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Dáil Éireann debate -
Wednesday, 29 May 1946

Vol. 101 No. 8

Public Health Bill, 1945—Report.

There are certain amendments tabled for the Report Stage which are required by Standing Order 98 or by practice to be considered in Committee. They are: Nos. 69, 117, 143, 174 --– (and Nos. 176, 178, 179 consequentially) and 229. I think that is Deputy Coogan’s amendment, but I understand that the Minister is willing to recommit that also. Amendments Nos. 69 and 229 impose charges on local rates. Amendment No. 117 involves an Exchequer charge and, consequently, must be taken in Committee. Amendment No. 143 imposes pecuniary penalties and, consequently, under Standing Order 98, that too has to be recommitted. Amendments Nos. 174 to 179 raise a substantial new point which while germane to [1049] the section concerned does not arise out of the Committee proceedings. A limited recommittal must therefore be taken to cover such of these amendments as it is proposed to move. Perhaps the Parliamentary Secretary will move accordingly.

Therefore we go into Committee when we come to amendment No. 69.

Of course the awkward thing will be that the House will be going in and out of Committee all the time.

Even so. We will not have to change our seats.

I do not mind.

We will run in a more reasonable sequence.

It might upset the sequence of the measure.

We will understand what we are doing better.

Then I understand we are to go into Committee as we meet the amendments?

I move amendment No. 1 :–

In page 6, Section 2 (1), line 13, before the definition of “infectious” to insert the following definition: – the expression “infected premises notice” means a written notice that, within the three months immediately preceding the giving of the notice, a person has been residing in or has occupied specified premises while suffering from a specified infectious disease.

This is a drafting amendment. It is related to the official amendments to Sections 25, 26 and 28. It defines “infected premises notice”. This is a written notice which has to be addressed[1050] to the district medical officer of the district in which the infected dwelling is situated and enables the provisions of these sections to be considerably simplified. The position will be better understood when we reach the actual amendments to the section, though I presume Deputies have already studied these.

Will the Parliamentary Secretary say to what sections does this refer?

It refers to amendments to Sections 25, 26 and 28. By the amendments we considerably simplify the sections in providing that the owner or occupier of an infected dwelling or lodging house will notify the medical officer of health, and the medical officer of health will inform the owner or occupier, within a period of seven days, of the form of disinfection, if any, that he requires to be carried out. This arises out of the discussion of amendments on the Committee Stage. It provides a much simpler procedure and the onus on the owner or occupier would be greatly simplified by this approach.

I should like to know whether this amendment implies that the Parliamentary Secretary will put the limit that we asked for in Committee? As it stood before, a person was required to do certain things, even though there was a period of a year or two years.

By other amendments I am limiting the period to three months.

When the Parliamentary Secretary speaks of an infected premises notice, could he tell us what matters will require to be dealt with in such a notice?

Merely that a person who has been in occupation of the dwelling within a period of three months has been suffering from an infectious disease. A number of the other details that we had there previously are being removed.

The person must now be suffering definitely from an infectious disease?

Yes. He knows he is suffering from such disease.

The notice will just report the fact?

Yes, and if the medical officer feels that certain disinfection, or certain repairs or alteration of the premises, should be carried out, he has to notify the owner or the occupier within seven days specifying what he requires. If he does not notify him, the owner or occupier is under no obligation. All this will be unfolded as we go along.

Amendments Nos. 1 to 6 are definition amendments and it might facilitate Deputies, and simplify the discussion, if I state for their information what the amendments are connected with. Amendment No. 1 is connected with amendment No. 42, a major amendment to be dealt with later on; amendment No. 2 is connected with amendment No. 19; amendments Nos. 3 and 4 are connected with amendments Nos. 27, 28 and 29; amendment No. 5 is connected with amendments Nos. 81 and 226, and amendment No. 6 is connected with amendments Nos. 23 and 60.

Amendment No. 1 agreed to.

I move amendment No. 2 :–

In page 6, Section 2 (1), line 15, to delete the definition of "infectious disease" and substitute the following definition: –

"The expression 'infectious disease' means primarily any disease included in regulations under sub-section (1) of Section 19 whether absolutely or by definition of a particular stage of such disease, but in any section of Part IV of this Act from the application of which a disease or a stage of a disease is excluded under sub-section (2) of the said Section 19, the expression does not include such disease or such disease in such stage, as the case may be."

This is related to the amendments to Sections 19, 20 and 21. In fact, it is[1052] part of the machinery of amendments devised to meet, in the main, all Deputy Mulcahy's arguments on the Committee Stage.

On the Committee Stage the Parliamentary Secretary circulated lists of various infectious diseases which he intended to regard as infectious diseases for the purpose of these sections. Will he say whether he has changed or modified these lists in the meantime?

Somewhat, but not radically. As we move along with the sections, perhaps the Deputy will raise questions with reference to a particular section and I could give him a list of diseases which will be excluded from the operation of that section. There is not any radical change. There are some diseases taken out of certain sections and others are left within the scope of those sections.

Those are possibly the sections we will not be allowed to say anything about.

I do not think the Deputy will have reason to find fault with the arrangement. It is towards the Deputy that the amendments are being moved, not away from him.

But there may be some sections on which we will not be allowed to open our mouths, the Bill being on Report.

I think the Deputy will be satisfied.

Amendment No. 2 agreed to.

I move amendment No. 3: –

In page 6, Section 2 (1), lines 53 and 54, to delete the definition of "principal".

With regard to amendments Nos. 29 and 108, to Sections 24 and 45, respectively, the principal teacher is mentioned and it seemed advisable to delete the definition of the word "principal" in order to avoid confusion. The definition of "school [1053] manager" has been substituted for that of "principal". Deputies will appreciate that, in the case of most national schools, the school manager is, in Catholic schools, usually the parish priest, and in other schools rarely is the principal the school manager. When the amendments to which this amendment is a forerunner become incorporated in the Bill, the notification of the proposed inspection will go to the school manager and a copy of the notice will be sent to the principal teacher. We had a discussion on Committee Stage as to various methods of approach in the matter of the notification of proposed inspections and, having carefully considered the views expressed by critics of the structure that was incorporated in the original draft, the amending machinery is now submitted to the House. I think it is much more simple and will operate more effectively than the original machinery.

Amendment No. 3 agreed to.

I move amendment No. 4:

In page 7, Section 2 (1), line 1, before the definition of "school medical officer" to insert the following definition: --–

the expression "the school manager" means in relation to a school or college, the person for the time being managing the school or college.

This is consequential.

Amendment agreed to.

I move amendment No. 5: –--

In page 7, Section 2 (1), lines 2, 3 and 4, to delete the words and figures "the Public Health (Medical Treatment of Children) (Ireland) Act, 1919, or" and substitute the words and figures "Section 41 or 42 of".

Deputies will observe that it is proposed to repeal the Public Health (Medical Treatment of Children) (Ireland) Act, 1919. In the original draft of the Bill we relied on the terms of that Act for purposes of school medical inspection. On further consideration it has been considered desirable to consolidate and extend that repeal, and to incorporate the relevant sections in the present Bill. The repeal will be found [1054] in amendment No. 226.

Amendment agreed to.

I move amendment No. 6: –

In page 7, Section 2 (1), line 5, before the definition of "temporary dwelling", to insert the following definition: –

"The expression 'surgical treatment' does not include hypodermic injection inoculation or other process of immunisation or the taking of blood or other specimens for examination or test."

This is a drafting amendment related to amendment No. 60, sub-section (2), paragraph (k) of Section 31. Deputies will recollect that this matter was very fully discussed in Committee. One of the difficulties we had about surgical treatment, and of putting statutory prohibition against affording surgical treatment to a patient, was that we would not be able to give a hypodermic injection or take specimens of blood. I undertook to look into the matter. We are providing that surgical treatment would be excluded unless with the consent of the patient. At the same time it is necessary to provide that a hypodermic injection and treatment can be carried out.

The Parliamentary Secretary says this is a drafting amendment but, in its operation, there is much more than drafting in it. If this amendment is passed it will be possible entirely against the consent of a person that he would be subjected to the administration of a hypodermic injection, and may be inoculated or immunised and a test of blood taken. I do not think the Parliamentary Secretary should ask the House to pass an amendment that will have that effect without giving some idea of the particular type of disease he has in mind in connection with this type of compulsory treatment, and the background from the point of view of public health and also the health of the individual. Behind the type of treatment he has in mind, if the amendment is passed, he will have power to have it compulsorily administered to any man, woman or child. I think the Parliamentary Secretary will realise [1055] that we would require a good deal more information on the subject.

When it is proposed to legalise a procedure by which you could forcibly interfere with the citizen, or with an individual's person, then we are definitely infringing on individual rights. If you are going to stick a needle into a person without his consent, or if you are going to inject, inoculate or immunise, that is interfering with the person. That is a very sacred matter so far as the individual is concerned. It would be in grave circumstances, requiring grave consideration as far as the public is concerned, that we would be justified in agreeing to compulsory legislation empowering a responsible official to compel an individual to submit to the treatment set out in the amendment. The Parliamentary Secretary should justify his reasons for asking for it, and state why he anticipates that the necessary precautions cannot be taken by asking the individual to consent voluntarily to the provisions that are necessary for the safeguarding of the public health. The Parliamentary Secretary ought to tell us how he has satisfied himself that it is necessary to take these very drastic powers.

Is the Parliamentary Secretary satisfied that the words "or other specimens" in the amendment are not too wide?

Undoubtedly. We have to use wide phraseology in order to have machinery to achieve the very desirable purpose that it is sought sometimes to achieve.

If they wanted to take a specimen from my eyes?

The eyes would not be looked upon as specimens in any sense. It might be necessary to take blood specimens or specimens of excreta or water. I think that is sufficient. Deputy Hughes complains again of interference with the person. He has in mind the rights of the citizen and so on. We are all concerned to interfere with the liberty of the person to the smallest possible extent, consistent with protecting the rights of the [1056] general body of the community. All these matters and the principles involved were fully discussed on the Committee Stage. I do not know whether we are expected to have another full debate on these principles now. I thought we had dealt fairly fully with these matters, and that while Deputies opposite were not completely convinced by the arguments advanced in favour of this, that they felt that there was more in it than at first met the eye.

Judging by the amendments, the Parliamentary Secretary must be convinced too.

I think it would be ungracious for the Deputies on the Opposition benches to twit me for the generous way in which I responded to the representations from the Opposition. I went very carefully through every word uttered by the Opposition.

You can blame yourself for much of it.

I do not blame myself for anything, as I do not feel that I did anything that was blameworthy. I have conceded everything it was possible to concede without seriously damaging the structure of the Bill. I think it would be regrettable if I were to be twitted now for having conceded so much. In relation to the amendment, and the consequential amendments that will follow, Deputies would find a good deal of information in the debates that took place in the Committee Stage on that matter. Provision has been made in the Bill --– and I think there was general agreement that it was a necessary provision --– for certain types of cases of highly infectious diseases, that are of a very deadly nature, so that when people suffering from these diseases are believed to be probable sources of infection, they have to be isolated from the general community, at any rate for a period of training in hygiene, or for a period of treatment where treatment is calculated to bring about a curable position.

As I stated many times during the course of the debate on this Bill, it would be unreasonable and it would be wrong to take a person suspected of [1057] being a typhoid carrier, to put him into an institution and to keep him there, without taking the necessary steps to ascertain, by examination, whether, in fact, he is a typhoid carrier or not. So long as he is there he is going to be maintained at the cost of the local authority, and it is not unreasonable to take such specimens as may be necessary to confirm the diagnosis or to enable the medical scientist to advise that we can, with safety, release that person as not constituting any danger to the health of the community. Similarly, in a case of suspected diphtheria, it may be necessary to take a swab in order to determine whether the person is, in fact, suffering from diphtheria. Again, in the case of venereal disease, it may be necessary to take a specimen of blood in order to confirm a well-founded suspicion that the person is suffering from venereal disease.

Apart altogether from the individual who is immediately concerned, there are other people who have to be considered. There are the people with whom the person suspected of being a probable source of infection has been in intimate and close physical contact. If, in fact, these people are sources of infection, certain protective steps must be taken regarding the people with whom they have been closely associated. Similarly, more widespread steps might have to be taken on the confirmation of the diagnosis.

Deputy Hughes advises that we ought to proceed by securing the consent of the patient. That is the ideal way, and that is the obvious method of approach in ordinary natural circumstances, but, in legislation such as this, we have to take powers to act in abnormal circumstances and to deal with abnormal and difficult people. If the co-operation of the patient can be secured, nobody will think of taking any measures other than the measures of persuasion, but if it should be necessary to take stronger measures, if it should be necessary, to confirm our diagnosis, to take specimens without the patient's consent, we must have power to do it in the interest of the [1058] community. I suggest to the House in all seriousness that the very fact that we have the power will, in 99 cases out of 100, make it unnecessary to exercise it.

As to the matter of hypodermic injections, it may be difficult for laymen to follow these matters very clearly, but again it is conceivable that a patient may be brought into an institution who is perhaps delirious, who is perhaps in a semi-conscious condition or perhaps in a state of collapse. Surely it will not be suggested that the doctor should stand helplessly by and allow that patient to die, in the knowledge that if he were free to give a hypodermic injection, he might save the patient's life. Neither can he expose himself to the possibility that, if he should take that obvious step to save the patient's life, the patient will have an action against him for damages. People ought to be reasonable in these matters and ought to try to be sensible.

We hear a lot to-day and heard a lot for the past few months about the freedom of the individual, the rights of the citizen and so on. Once again, let me say that I am just as keen on that attitude of mind as any Deputy, but, while I am, I am also keen on securing that the individual will not be permitted to abuse his freedom to the danger of his neighbour. Deputies to-day are apparently perturbed that we are going to take power compulsorily to immunise in an effort to limit the spread of dangerous infectious diseases, let us say, in the matter of diphtheria or in the matter of smallpox. We are not to take power to immunise, regardless of the virulence of an outbreak, regardless of the toll of death which may result from such an outbreak; we are to stand helplessly by. I wonder why Deputies never found fault with compulsory vaccination. It is a form of immunisation and has been in operation in this country for quite a long time, and yet, once again, it is only when a Fianna Fáil Government talk about doing these things that they are found to be wrong.

The Fianna Fáil Government are wiping out compulsory[1059] vaccination and introducing compulsory diphtheria immunisation.

We are in Committee and Deputy Mulcahy, I am sure, will –

I understand that we are not in Committee and I was feeling very pained about it. That is why I was keeping so quiet.

Perhaps I would not have said half as much if I thought the Deputy could not reply to me.

We will meet again.

I was looking forward to hearing the Deputy and going after him again.

Could the Parliamentary Secretary recommend any inoculation against obstruction?

Or construction?

We could not immunise against obstruction. I am afraid it is contagious, because I have seen it go right around the House.

We know where it started this time.

I am glad that Deputy Mulcahy cannot go after me for a few days. He may be in better humour next week.

For a few amendments.

We are blamed when we repeal the compulsory vaccination law and say that, in substitution for compulsory vaccination, we will take power to make vaccination compulsory if and when it appears to be necessary; in other words, if an outbreak of smallpox occurs in any part of the country in future, we will have power to enforce vaccination in a limited area --– whether it be the whole of the State or a part of the State. That change in the law has been criticised by the Opposition, and very severely criticised. No matter which way we turn, we are apparently going wrong. If we make immunisation compulsory, it is wrong, and if we discontinue the compulsory legislation relating to immunisation, it [1060] is wrong. Both cannot be wrong, and I think that Opposition Deputies particularly might be a little more helpful and a little more realistic and ought to appreciate that these are powers which we ought to have and about which there should be general agreement.

As a matter of information, could the Parliamentary Secretary give the House any idea of what happens in the normal practice of a general practitioner, to what extent he comes up against opposition as a result of which the individual has to be treated according to the Parliamentary Secretary's ideas? Is there much opposition from the normal individual?

It very rarely occurs.

Very rarely.

Very rarely.

I presume on Report the section, as amended, will be put? I just want to make a remark on a definition which I think now is unnecessary.

On Report Stage the section is not discussed.

Could I suggest a definition that should be left out? I think there is an unnecessary definition to the Parliamentary Secretary's own amendments.

The Deputy should have mentioned that when the matter was under discussion.

This was never under discussion.

It is under discussion now.

Is that definition No. 6?

It is the definition of an adult person. It now disappears through the amendments in Sections 44 and 45, and I wonder if it is necessary.

I think it arises.

In Report, under a section as amended, can the section as amended be discussed?

No, you merely discuss the amendments on Report, unless you are recommitting it, in which case you will take it in connection with the section.

Is there only part of this Bill recommitted?

But the Deputy understood the whole of it.

I knew the reason why part of it was recommitted.

That is more than I knew.

Amendment agreed to.

I move amendment No. 7: --–

In page 7, line 33, before sub-section (2) of Section 7, to insert the following sub-section :–

(2) No regulation which includes provision in respect of a payment to be made to or by the Minister shall be made by the Minister under this Act without the consent of the Minister for Finance.

This is merely a drafting amendment.

Amendment agreed to.

I move amendment No. 8: –--

In page 8, lines 22 to 26, to delete sub-section (1) of Section 12 and substitute the following four sub-sections: –--

(1) The Minister may by Order establish a council to be called "the national health council" to give to the Minister when so required by him advice on matters affecting or incidental to the health of the people.

(2) The Minister shall cause the name of every person who is appointed to be a member of the national health council to be published as soon as may be in Iris Oifigiúil.

(3) The Minister may, if at any time he requires special advice or assistance in connection with the particular matter relating to his powers and functions, by Order establish a special consultative council to give [1062] in the manner specified in the Order such advice or assistance.

(4) The Minister may by Order determine the tenure of office of the members and the procedure of the national health council or of any consultative council established under this section.

The amendment provides for the establishment of a body entitled the national health council, of a continuing nature and for the publication in Iris Oifigiúil of the names of the members of that council. This body is intended to give the Minister, when required, advice on matters affecting or incidental to the health of the people. It also gives power to provide further consultative councils or committees. This is an effort to meet representations made, by Deputy Mulcahy in particular, on the Committee Stage regarding the publication of the names of the members of such consultative councils. As I pointed out on that occasion, where councils are being set up, or even advisory councils, they only remain in existence for a short period and it would not be necessary or desirable on occasion to publish their names. I have in the amendment now before the House endeavoured to meet the Deputy's viewpoint in so far as the main continuing council is concerned.

Sir, the Parliamentary Secretary has not given us much information about how this new national health council is to be constituted. When I raised this matter I raised it definitely in relation to the report of the Commission of Inquiry into Vocational Organisation, and the House will recollect that that body, having examined the whole organic structure of the country in relation to its employment and its professions, three particular branches of the professions were picked out in the unanimous report as being sufficiently developed now to be able to provide a council, representing various branches of the profession, competent to advise and assist the Government in carrying out the work of the country. One such council was the Council of Law; another council was the Council of Education; and the [1063] third was a Council of Public Health. The Parliamentary Secretary now, as far as I can understand him, tells us that he is setting up a national health council, but a national health council of hand-picked persons selected by himself to come together and advise him as a council. That may be a bit of an advance but had we known that there was a national health council and that the members of it, representative of the particular branches of their own profession, were advising the Parliamentary Secretary when he was drafting this measure we would have had more information. We would have had a little more knowledge of the background behind this measure and we might have had a little more confidence in some of the statements made to us by the Parliamentary Secretary.

At any rate, we would have had generally a better understanding of the various problems which have been tackled by this measure and the manner in which those problems were being tackled. I do not stand for a national health council which is merely hand-picked by the Minister. That might very well prove a danger to public health rather than a benefit. I suggest that it might be a danger because we have had here very interesting examples of the Ministerial treatment of the medical profession in the preparation of this Bill. The fact is that the Parliamentary Secretary and the Minister for Local Government have completely spurned consultation with any branch of the medical profession in dealing with this measure. In an atmosphere like that and dictated by a spirit like that, a hand-picked national health council could not be relied upon by the Oireachtas as being the kind of guide emanating from the profession which we would like it to be. It might very well be an addendum to the Ministerial strength simply following out and supporting the Minister in his prejudices and might, in fact, be an invasion of the integrity and the professional outlook and almost of the conscience of the medical profession as a whole. What we would like to see is a national health council guiding the Minister and the Parliamentary Secretary and, through [1064] them, guiding Parliament – a council established by the profession itself as representative of the various branches of the profession and in the manner in which it is suggested in the Report of the Commission of Inquiry into Vocational Organisation such a council should be formed.

I would direct the attention of Deputies to the proposals in pages 335 and 337 of that Report where it is suggested that a council of health be set up:

"We recommend, therefore, that a Council of Health be established and constituted more or less as follows: --–

I. Representatives of Central and Local Authorities: 1 from Department of Local Government and Public Health; 1 from Department of Industry and Commerce; 1 from the General Council of County Councils; 1 from the Association of Municipal Authorities of Ireland.

II. Representatives of medical profession, to be appointed by the Medical Professional Board: 1 from the Medical Research Council; 1 from the teaching bodies; 1 from the voluntary hospitals; 1 county medical officer of health; 1 dispensary doctor; 1 general medical practitioner in private practice.

III. Representatives of other professions, to be appointed by their respective professional boards: 1 dentist; 1 veterinary surgeon; 1 nurse; 1 engineer or architect; 1 chemist; 1 pharmacist.

IV. Representatives of other organisations: 1 from the National Health Insurance Society; 1 from the voluntary bodies, e.g., the Red Cross Society; 1 from the Council of Education; 1 from the National Conference of Agriculture."

These were the lines upon which it was suggested in the unanimous report of the Vocational Organisation Commission that a council of health should be set up. They say: --–

"The function of the council should be to advise, to co-ordinate and to plan.

It should serve first of all as a consultative body, possessed of specialised knowledge, information [1065] and experience, to which the Minister could look for technical advice on public health problems. It should examine and report to the Oireachtas on proposed public health legislation. It should ensure that in housing schemes the requirements of public health in regard to drainage, sewerage, sanitation and hygiene are met.

Its second function should be to co-ordinate the work of the many isolated and independent agencies interested in public health, to eliminate overlapping and to secure unified effort for agreed objectives. It should be the organ to stimulate public interest and co-operation in health services and should be a sensitive interpreter of the needs and complaints of the public. Thirdly, it should act as a planning body to draw up a long-term programme for the development of health services, stressing preventive rather than remedial measures. It should encourage research in public health with a view towards constant improvement and progress along the latest scientific lines. A positive constructive policy is most desirable in regard to dietetics and pure food, domestic and public hygiene, physical training and fitness. Obviously its plans must be practical in relation to the taxable capacity of the country and our available resources.

Among its more immediate tasks the council might make a survey of the present state of public health, the causes of death and the incidence of diseases; it might review the present 'red ticket' service and dispensary system and consider how far adequate medical, dental, hospital and maternity services are provided at reasonable costs for persons of small or moderate means.

Such a council would need a standing executive committee and a permanent secretariat and should have power to appoint its own full-time director who should not be a civil servant. The amount and importance of its work would involve a No. of meetings in each year and the appointment of sub-committees for special problems. It [1066] should issue an annual report to be sent to the Oireachtas. The expenses of the council should be borne by the State by means of a grant-in-aid."

That is the general line of thought and that is the general outline of the way in which the Vocational Organisation Commission consider that a council of health should be set up, that is, a council growing as a top to the organic bodies already developed and carrying on the practical work of dealing with public health, medical, dental, and other services for the people at the present time, not a departmental, administrative or political kind, imposed on top of the naturally-growing and developing profession that is saddled with complete responsibility for being the last thing in training and the last thing in principle in dealing with their particular work.

I suggest to the Parliamentary Secretary that the whole spirit of his approach to co-operation between the Department and bodies dealing with public health and with medicine in all its various aspects, is entirely wrong. Instead of providing this type of national health council, which may mean anything – because the present form of the amendment gives us no information, good, bad or indifferent, as to how he is going to form the council of health or what the nature of the order will be – he should express his approval, or otherwise, of the type of national council suggested by the Vocational Organisation Commission and, if he objects to that, he should state in what other way he would propose to draw naturally, from the profession itself, a national health council representing the profession, and not a national health council representing the particular people that the Minister wanted to select, either for consultation on the one hand, or to be the machinery through which the Ministerial hand would guide, direct and push the profession on the other.

The only point that occurs to me is that in the previous Section 12, sub-section (1), power was taken to establish consultative councils, but in the new section the Parliamentary Secretary is seeking to establish a national council which [1067] presumably will be of a permanent character and, so far, he has given no indication to the House on what lines that council will be formed except that his reply might be found in the existing sub-section (3). The old arrangement provided for consultative councils, presumably, on various aspects of public health, and presumably again they were to be of a scattered nature, intermittent or otherwise, but in this particular case we are to have a permanent framework and I suggest that the Parliamentary Secretary is called upon to give us a little more information as to what sources he will draw upon for that permanent institution.

It would not be in order.

That is nonsense.

The House can do anything by agreement and we will all agree to allow the Parliamentary Secretary to give us more information.

You would not agree to read the Vocational Commission Report from start to finish?

I am getting it read to the Parliamentary Secretary.

We will agree to allow the Parliamentary Secretary to give us a little more information.

I think you know enough. We are not in Committee.

I want to treat this thing seriously.

We treated it seriously in Committee. Deputy Mulcahy made certain suggestions which I have tried to meet by amendment. I am not going into Committee again on it.

I am not asking you to do any such thing. We are asking what we are entitled to ask and that is for information, when a completely new section is being introduced on Report Stage. We are entitled to know whether it is the Minister's intention to set up a national council, because it is purely permissive. We are entitled to know whether this national council, if and when it is set up, is going to be of value. That will depend very largely on its constitution. I [1068] should be glad to know from the Parliamentary Secretary that it is his intention to set up a national health council, that it is his intention to have it constituted in a way which will make it most useful and most valuable. If I can get an assurance from him on that, so far as I am concerned, I would welcome it. We know that it might be a big improvement in the Bill. On the other hand it might be merely a useful cloak. We get the name of having a national health council and the people are told that they have a national health council. That national health council may be so constituted as to be of very little value from the point of view of the public. We feel that this national health council is a thing that is absolutely essential and, having regard to what is contained in the Bill, having regard to its very wide powers, I think it is desirable from every point of view that that council should be constituted in a way that is going to make it most valuable and most useful, not only to the Minister but, what is of much more importance, to the public health. With all respect to the Parliamentary Secretary, he should not consider it unreasonable that we should seek information on this matter and, so far as I am concerned, I do not want this council if it is going to be set up and if its personnel are to be confined exclusively to professional bodies or professional men.

I should like to see on it one or two ordinary commonsense citizens who might make their contribution to it also. All that we are asking for, and apparently the Parliamentary Secretary considers it unreasonable, is information as to (1) if it is seriously intended to establish this council, because, as I say, as it stands it is purely permissive; he may or he may not establish it; (2) if he will indicate how he proposes to constitute it and what the personnel of it will be like. There is nothing very unreasonable in that. Are we to have no reply?

This matter was fully discussed already.

I see. If that is the line, we know where we are. We [1069] can only take it that it is not seriously meant.

I want to suggest –--

I should like to point out that we are not in Committee.

I want to suggest that it is unprecedented on Report for the Parliamentary Secretary to refuse at the end of a discussion to reply to the questions raised.

The Parliamentary Secretary has no right to make another speech.

He has a perfect right.

The position with regard to our work on the Report Stage is that the Parliamentary Secretary, if he has an amendment, introduces and explains it, and then, after the discussion has taken place, the Parliamentary Secretary makes a contribution to the House by way of replies to the discussion.

Will the Parliamentary Secretary let the Chair rule on that?

I should like to give the Parliamentary Secretary the right to conclude the discussion, if he wishes to do so.

Therefore, the Parliamentary Secretary cannot hide under that cloak.

I do not want to hide under any cloak. I see your game all right; you are at it again.

If there is any game in asking for information, I should like to know where it is.

The Deputy got lots of information on this before.

If the Parliamentary Secretary is going to start on the Report Stage in the same way as he started on the Committee Stage, he knows what is ahead of him.

I am not worried about what is ahead of me.

I should like to ask the Parliamentary Secretary in what way the national health council will be constituted.

It may not be constituted at all.

Will the Parliamentary Secretary say whether the Order under this section will be an Order containing a number of names or an Order outlining a certain number of bodies from which representatives will be drawn?

It will be an Order containing a No. of names, if it is made at all.

Amendment put and declared carried.

I move amendment No.9 :---

In page 8, Section 12(2), line 29, to insert before the word "any" the words "the national health council or".

This is consequential.

Amendment put and agreed to.

I move amendment No. 10 :--–

In page 8, section 12, line 35, to insert at the beginning of sub-section (3) the words "The National Health Council and".

Amendment put and agreed to.

I move amendment No. 11 :--–

In page 8, section 13, lines 45 to 47, to delete sub-section (2) and substitute the following sub-section: –

(2) the Minister, after having caused a local inquiry to be held into the desirability of so doing, may by Order direct a health authority to–--

(a) provide and maintain at a specified place an institution of a specified character and size, or

(b) restore, enlarge or otherwise alter in a specified manner any institution maintained by them pursuant to this section;

and such health authority shall comply with such Order.

This too, like most of the rest of the amendments, arises out of representations [1071]made by the Opposition Party on the Committee Stage. The Deputies on the opposite benches pressed for a public inquiry before an Order would issue by the Minister to a local authority directing them to provide and maintain an institution. Deputy McGilligan pressed this matter very strongly and this amendment is submitted to the House for the purpose of meeting the representations made on that matter.

I do not think that the amendment meets all the representations that were made, because the House pressed for and insisted on the necessity for publishing the report of that inquiry. Surely if an inquiry is held and, so far as the findings of that inquiry are concerned, they are submitted privately to the Minister and the public do not know anything about them; so far as the public are concerned that does not serve any good purpose. The inquiry might find something altogether different from what the Minister would say afterwards about it.

Does the Deputy realise that this is a public inquiry open to the Press?

And the report will be published?

Open to the Press and the public.

And the report will be published?

No. The proceedings of the inquiry will be published in the local Press.

Will the report be published?

Not at all. We discussed all that in Committee and I gave no undertaking to reconsider that.

You did not, but you should have.

I should have told you people to draft a Bill.

That would be a very intelligent thing for you to say.

It would, if I were not interested in public health.

There is no use in having a public inquiry without publishing the report. That amounts to a farce.

There is no public inquiry that amounts to a farce.

The Parliamentary Secretary seems to think that a lot of things were settled in Committee but, in respect of this matter, nothing was settled in Committee. The position with regard to this section as it stands is that the Minister can order a local authority to set up an institution which he tells them to set up. Our line in Committee, in the first place, was that there should be a public inquiry into the matter and, after the inquiry and consultation with the public authority and the publication of the report, then, if the Minister still dictated that they should put up the institution, that except he got at least one-third of the local body voting to agree to his proposal, the local authority would not be bound to put up the institution and to impose the cost of the setting up of that institution on the ratepayers.

Was not an amendment to that effect dealt with in Committee?

It was and the Parliamentary Secretary is now dealing with the amendment here. I propose to deal with the background. We are amending the section here.

Do you propose to deal with the whole of the 500 backgrounds?

I propose to deal with the section the Parliamentary Secretary is proposing to amend, and I would ask, Sir, if there is any Parliamentary precedent in this country or in any other country which would prevent a House which is asked to amend a section of a Bill considering the section that they are asked to amend. Can I continue?

There is nobody stopping you.

I am trying to meet the Parliamentary Secretary's objection. I am trying to get him to understand that, if he asks us to amend a section of a Bill, we have to consider the amendment in relation to the section.

You have to consider what crooked construction you can put on the amendment.

I am not putting any crooked construction on the section here. This is a section which would give the Minister power to order a local authority, without any consultation of any kind, to set up a certain institution.

The Deputy does not deserve to have the point made.

I am not speaking of my own deserts, but the deserts of the people of the country. My point is not the matter that is of importance. The facts that affect the local authorities in the country and their institutions and the people who have to pay for them and who are to be treated in them are of importance.

Did we not hear all that many times?

The Parliamentary Secretary's remarks would suggest that he had not heard enough about it.

Did we not hear it debated for days until the Deputy and others walked away?

The Parliamentary Secretary said he was only entitled to speak once.

These are only little interruptions.

Deputy Mulcahy is in possession.

I object, Sir, to your looking at me when you make that observation. Look to your left.

He would rather be looking at you.

I was addressing the House, Deputy, including everybody in it.

Including Deputy Morrissey. I hope we have not put Deputy Mulcahy off the track.

I shall do my best not to be put off. The amendment before us---if the Parliamentary Secretary will excuse me while I clear my mind of some of the fog he attempted to create---is amendment No. 11, which seeks to have certain lines deleted in Section 13. The lines the Parliamentary Secretary seeks to delete are:---

"A health authority shall provide and maintain any institution which the Minister by Order directs them to provide and maintain."

The Parliamentary Secretary thinks that because we say anything on Report we do not deserve to have that sub-section in Section 13 removed. I wish the Parliamentary Secretary could forget our personalities in the matter.

It is not your personalities, it is your play-acting.

I do not think it is play-acting, when we are discussing Section 13 and ask you to amend it, to recall what we are doing. We are proposing to remove here this part of Section 13:---

"A health authority shall provide and maintain any institution which the Minister by Order directs them to provide and maintain."

The Parliamentary Secretary, by his amendment, is making an advance on that position. The amendment sets out:---

"(2) The Minister, after having caused a local inquiry to be held into the desirability of so doing, may by Order direct a health authority to---

(a) provide and maintain at a specified place an institution of a specified character and size, or

(b) restore, enlarge or otherwise alter in a specified manner any institution maintained by them pursuant to this section;

[1075] and such health authority shall comply with such Order."

We are asking that when a local inquiry is held, the report of that local inquiry should be made public.

Why did you not put down an amendment again on that? It is not here.

It is not here. We gave 15 long days to a discussion of this in Committee. The year is rather short and there are quite a No. of things we would like to do with the Parliamentary Secretary’s amendment if other matters were not pressing on us and if we had an opportunity of going as thoroughly through the amendments as we did in the Committee Stage.

And if you put amendments down, you will be accused of play-acting.

In spite of the generosity that the Parliamentary Secretary talks about this evening, that spirit was not apparent in the Committee Stage discussions lasting for 15 days.

Be fair, now. Sure, you nearly all came over to me.

It was the other way round.

I am prepared to be fair. If the Parliamentary Secretary asks me why I do not deal with all his amendments in the way in which amendments were dealt with on the Committee Stage---and we felt it our duty to deal with them in that way---I am prepared to give sound reasons for it, but I do not think that that would help us in our discussions here.

Do not bother.

The question that arises here is not why I did not put down an amendment to this, but what chance would there be of having such an amendment accepted.

Quite so. We can summarise now what the position will be when the Parliamentary Secretary’s [1076] amendment goes through. The Minister will undertake to hold a local inquiry as to whether a particular institution should be set up and, having held that inquiry and received a report from the inspector who held it, he will pigeon-hole the report in the recesses of the Department and will issue his Order without giving the local authority or anybody else a chance of seeing what were the terms or the general lines of the report. The Minister may issue an Order to a local authority to put up the particular institution to which they objected in the first instance. They will be in the position of knowing that the Minister has a report about it, but they will not be allowed to know the terms of that report. I do not think the Minister is fair to local representatives if he denies them knowledge of the report that has been made following the inquiry.

There is a certain amount of concession here, but as regards improving the machinery for dealing with local affairs, as between the Ministry and the local representatives, the Parliamentary Secretary is not making any very great concession. The position is all the more difficult to understand in view of the powers the Minister is proposing to take---that is, simply to order a certain building to be erected by the local authority, or he will clear the way and have it put up. I ask you to consider the powers the Minister is taking and the extent to which we went in Committee, not only to ask for publication of the report of the local inquiry, but to see that the Minister would have to have the support, at least, of some fraction of the local authority. The Minister is not going sufficiently far to establish the necessary relations of mutual confidence between the local representatives, to whom he will be issuing an Order such as this, and himself.

Amendment agreed to.

I move amendment No. 12:---

In page 9, Section 13 (3), lines 1 to 3, to delete paragraph (a).

This amendment is consequential on amendment No. 11.

Amendment agreed to.

I move amendment No.13:---

In page 9, Section 13 (3) (b), lines 6 and 7, to delete the words "so maintained" and substitute the words "maintained by them pursuant to this section".

Amendment agreed to.

I move amendment No. 14 :---

In page 9, Section 14 (2) (b), line 29, to delete the words "a health" and substitute the word "an".

This is a drafting amendment. Deputy Hughes caught us out in the Committee Stage on a point of order in connection with this amendment.

It was not moved in Committee.

Amendment agreed to.

I move amendment No.15:---

In page 10, Section 16 (3), line 9, to delete the word "management" and substitute the words "carrying on".

This is a drafting amendment.

Amendment agreed to.

I move amendment No.16:---

In page 10, Section 17, line 22, before sub-section (2) to insert the following new sub-section:---

(2) Where a person is detained in an institution under Section 31 of this Act no charge shall be made under this section in respect of any institutional services which such person receives during such detention.

This deals with the point that I made.

Yes, either you or Deputy McGilligan. It was not clear that the person detained might not be charged maintenance while under detention. This amendment meets that point.

Amendment agreed to.

I move amendment No.17:---

In page 10, section 17 (2), line 22, to delete the words "Where a health authority are" and substitute the [1078] word "In", and in line 24 to delete the words "they shall have regard" and substitute the words "regard shall be had".

This is a drafting amendment. It arises out of a debate in which Deputy Costello was particularly interested. It is intended to clarify the position of determining charges for services received by a person.

Amendment agreed to.

I move amendment No.18:---

In page 10, Section 17 (3), to delete lines 26 and 27 and substitute the words: "A charge under sub-section (1) of this section for institutional services received from a health authority by any person may be recovered as".

Amendment agreed to.

I move amendment No.19:---

In page 10, Section 19, lines 54 and 55, to delete sub-section (1) and substitute the following two sub-sections:---

(1) The Minister may by regulation specify the diseases which are infectious diseases.

(2) Regulations under sub-section (1) of this section may exclude an infectious disease from the application of any particular section of this part of this Act.

Under the Bill as drafted: "The Minister may by Order declare that the disease is infectious." Deputy Mulcahy prefers the declaration made by regulation rather than by Order. The amendment has been circulated to meet that point, and to give the Minister power to specify the disease or infection, and general power to exclude an infectious disease from any particular section of this part of this Act. In sub-section (2) of the proposed amendment the Minister can exclude from the application of any section in this part of the Act a particular infectious disease. That seems to be better structural machinery and, incidentally, to meet the Deputy’s point, by substituting "regulation" for “Order".

Amendment agreed to.

I move amendment No. 20:---

In page 10, Section 19 (2), line 56, to delete the words “an order” and substitute the word “regulations”.

Amendment agreed to.

I move amendment No. 21:–

In page 11, lines 1 to 4, to delete Section 20.

This is consequential.

Amendment agreed to.

I move amendment No. 22:–

In page 11, Section 21, lines 18 to 54, to delete sub-sections (3) to (10) and substitute the following sub-section: –

(3) A person who contravenes sub-section (1) or (2) of this section shall be guilty of an offence under this section and shall be liable on summary conviction thereof to a fine not exceeding £50.

This relates to a subsequent amendment. As drafted, Section 21 has been broken up and simplified and a couple of sub-sections deleted as being unnecessary and cumbersome. No new principle is introduced.

There was a good deal of argument by Deputy McGilligan on “summary conviction”.

We met that.

In this amendment?

We meet it in one of Deputy McGilligan’s amendments later.

Covering the whole thing?

Yes. I will not be accepting the amendment. There can be a discussion.

Amendment agreed to.

I move amendment No. 23:–

In page 12, Section 22, line 4, before sub-section (3) to insert the following sub-section:–

(3) Regulations under this section shall not require a person to submit to surgical treatment. [1080]

This provides that regulations under this section shall not require a person to submit to surgical treatment. We have fairly fully discussed it. The section authorises the making of regulations preventing the spread of infectious disease. Section 31 deals with the detention of a person who is a probable source of infection. It was originally proposed to include medical treatment in the prohibition, but on consideration it was decided that it would be dangerous. The prohibition is confined exclusively to surgical treatment. Surgical treatment is defined in the definition section, which we have already discussed.

I take it that consequent upon this it will not be possible for any operations to be performed on a person against his will.

That is so, definitely. We have now defined surgical treatment.

The Minister mentioned in regard to the definition section the position a doctor might be in when a patient was only partly conscious. What position would the doctor be in now if a patient required surgical treatment?

He cannot do it without the patient’s consent or, in the case of a child, without the consent of the appropriate guardian.

And if it would be necessary?

The doctor would have to take the risk of an action in court. There is no protection. I might point out in that connection that this refers only to infectious diseases, but there is a type of case that is causing some anxiety, zymotic disease, or where a patient in an advanced state of diphtheria might be brought in, and it might be a matter of great urgency. There might not be time to get consent. There it is. I thought it better to concede the point. If the doctor does act without the consent of a parent, and if the child died, he would have to risk an action in court.

That is so, as far as the Parliamentary Secretary has put [1081] it, but he was seeking to take powers that were never there before.

That does not alter the position.

Amendment agreed to.

I move amendment No. 24:–

In page 12, Section 23, lines 41 to 46, to delete sub-sections (1) and (2) and substitute the following sub-sections:–

(1) A person who knows that he is verminous shall, in addition to any precautions specifically provided for by or under this Act, take every reasonable precaution to prevent his infesting others with vermin.

(2) A person having the care of another person and knowing that such other person is verminous shall, in addition to any precautions specifically provided for by or under this Act, take every reasonable precaution to prevent such other person from infesting others with vermin.

Under Section 23 as drafted sub-section (1) read: –

“A person who knows that he is verminous shall not expose himself in any street, public place, club, hotel or shop.”

Sub-section (2) read:–

“A person having the care of another person and knowing that such other person is verminous, shall not permit such other person to expose himself in any street, public place, hotel or shop.”

It is proposed to substitute for sub-section (1) what is contained in the amendment, and similarly, in the case of a person having the care of another person. After full consideration it was felt that the section as drafted might be too drastic, and that a modified form would meet all reasonable requirements. We discussed the matter on Committee Stage and it is not necessary to repeat the arguments now.

Can the Parliamentary Secretary say in what particular circumstances a person could contravene the section? What are the reasonable [1082] precautions that might be taken outside those provided here?

I am afraid that if a man was charged with having violated the section a court would have to decide whether he took reasonable precautions to prevent infestation. That can only be decided in court.

What precautions might be taken outside the precautions provided for?

A man might get disinfecting powder and as D.D.T. is available he might free himself. He has only to dust his clothes with the powder in order completely to disinfest himself. If he refused to do that, and if other people were infested in consequence he would be liable. The Deputy must bear in mind that I am not the judge. That is a personal opinion.

In any case, it is an improvement on the original section that he now can come out in the fresh air. It is certainly refreshing to hear the Parliamentary Secretary admit, even at this late hour, that any sub-section or section in this little pet Bill of his could be considered as being too drastic.

This is a big pet, not a little pet.

And you are making it bigger.

It will be the Deputy’s pet before he is finished with it.

Let the Parliamentary Secretary not lose his sense of humour, if he ever had one. We are trying to be as helpful as we were on Committee Stage.

The measure of that helpfulness is here in this sheaf of amendments, about 150 of them.

I heard that to-day already when the Deputy was out.

It is not by any means the first bit of truth you heard from this side of the House. We are [1083] finding it difficult to penetrate over there, but that is not the point. I got up to congratulate the Parliamentary Secretary –

Go on; do it.

–on getting away from the impossible section originally in the Bill and on bringing in something that is reasonable. I think this is reasonable, and I was merely about to advert to that, and to congratulate the Parliamentary Secretary that, even at this late hour he concedes that even this section might be deemed to be too drastic. I would not like to see him losing his sense of humour so early on this stage.

Amendment agreed to.

I move amendment No. 25 :–

In page 13, Section 23 (9), line 17, to delete the word “verminous” and substitute the word “vermin”, to delete in line 17 the words “infested with”, and to add at the end of the sub-section, line 22, the words “and the word ‘verminous’ means infested with vermin”.

This is a drafting amendment.

Amendment agreed to.

I move amendment No. 26:–

In page 13, line 23 before Section 24 to insert the following section: –

(1) The parent of a child shall not send the child to any school, or permit the child to attend any school, if he has reason to believe that the child is suffering from an infectious disease.

(2) Where a registered medical practitioner attending a child or attending a person in a dwelling where a child resides, is aware that the child is a probable source of infection with an infectious disease, he shall so inform the district medical officer for the district in which the child resides.

(3) Where a school medical officer finds, on inspection of a child, that the child is a probable source of infection with an infectious disease, he shall so inform the district medical [1084] officer for the district in which the child resides unless he is himself such district medical officer.

(4) Where a district medical officer becomes aware, whether from information given under sub-section (2) or (3) of this section or otherwise, that a child residing in his district is a probable source of infection with an infectious disease, such medical officer may serve notice on the parent of the child prohibiting the attendance of the child at any school until such district medical officer gives a certificate (for which no charge shall be made) that the child is fit to attend school.

(5) When notice in respect of a child is served on its parent under sub-section (4) of this section the parent shall not send the child to any school or permit the child to attend any school in contravention of such notice.

(6) A person who contravenes sub-section (1) or (5) of this section shall be guilty of an offence under this section and shall be liable on summary conviction thereof to a fine not exceeding £50.

I referred to this amendment earlier, when we divided the larger Section 21 into two new sections. No new principle is introduced – it is merely a drafting amendment.

Does it make any material alteration?

It does not alter the statutory obligation. It merely removes some of the redundant stuff in the other section.

Amendment agreed to.

I move amendment No. 27:–

In page 13, Section 24 (1), line 25, to delete the words “principal of the school or college” and substitute the words “school manager”.

This amendment is consequential.

Amendment agreed to.

I move amendment No. 28:–

In page 13, Section 24 (2), to delete in line 33 and in lines 36 and 37 the [1085] words “principal of the school or college” and substitute in each case the words “school manager”.

Amendment agreed to.

I move amendment No. 29: –

In page 13, Section 24, lines 38 to 44, to delete sub-section (3) and substitute the following sub-sections :–

(3) A notice under sub-section (2) of this section may be addressed to the “school manager”, and may be given by delivering it to the school manager or by sending it by post to the address at which he ordinarily resides.

(4) A copy of every notice under sub-section (2) of this section in respect of a national school shall be either delivered to the principal teacher of the school or sent by post to such teacher at the school.

I referred to this amendment earlier. We are deleting sub-section (3) as set out. That sub-section provided that a notice could be served on the principal of the school or college and addressed to the manager or principal, as the case might be appropriate. We are providing now that the notice under sub-section (2) may be addressed to the school manager and may be given by delivering it to the school manager or by sending it by post to the address at which he ordinarily resides. In the section as drafted, we had a provision for sending it by post or delivering it to an adult person or to the principal. This is a definite improvement because we notify the manager by post and send a copy of the notification to the manager and the principal teacher of a school, so that they will both in fact be notified.

Is there any objection to saying: “registered post”?

The ordinary post is considered to be quite satisfactory. There is no rooted objection to prescribing registered post, except that it is a little more troublesome to administer. The person delivering a registered letter is supposed to get a receipt for a registered package from the person to whom it is addressed. That person may not [1086] be there and the letter might be taken back, with consequential delay. As we are notifying the manager and the principal teacher of a school and providing for double notification through the post, it is unlikely that there will be any miscarriage of notification.

I think it very necessary for the Parliamentary Secretary to put in sub-section (4) because the principal is certain to be in the school at all times, while the manager might be away for days and the notice might lie at his house for the period during which he is away. I am worried, however, as to whether the principal can take the necessary action in the absence of the manager.

Without the manager questioning his action afterwards?

With regard to the point I attempted to raise earlier, is the Parliamentary Secretary satisfied that the words “adult person” now occur in the Bill?

“Adult person” applies to a different matter altogether. “Adult person” is disappearing here, but we require to distinguish between a child and an adult person for the purposes of the Bill. An adult person would be a person over 16 years of age for the purposes of the Bill.

There is a definition of a child as a person under 16 years of age. You really need both definitions.

I think we do, and I will look into it, if necessary. If the Deputy refers to the Second Schedule, he will find the justification for retaining the definition of an adult person.

Amendment agreed to.

I move amendment No. 30:–

In page 13, Section 25 (1) (a), lines 54 and 55, to delete the words “a probable source of infection with” and substitute the words “suffering from”.

[1087] This amendment, together with other similar amendments later on, will, I think, be welcomed.

Amendment agreed to.

Debate adjourned.

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