer to the powers mentioned in the Local Government Act of 1925. I should be glad if the Deputy would further elucidate the difficulty that he has in mind when I shall try to have it cleared up.
I am anxious to get some information on the point raised by Deputy O'Sullivan. If a member of a local authority is not a member of the visiting committee, is he entitled to present himself at any institution under the control of that local authority and say to the matron: "I am a member of the local authority and I want to inspect this institution"?
I do not think so.
He is not entitled to visit?
I think not.
That is what I thought, but I want to have the matter cleared up.
I am surprised at the ignorance of public representatives on this question, and particularly those from Dublin. Deputy O'Sullivan stated that local representatives had not the right to visit these institutions. That is not so.
The local government regulations apply all over the country.
That does not apply in Limerick.
The regulations are the same from Dublin to Cork. I have here an agenda for a meeting of Louth County Council on Monday next, and the first item on it is one to consider procedure in regard to the implementation of visiting committees to district institutions. We decided that public representatives of the district in which the institution is situate have a right to form a committee to carry out inspections and investigations, and if they find anything wrong to report to the Department.
That is a different matter.
Everybody agrees on that.
When Deputies criticise and find fault in that respect it is due to their own apathy.
The Deputy is under a complete misapprehension as to what we are talking about. Deputy O'Sullivan asked whether a member of a local authority per se had the right to present himself at an institution and say that he was going to inspect it. He has no such right.
There is that right. I have exercised it.
For the information of the Deputy, I suggest that a local authority has not the right to appoint a visiting committee without the consent of the county manager. That is the position under the County Management Act.
Speaking from recollection, I agree with Deputy O'Sullivan that in law the only visiting committee that I know of is that for a mental hospital where visitation is provided for by statute. An advisory committee may be set up by a county council, such as a general purposes committee, but that is a different matter. I do not think in law there is the right to set up a visiting committee, except for mental hospitals.
As we are on that, I should like Deputy Cogan to realise that if he presses this amendment the Parliamentary Secretary may accept it and you may get a visiting committee for these institutions which will have no power at all but will be so much window dressing for the Parliamentary Secretary to be able to say, "Well, we gave you a visiting committee. We are preserving the right of public representatives to go in there". But, what happens when you go in there? You may look at the public buildings—you are really inspectors of public buildings—and you may see if they want repair—a job, of course, that the engineer of the institution can deal with. You may walk around and ask a patient—mind you, a mental hospital patient, at that—if he has any complaint. Fancy asking a mental hospital patient if he has any complaint to make. You may do that by law and you may do a few more things, but you dare not approach an official in the institution or establish any contact with him as to how the law is functioning or how the administration is being carried on. You have no power at all there. So that your source of information is, strictly speaking, confined to the patients and if you do not get any complaint from a patient you certainly cannot entertain a complaint from a member of the staff.
That is the Managerial Act.
That is the Managerial Act, undoubtedly, but when Deputy Cogan presses for a visiting committee for institutions, I want to warn him of the danger that is involved in suggesting even a visiting committee to the Parliamentary Secretary. They may accept the principle of a visiting committee and give you a visiting committee without any powers.
I would not do that on Deputy Cogan.
As you have done in the case of the mental hospitals. It is a fact that in the case of the mental hospitals, the powers of the visiting committee are really negative.
I wonder would Deputy Larkin agree with that?
I want to say that I am a member of a mental hospital committee. I am also a member of a committee of district institutions and we have the right to go in there and inquire from the patients as to how they are being treated and if they have any complaint. What other function could representatives have visiting those institutions? Is not that the purpose for which we visit? The legal aspect is another matter and does not concern elected representatives. I quite see Deputy Coogan's point. He is looking at it from the legal point of view as to whether committees take the responsibility when they assume membership of a committee. If we have not that right, it means that you hand over the entire institution completely into the hands of officials. I am rather surprised to learn that there are public representatives that have not asserted that right. Even before this committee was established, I exercised that right.
I put down this amendment merely for the purpose of eliciting some information and clarifying the position in regard to visiting committees and in regard to rights of locally elected representatives. I was under the impression, definitely, that a member of a local authority has the right to visit any institution under the control of that local authority to see how it is being administered.
That right should be inherent in the generally acknowledged duty of a local representative to supervise all the local affairs in his county and to supervise the local administration. It is impossible for a county councillor to supervise local administration if he cannot go into any institution and see how things are being run. My impression of the duties of a local representative, up to the present, has been exactly the same as that of Deputy Walsh, but it seems there is conflict of opinion now in the Government Party in regard to the duties of local representatives and, in view of the Parliamentary Secretary's statement that local representatives have not the right to visit any institution under their control, I would not dream of pressing this amendment.
They have, of course, if they are appointed on a committee.
They might become a nuisance on the committee.
I am not at present a member of the mental asylum committee in South Tipperary, but I was for three years. After each meeting any member who wished to do so visited the institution and chatted to the patients. It is not a very pleasant task. I cannot say whether the manager's permission had to be obtained or that permission is statutory. I have not visited private mental homes, but there are a good many, I am sure, in the cities. I am just wondering is there any visiting committee associated with them. That is the point I raised previously.
No, except the committees of management of private homes.
There may be somebody incarcerated there, kept there against his will, having recovered.
They are safeguarded by the inspector of mental hospitals.
Of course there are now two doctors, as against one in the olden days. Charles Reade exposed the need, and it led to the appointment of a second doctor. While it is not a matter that may count so much from a national point of view, there may be a need for visiting committees in private asylums of which there are not a few in Ireland.
They would not welcome you.
Deputy Walsh seems to be surprised at the conflict of opinion there is on this particular subject and he is basing his statement on what was custom and practice when the local authorities had full and complete power in their own hands. There is a number of these customs still in operation even in the City of Dublin that, I presume to say, are not in operation in County Louth, and which are working quite smoothly in their own way, but when he says that he has the right to visit hospitals or to set up a visiting committee, I would like to get quite clear in my mind as to what is the origin or source of his right, because I still maintain that in cases like Crooksling Sanatorium and in Clonskea—I think I will be borne out by other members of the corporation who are present here—to set up a visiting committee for these institutions the sanction of the manager is necessary in the first instance.
Would Deputy Keyes mind telling me what is the institution in Limerick that he is concerned about?
We have to get the consent of the manager to visit the City Home and Hospital.
The City Home and Hospital. I will look into that, but it is not in accordance with law because the City Home and Hospital is a public assistance institution. There is no question about the position there.
Will the Parliamentary Secretary tell us the date of the issue of a circular from the Minister for Local Government and Public Health as to the question of setting up such committees?
Everybody understands that it is Ministerial policy to encourage the setting up of these committees. There is no doubt about that.
How would it apply in the case of the two hospitals I have quoted?
I could understand the matter in relation to Clonskea, being a fever hospital, but I do not understand the position in regard to Crooksling and I will certainly look into it. The position in Limerick, as adverted to by Deputy Keyes, does not appear to be in accordance with the statutory rights of the members of the local authority. I will certainly have that looked into.
It has caused a good deal of discussion there.
From my knowledge of the legal position, it is not in accordance with law.
I can confirm what Deputy Keyes has said, that the members of the Limerick Corporation under the Limerick City Act cannot form any visiting committee without the consent of the city manager.
There is something there to be looked into.
I want to point out to the House that there is a series of amendments, Nos. 40 to 60, which are all dealing with the provision and maintenance by health authorities of institutions. There is a good deal of overlapping in all these 20 amendments. They all principally deal with six points and these six points can be dealt with by a selection of the amendments offered. The first point is whether the discretionary power, vested in health authorities by sub-section (1), to provide and maintain institutions shall be with the consent of the Minister and in accordance with any directions he may issue, or whether it shall be absolute or, as proposed in No. 40, it shall be at the request of the Minister. That one point could be fixed or determined by a decision on amendment No. 41. The second point is whether the provision of the institution has to be proved to be in fact reasonably necessary. That could be dealt with by a decision on 43 and that should also guide amendments Nos. 46 and 54.
The third point is: Whether the Minister is to have power to direct a health authority (a) to provide and maintain an institution, and (b) to restore, enlarge or alter an existing institution. Point (a) could be decided by amendment No. 45 and (b) could be decided, if necessary, by amendment No. 52. The fourth point is: If so, whether an inquiry should be held before the Order is made. That can be decided by amendment No. 47. The fifth point is: Further, whether the Minister's Order will not be effective if opposed by two-thirds of the health authority meeting called to consider it. That could be decided by amendment No. 50. The sixth point is: Whether the institution ordered by the Minister to be established must be so established in the area of jurisdiction of the health authority. That could be decided by amendment No. 51. These six points could be dealt with by these specific amendments.
I move amendment No. 40:—
To delete sub-sections (1) and (2) and insert the following sub-section:—
Whenever the Minister is satisfied that existing institutions under the control of a health authority are inadequate for its requirements, he shall indicate to such health authority particulars of the institution or institutions required and shall request such authority to provide such institution or institutions as soon as possible.
Will the Deputy take amendment No. 41 to govern that?
I do not think so. What about sub-section (2)? That sub-section states: "A health authority shall provide and maintain any institution which the Minister by Order directs them to provide and maintain." Amendment No. 41 does not delete that.
Would not amendment No. 43 decide that?
You did not mention amendment No. 43.
Amendment No. 43 was mentioned.
Anyway, on the principle, I think that a local authority ought to have discretionary powers. We ought to have some respect for democratic institutions and for the institutions set up by the people. If we believe in government by the people for the people, we do not want dictation. This whole section aims at dictation. The Parliamentary Secretary might argue that the local authority might be recalcitrant and not be prepared to provide an institution that is essential from a medical point of view. In reply to that I say that the period of office of the local authority is not very long in any case. Amendment No. 40 provides that the Minister can have the institutions of a local authority inspected, and, if he is satisfied that they are not sufficient for the requirement of that local authority, he should inform the local authority that in his opinion it is essential that such an institution should be provided or an existing institution repaired and enlarged. He should not go beyond that. This House should not give him authority to go beyond that. I submit that the people concerned in that particular administrative area will be aware of the direction given by the Minister and, if the local authority turns down the recommendation of the Minister, within a very short period the people in that area will get an opportunity of deciding whether the Minister or the local authority is right. If they believe the Minister is right, then they can change their local authority and elect persons who they are satisfied will provide the institution necessary.
There are many aspects of this whole problem. The Parliamentary Secretary is anxious to ensure that all the institutions necessary for public health on purely medical grounds will be provided. But there are economic aspects of this matter of the provision of institutions and the size of institutions and whether they are too elaborate for the people of a particular locality to maintain, and the best judges of that ought to be the local authority elected by the people to look after their affairs.
This is simply making a sham and a farce of local bodies, because the Minister is divesting local authorities of the power which they are entitled to exercise. If the Minister was prepared to provide the full 100 per cent. of the cost of an institution it would be a different matter. But, where a contribution is made by a local authority and where there is responsibility on that authority to maintain and run the institution properly, surely it is their right, if we think democratically on this matter, to decide whether that institution should be provided or not.
I feel very strongly on this matter. I feel that we have already restricted the powers of local authorities far too much and that we have travelled too far on the road of providing local administration at the dictation of the Minister, to be carried out by his creature, the county manager. It has gone too far and it will have to stop. The people will not stand for that sort of thing any longer. The sooner the Parliamentary Secretary and the Minister appreciate that the better. It is the first step towards the destruction of democracy and democratic institutions. Once you destroy the local authorities, the immediate step after that will be directed to restricting the power of Parliamentary institutions. If Deputies believe in democracy, if they believe in the right of the people to direct their own affairs through their own representatives, then they ought not to stand over a provision of this sort by which we are going to empower one individual to decide what is or what is not necessary so far as institutional requirements in an administrative area are concerned and completely neglect the opinion of the local authority.
Do I understand that we are discussing all the amendments from No. 40 to No. 60?
Amendments Nos. 40 and 41 at the moment.
Amendment No. 41 deletes portion of the sub-section.
The point I put before the House was: Whether the discretionary power vested in health authorities by sub-section (1) to provide and maintain institutions shall be with the consent of the Minister and in accordance with any directions he may issue, or whether it shall be absolute or (as proposed in amendment No. 40) whether it shall be at the request of the Minister. The amendment will give a decision on that particular point.
I want to get that clear. I take it that, if we had a decision on amendment No. 40, it would give us a clear decision. As I read it, a decision on amendment No. 41 would only give us a decision on one point. It does not cover as much as amendment No. 40.
It has no reference to sub-section (2).
It would be just as well to take amendment No. 40.
The Deputy can discuss amendments Nos. 40 and 41 together and raise whatever points he wants to raise.
We have already indicated our views on this matter and I do not want to cover ground already covered. The extraordinary thing about Section 13 is that there is no provision whatever made for a local inquiry or consultation of any kind with the Minister whereas if Deputies look at Section 14 they will find that, where it is proposed to discontinue a health institution, the Minister provides for a local inquiry. I cannot, for the life of me, see why the same principle should not apply to Section 13. It is certainly more important from the local point of view that an inquiry should be held and that consultation should take place with the local authority, where it is proposed to erect new institutions, particularly having regard to the prohibitive cost of these institutions to-day. It is far more essential that there should be an inquiry in that contingency than in cases where an institution is about to be abandoned.
The main purpose of the amendment is to ensure that the Minister will, first, examine the position—in other words, consult the local authority, make an inspection of the institution, and indicate his requirements—and then give the local authority a full and ample opportunity of discussing the merits of his proposals. As I have said, time and time again, it is the local authority which has to find the money to pay the cost of erecting the new institution; it is the local authority which has to find the money to maintain the institution, to pay the staff, personnel, and so on, and it is a principle of taxation that there should be no taxation without representation, that no tax, central or local, should be imposed on the community without the public representatives of that community having a full say in the matter, not only of the imposition of the tax and its assessment, but of the amount of tax.
We are seeking in this amendment to preserve that principle for the local authorities. It is a very serious matter for a local authority to have to face the colossal cost of setting up, say, a county hospital or county institution of any kind. They may be faced with an expenditure of anything from £100,000 to £500,000 in a matter of that kind, and surely it is only right and reasonable that a local authority should have every opportunity of ventilating their views on a matter of such grave local importance as that, before the scheme is embarked upon. That is the principle we are seeking to preserve in this amendment, and it is in support of that principle that I rise to support the amendment.
I am not so sure that the amendment will go far enough, that a mere request would be acted upon. Something more than that may be necessary, but I think the Minister should in this section try to preserve that principle which I have outlined, and should give us in this section the same facility as that which he provides in Section 14, that at least a local inquiry will be held before embarking on any scheme of new institutions.
Sub-section (1) of Section 13 says:—
"A health authority may, with the consent of the Minister and in accordance with the directions (if any) given by him from time to time, provide and maintain any institution which they consider necessary."
That proposal is not by any means an innovation in the law relating to the provision of institutions. Deputies, I am sure, are familiar with the terms of the Public Assistance Act, and with the terms of the Mental Treatment Act, in both of which the Minister is given full powers in relation to the provision of institutions, the renovation, restoration, and alteration of institutions and the discontinuance of any institution found or considered to be redundant. These Acts were comparatively recently endorsed by the House and it is puzzling to me why we should now have such a fuss regarding public health institutions. The amendment sets out: (amendment read). There is no objection in principle to the amendment, unless it assumes that the Minister would not act in a responsible way. Institutions are not provided by local authorities without a prolonged exchange of views. The trouble is that the exchange of views extends over such a long period that it is very difficult to get anything done and the presumption that the Minister, without any consultation with a local authority, would say: “Provide this institution and provide it quickly, whether you like it or not”, is not justified. That does not occur, and has not occurred.
But it can occur under this section.
It can occur under the law at present, under the Public Assistance Act and under the Mental Treatment Act. Will Deputies refer to Section 31 of the Public Assistance Act, 1939? Sub-section (1) of that section says—
"Every public assistance authority shall provide and maintain within their district such and so many (if any) homes, hospitals and other institutions (in this Act referred to as district institutions) and at such places as the Minister shall from time to time by Order direct and shall not provide nor (save as is otherwise provided by this section) maintain any other home, hospital or other institution."
Sub-section (2) says:—
"Every public assistance authority shall, as and when the Minister by Order so directs—
(a) restore, alter, or enlarge in accordance with such Order any district institution, maintained by such authority,
(b) provide in accordance with such Order new, improved, or additional drainage, ventilation, water supply, lighting, heating, or any other service for any district institution so maintained,
(c) provide and maintain in any district institution so maintained all such fixtures, fittings, furniture, surgical and medical appliances, and other conveniences as shall be directed by such Order."
In Part V of the Mental Treatment Act, full directive powers are given to the Minister in relation to the institutions and accommodation to be provided. He may, if of opinion that a mental hospital authority have failed to perform their duty, require them to remedy their failure. He may direct them to provide an auxiliary mental hospital, under Section 22; to provide accommodation for temporary and voluntary patients, under Section 23; to provide consulting rooms and clinics, under Section 24; laboratories, under Section 25; or any other additional institutions and accommodation, under Section 26. That is a very recent Act and, at the time it was being discussed, there was none of this sort of opposition to these powers, and there was no suggestion, by the type of amendment we are now discussing, that the Minister would act in an irresponsible or dictatorial way.
Later still, we had the Tuberculosis (Provision of Sanatoria) Act, where the Minister was given absolute power to take any site he wished, in any portion of the State. There was complete and absolute power. Compensation was provided, if the price were not agreed upon, to be arranged by arbitration, but it was a very drastic power to meet, of course, a very pressing situation. The Minister has not abused that power. There was no talk of dictatorship then and it is a very recent occurrence. Talking about dictatorship does nobody any good, neither the State nor the Parties, nor does it do any good in relation to public health. There is a lot of scope here for that kind of talk, if it is necessary to talk in that strain, but in relation to public health it would be a good thing if we took a broader view of the issues confronting us, because of the nature of the problems with which we have to contend.
On the question of consultation, there need not be any anxiety, since if we err at all, it will be in the time we spend consulting before we get things done. It is necessary, and it will be necessary, to proceed in some ordered way. If we provide, as we are going to provide—and I can assure the House I am working on that problem as hard as any man can work—these regional sanatoria, starting off with the provision of 2,100 beds, as soon as it is humanly possible to provide them, we may find that certain local institutions will become redundant as a consequence. They may become redundant, perhaps, because we cannot provide the specialised treatment there that it is proposed to provide in the regional institutions, or redundant because of their structure and suitability. It is very difficult to get a local authority to part with any local institution, even though it may not be altogether necessary, and it is quite conceivable that it may be necessary to close some local sanatoria that are entirely unsuited to the purpose at the present time, as soon as the regional sanatoria are ready.
We have that power so far as public assistance institutions are concerned, and they are, in the main, the district hospitals, the county hospitals, the mental hospitals, in fact, what are known as public health institutions at present at any rate constitute—quite a small proportion of our hospital institutions. Our dispensaries and clinics are public assistance institutions, and will remain so until the local authorities decide that they should get away completely in the matter of medical treatment from the public assistance code. I do not want to appear in any way unreasonable about this. I have no objection at all to a local inquiry before an institution is forced upon a local authority or closed down. There is no objection, except that of the waste of money on the inquiry.
There is provision already for an inquiry before closing down an institution. Our quarrel is that the same is not being done where a new institution is being erected.
Well, I have no objection to it in principle, but I would have to examine the point. I do not suppose it could cut across the power we have already for providing an institution under the Tuberculosis (Provision of Sanatoria) Act. The draftsman would have to examine it, to see that by conceding an inquiry in relation to institutions it was proposed to provide, we would not cut across some plan for which the House has recently given authority.
The Parliamentary Secretary quoted some previous Acts to show the extraordinarily wide powers already enjoyed by his Department, and said he could not understand our anxiety about the further powers which he seeks under Section 13, which we ask to have deleted. If the powers which he says he has already in dealing with public health and the setting up of institutions are so great, perhaps he might address himself to the necessity for sub-section (2) of this section. He says we should not have any anxiety, that there is no danger of any abuse of those powers.
I do not want to interrupt the Deputy or put him off his line of argument, but the institutions I referred to in respect of which we have all these extensive powers, are the public assistance institutions, the mental institutions and now the institutions under the Tuberculosis (Provision of Sanatoria) Act. In fact, the public assistance institutions constitute the main bulk of our local authority institutions—our county hospitals, district hospitals, dispensaries and so on. They are all public assistance institutions and the Minister has that unlimited power in relation to them already.
This is one of the main sections of the Bill and, in our view, one of the most potentially dangerous sections. Notwithstanding that, the Parliamentary Secretary does not seem to be able to disabuse his mind of the feeling that we are actuated merely by obstructionist tactics in putting forward amendments. I want to assure him that there are very genuine fears held on this side of the House in regard to these powers.
He is falling into the old error of saying: "Such and such is not likely to happen; such and such will not happen." We are dealing here with what is before us, with the law, and we are in duty bound to see, so far as we can, that things which should not happen cannot happen. It is not the intention of the present Minister or the present Parliamentary Secretary that concerns us. The present Parliamentary Secretary may be in charge of public health for a considerable time. He may not; be may be succeeded by another person, who may have completely different ideas on those matters. It must be remembered that we do not legislate every time we change the head of a particular Department. Let us take sub-section (2) of the section:—
"A health authority shall provide and maintain any institution which the Minister by Order directs them to provide and maintain."
There is no limitation whatever there, no appeal from that, no power left to the local body to object in any way. They have no machinery by which they can question either the suitability of the institution, the necessity for it, the cost of its erection, and of its equipment and maintenance. It is solely in the hands of the Minister, and, because the House refused to pass an amendment moved earlier to deal with this question of Orders, the House itself cannot question an Order. That is what we are concerned with, and I think we have every reason to be concerned with it.
Is not that the position under the Public Assistance Act and the Mental Treatment Act?
Does the Parliamentary Secretary say that he already has the powers? Under the Public Assistance Act and other Acts, things are set out more specifically than they are here, and the local authority are not completely ignored.
Are they not? The powers are exactly the same.
If the Parliamentary Secretary can find, in any Act passed by this House, a sub-section exactly the same as this sub-section (2), I would be very interested to hear of it. This sub-section says:
"A health authority shall provide and maintain any institution which the Minister by Order directs them to provide and maintain."
Section 31 (1) of the Public Assistance Act, 1939, says:
"Every public assistance authority shall provide and maintain within their district such and so many (if any) homes, hospitals and other institutions (in this Act referred to as district institutions) and at such places as the Minister shall from time to time by Order direct ..."
May I say, without having that Act before me—I accept the Parliamentary Secretary's reading of it—that it is not the same— definitely not the same?
And similarly in the Mental Treatment Act.
It is definitely not the same. The Parliamentary Secretary tells us we need not be worried, but Deputies must remember that when we are dealing with sub-section (2) we have not got any idea as to the cost of those institutions; we have not any idea even of the number of institutions. This has a far wider implication and gives the Parliamentary Secretary far wider powers than he has under the two Acts to which he referred. A previous section sets out by name a whole series of institutions. That not being enough, it goes on to say "or any similar institution". There is no restriction on the site, the location, the suitability or the cost. We have no indication as to what this will cost or what proportion of the cost will have to be borne by the local authority and what proportion will have to be borne out of central or other funds. So far as we know, and so far as we can see into the future, the Parliamentary Secretary, under sub-section (2), which we are now seeking to have deleted from the Bill, may direct a local authority to establish, equip and maintain certain institutions and he may also direct that the total cost of the erection, equipment and maintenance of that institution shall be borne by the rates.
People will say that it is unlikely to happen; people will say: "Oh, the sweepstakes fund is there." If people were told 12 months ago that there was to be an impost of £100,000 put on the ratepayers of the City of Dublin in connection with hospital treatment, they would have said: "That cannot happen; the Minister would never dream of doing that; he will not do it because there is no necessity, as the voluntary hospitals are there and there is a huge fund accumulated out of the Hospitals Sweepstakes." If we alleged here 12 months ago that that impost of £106,000 would be placed on the City of Dublin, the Minister himself would probably have been the first to tell us that it was purely fantastic, all nonsense.
When we are talking about a huge scheme like this, we must bear in mind the mentality that is being displayed by the Department of Local Government and Public Health. The Parliamentary Secretary has been talking about 25 years ago. At that time we were thinking in thousands, and certainly not more than hundreds of thousands. Now the Department is thinking not only in millions, but in tens of millions. It has tremendous ideas, grandiose ideas, about everything. We hear of £24,000,000 for hospitalisation and public assistance and £21,000,000 for roads that will be 100 feet wide, and that will take up half the arable land in the country. I am referring only to the danger, Sir.
The Chair did not say anything.
I must have mistaken your look of interest in my remarks. The Department, acting on advice of its experts, if it does act on that advice—sometimes when we see some of the schemes produced by the Department we are forced to the conclusion that it is acting against the advice of its experts because one can hardly conceive an expert giving advice that would lead to the production of some of the schemes that have been produced by the Department so far—will follow a certain course. The Parliamentary Secretary cannot find very much to say against the amendment. It is, I think, a very reasonable amendment. This is what it says:—
"Whenever the Minister is satisfied that existing institutions under the control of a health authority are inadequate for its requirements, he shall indicate to such health authority particulars of the institution or institutions required and shall request such authority to provide such institution or institutions as soon as possible."
The Parliamentary Secretary asks us to be reasonable and not to see difficulties where they do not exist; not to assume that he is going to be bullheaded in the administration of this measure. May I ask him to be reasonable in his approach to a local authority? So far as I know, I do not think a single case can be quoted of where a local authority refused to provide whatever institutions for the treatment of disease or in the interests of public health it was requested to provide by the Department.
I want the Parliamentary Secretary to accept from me, if he will, that in dealing with matters such as this, we are genuinely concerned. You have to be concerned when you are in the position of imposing those very heavy obligations on a local authority that is absolutely powerless to make any objection. The point is that you are placing complete power in the hands of the Parliamentary Secretary or of the Department. It is a power which cannot be questioned by any authority in this country. We ought to realise that the Parliamentary Secretary and the Department are not infallible. The Parliamentary Secretary said that we need not have any anxiety about consultation. He is only too anxious to consult and, if anything, the suggestion is that they take too much time in consultation, thereby delaying schemes. It is one thing for the Parliamentary Secretary to say that in relation to this amendment, but that has not been borne out by his approach to previous amendments dealing with public health councils and consultative councils. The Minister's approach to the matter is that it is unnecessary to have such a committee, and that this has to be looked at purely from the medical point of view. I am perfectly satisfied that any reasonable request made to a local authority to set up an institution, which can be shown to be necessary, will be responded to in the right way. If we refuse to pass this amendment and give the Minister the powers he is given in Section 13, then it is the last kick, as far as local government and local authorities are concerned.
Are we dealing with all these amendments now?
The trouble is that this amendment would wipe out a whole series of amendments. A suggestion was made about six amendments which I think were mentioned by the Leas-Cheann Comhairle, which would afford a decision on different points in the section. Amendment No. 40 is being considered and, I understand, will not be pressed to a division, as such procedure would obviate any chance of putting the other amendments.
This discussion is on amendment No. 40?
Does the Chair propose to put amendment No. 40?
I would put amendment No. 41.
I am anxious about the future. I want to preserve the rights of other Deputies.
If 40 is pressed to a division it will wipe out all amendments to sub-sections (1) and (2).
I am concerned as to where we will get a decision on sub-section (2).
Amendment No. 45. Has the Deputy a note of what was suggested? Amendment No. 41 would decide whether the discretionary powers of a public health body would be with the consent of the Minister. Amendment No. 43 would decide whether the provision of institutions should be proved to be reasonably necessary. That would cover amendments Nos. 46 and 54 on which the same point is raised. Amendment No. 45 is as to whether the Minister would have power to direct public health authorities to maintain institutions; on amendment No. 47 whether an inquiry should be held; and on amendment No. 50 whether the Minister's Order should not be effective under certain circumstances. There is a straight issue on No. 51 as to whether institutions should be established other than in the area of jurisdiction of a local authority. It was suggested that Nos. 41, 43, 45, 47, 50 and 51 would give a decision on the main points of the section. The Deputy sees that if amendment No. 40 is pressed a number of others will disappear.
That is the reason I do not want to press it.
The Deputy is clear about it now?
The present debate is on amendment No. 40?
Yes. On amendment No. 41 there will be the specific point about the discretionary power of the Minister. Shall we take it that amendment No. 40 is withdrawn and proceed to No. 41?
I was hoping that the Parliamentary Secretary might make a move.
I moved all right but I did not get much response. I indicated in relation to this, that I would be prepared to have an inquiry before any institution would be forced upon a local authority. That was not very well received.
I gave a reason from the Parliamentary Secretary's own words why it was not well received. He said that he did not think an inquiry was very useful; that it would be waste of time.
It is not necessary at all.
May I say to the Parliamentary Secretary, and to the Deputy, that that specific point will arise on an amendment?
On a different matter. It is in relation to the closing down of an institution rather than on erection. The Parliamentary Secretary was quite frank in his opinion of local inquiries. Having regard to the method in which local inquiries are now carried out, I am inclined to agree that they are largely a waste of time and money.
We will have no agreement, then, on amendment No. 47?
I think some local inquiries are very effective.
I would be glad if the Parliamentary Secretary expressed his views on the amendment. He has not indicated his objection to it. I think I am correct in saying that there is not one single case on record where a local authority refused to set up an institution to provide for the public health or for the public welfare. If that is so, why should the Parliamentary Secretary anticipate such objections in future?
And the Parliamentary Secretary gave a very full reply. He might as well have been talking to the wall. That is the fact.
It is not the fact. The Parliamentary Secretary did not once address himself to the amendment. As a matter of fact that has been the technique from the start of the Bill. He has never dealt with the merits of a single amendment.
What is the use of talking nonsense like that?
Thanks be to God, we can talk even nonsense yet in Leinster House. The Minister may get more power than he has, but there is no power to suppress me like a local authority. Thank God, up to this we can talk even nonsense. I have often listened to a good deal of nonsense here.
The Deputy believes in a little nonsense now and then.
I do. There is a difference in the types of nonsense. I want the Parliamentary Secretary to indicate why the amendment should not be accepted. I submit that not a single reason has been given for its non-acceptance. I challenge the Parliamentary Secretary to give one.
Let the House decide it.
That is the mentality of the man who resents anyone talking about dictatorship. That is not argument; it is the power behind the front benches opposite.
Where did we get it but from the people?
I am not questioning that. I never did. The public health of this country is not going to be decided by reason or by argument in this House. It is going to be decided in the Division Lobby without any reference to reason. I ask members of the Parliamentary Secretary's Party to read amendment No. 40 to see if there is anything unreasonable in it. I challenge the Parliamentary Secretary to produce from the files in the Department one single case where any authority, at any time, refused to provide such institutions, or to provide for their maintenance and equipment.
We have on record that they refused to strike a rate for any purpose. The Deputy is well aware of that.
The Deputy is not going to side-track me in that way. I am issuing a challenge here to the Parliamentary Secretary. If he can show that local authorities in the past have ever refused to provide and maintain institutions in connection with public health in this country, then he may have some case against this amendment. He knows he cannot do that, and I am entitled to ask why, in face of that, the Minister wants those extraordinary powers. I can only come to the conclusion that it is because he is going to make extraordinary use of them and that he is going to put an impost so enormous on local authorities that he knows there will be reaction against him and that there must be reaction against him and that is the reason why he wants to get this basic dictatorial power. This is complete and absolute dictatorial power. Remember, the Minister directs the local authority to erect any institution, in any place, of any size and costing any amount. There is no limit. Is the House going to stand for that?
I move amendment No. 41:—
In sub-section (1), to delete all words from the word "with" in line 31 to the word "time" where it secondly occurs in line 33 inclusive.
This amendment asks to delete in sub-section (1) certain words. Sub-section (1) as it stands says:—
"A health authority may, with the consent of the Minister and in accordance with the directions (if any) given by him from time to time, provide and maintain any institution which they consider necessary."
My amendment would make that sub-section read:—
"A health authority may provide and maintain any institution which they consider necessary."
The reason why I am moving to delete the words that I ask to delete in this section is that the amendment links up with amendment No. 47 in relation to a public inquiry and with amendment No. 50 in relation to the attitude of local representatives to the Minister's proposal. Sub-section (2) is:—
"A health authority shall provide and maintain any institution which the Minister, by Order, directs them to provide and maintain."
That is, the whole of Section 13 as it stands would provide the Minister with dictatorial powers to order any local authority to maintain any institution that he directs them to maintain. In the group of amendments, Nos. 41, 47 and 50, I go a long distance to outrage my sense of what is right. I have been rather dragged along these lines by the determination of the Minister to get the whole of these dictatorial powers that he seeks. I seek to secure that the Minister shall not order a local authority to provide any institution without the holding of an inquiry and the publishing of a report and that the local authority shall not be required to obey the Minister's edict with regard to erecting an institution that he orders them to erect where the proposal is opposed by two-thirds of the members attending and voting. My amendment No. 50 says that they shall do so providing that at a meeting of the health authority duly called to consider the matter the proposal shall not be opposed by two-thirds or more than two-thirds of the members attending and voting.
That is a surrender of my own judgment and a surrender of the principles on which I think we should deal with local authorities duly elected and representing the people for local purposes. As a step to amending the section somewhat on these lines I ask that that part of sub-section (1) which deals with the consent of the Minister and the local authority acting in accordance with the directions of the Minister from time to time shall be left out so that the sub-section will read: "A health authority may provide and maintain any institution which they consider necessary."
If the Deputy's amendment were accepted a health authority would be free to provide an institution of any particular type or of any particular dimensions without, perhaps, regard to the actual requirements. The tendency in the treatment of tuberculosis is towards centralisation, in regional sanatoria. In the treatment of fevers the tendency is to treat them now in one county institution rather than in a number of small isolated units that are insufficiently staffed, badly equipped and very often badly constructed. When these questions come to be determined the local authority may, in certain instances, require a direction as to the type of institution and the accommodation, etc., that it may be necessary to provide. Clearly, we may run into a condition of confusion in hospital administration if the Minister's rights in that matter are to be curtailed. I do not think that the Deputy himself has any great enthusiasm for this amendment but, anyhow, I cannot accept it.
Is the amendment withdrawn?
No, Sir. I might be prepared to withdraw the amendment in deference to the next amendment, No. 42, in the name of Deputy Sheldon. If that amendment were accepted, the sub-section would read: "A health authority may, with the consent of the Minister, provide and maintain any institution which they consider necessary."
On behalf of Deputy Sheldon, I move amendment No. 42:—
In sub-section (1), lines 32 and 33, to delete the words "and in accordance with the directions (if any) given by him from time to time".
The same argument holds. Amendment, by leave, withdrawn.
I move amendment No. 44:—
To delete sub-section (2) and substitute therefor the following sub-section:—
The Minister having caused a local inquiry to be held as to the desirability of so doing may by Order direct a health authority to (a) provide and maintain any institution which he considers necessary, or (b) restore, enlarge or otherwise alter in accordance with the Order any institution already maintained by them.
There are other amendments of a similar character. I am not particular as to the type of amendment that is accepted, so long as it achieves the object I have in view. I put down the amendment in view of the serious effects this Bill may have on local authorities in regard to the expenditure of public money. In one way or another, the administration of this Bill will inflict on local authorities a very heavy expenditure of money and a very heavy increase in rates. It was argued on the Second Reading by many Deputies that it was a pity some provision was not made for financial assistance from the Central Fund, so that local authorities would be relieved and there could be general assent to the principles of the Bill, with which most of us agree. The great objection generally to the Bill will be the increase in expenditure of local authorities, and everywhere in this Bill that we can possibly prevent an addition to such expenditure, some of us at least are going to do it. This section provides for various things. The Parliamentary Secretary thinks that the Minister can force a local authority to put up any building he desires.
Perhaps I can help the Deputy. I am prepared to concede the principle of an inquiry before forcing a local authority to provide any such institution. Perhaps that will meet the Deputy.
I ask leave to withdraw the amendment on that assurance.
I will circulate an amendment dealing with that on the Report Stage.
I move amendment No. 45:—
To delete sub-section (2).
I have such a rooted objection to this particular sub-section that I could not allow it to pass.
Has not that point been disposed of by the decision on amendment No. 40?
There was no decision on amendment No. 40. The reason there was no decision on it is because this amendment is on the Order Paper. That is the reason I am moving this amendment now. I want to direct the attention of the House to what I am asking to have deleted. Sub-section (2) states: "A health authority shall provide and maintain any institution which the Minister by Order directs them to provide and maintain". As I said earlier, we are asked to pass that without any indication from the Parliamentary Secretary as to the number of types of institutions he has in mind, as to where they are to be placed, as to what they are to cost, as to what proportion, if any, of the cost of erection, equipment and maintenance of these institutions will be met out of the Central Fund or the Hospitals' Trust Fund.
So far as this Bill is concerned, the local authority may be made responsible in full for the cost of erection, equipment and maintenance of any institution or institutions which the Minister may direct them by Order to erect and maintain. Once it is made by the Minister, that Order cannot be questioned either by the local authority or in this House. We are reaching the stage, if we have not already passed it, where any further financial obligations which will have to be borne by local authorities ought only to be borne by them after the most careful inquiry, and after every aspect of the matter has been considered, and after assuring ourselves (1) that the institution is necessary, (2) that it is the right type of institution, and (3) that it is not being erected on an extravagant scale, extravagant to erect and extravagant subsequently to maintain.
At this stage I do not want to go into the question of some of the institutions erected in this country in recent years. I think I am entitled to say, however, speaking as an ordinary layman who has observed these institutions both from the outside and from the inside, that they appear to me to have been designed rather from the point of view of appearance than from the point of view of utility. Some of them look very nice until they have been a couple of years suffering from our particular climate. Then, to say the least of it, they have a shabby appearance externally. Some of the institutions which I have seen when travelling through the country might be very suitable if we had a climate like Florida or some place like that. They certainly do not seem to be suitable for their present location. Some of them are very large buildings; but when you go into them, you are surprised to find that they contain a comparatively small number of beds. Most of the space is taken up by a most elaborate entrance, corridors, and so on. In many cases the number of beds for patients is no more than and, in some cases, fewer than was in the institutions which they have replaced.
I am satisfied that no local authority will object to meeting any demand that is necessary to provide for the public health. But it is our duty to ensure that the local authority shall have some say in the matter and that there will be some assurance (1) as to the original cost, and (2) how the cost is to be met. I am not one of those who believe that low rates in themselves are good either for the particular rating area concerned or for the country as a whole. Low rates are not necessarily good. You may have a high rate which is justified by corresponding service to the community paying the rate. But it is one thing to have a local authority, having been fully satisfied as to the requirements of their own locality, imposing this rate on the people who elected them. It is another thing to have a certain expenditure imposed on them by order of a central authority without the local authority having any right to question it.
I move to report progress.