Dáil Éireann debate -
Friday, 15 Nov 1946

Vol. 103 No. 7

Ministers and Secretaries (Amendment) Bill, 1946—Second Stage (Resumed).

Question again proposed: "That the Bill be now read a Second Time."

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

When the House adjourned last night I had pointed out that the establishment of the two new Departments contemplated by this Bill had been demanded for some time by public opinion which had been voiced in many quarters of this House. I had also pointed out, however, that the Government had taken action far in advance of public opinion in this matter, and so far back as 1942 had been considering the problems involved in setting up the new Departments. In that connection, I had reminded the House of the statement which I made in February, 1944, and of the delegation Order which the Government had made in the following month as a step preparatory to setting up the new Ministry of Health. Therefore, it will be seen that the decisions to which the Bill now under discussion will give effect have been arrived at only after full and mature consideration of every factor involved. Leaving this aspect of the matter, I was in the process of reviewing the present duties which in such numbers and in almost infinite variety fall upon the Minister for Local Government and Public Health. As I have stated, when the House adjourned I had mentioned in a general way, but in no great detail, the functions which the Minister and his Department have to discharge in relation to maternity and child welfare, free milk and school meals, the welfare of the blind, the prevention and treatment of venereal diseases, tuberculosis services, standardisation of foods, control of proprietary remedies, medical research, bacteriology, public hospitals, voluntary and otherwise, hospital finance and construction, Public assistance— domiciliary, institutional and financial —medical services.

I had mentioned that the Minister has to determine the numbers and types of district institutions which are provided and maintained by local authorities, and that he has to decide, among other things, for the continuance or discontinuance of particular institutions and to regulate the class of patients or inmates to be maintained in each.

Last year the House passed a measure which was hailed everywhere as marking a great advance on the present methods of dealing with mental diseases. The Mental Treatment Act has recast the legal basis for the detention and care of persons suffering from these disorders, and it will be brought into operation on the 1st January next. Once again, a considerable weight of extra duties and responsibilities will be thrown on the Minister for Local Government and Public Health as that Ministry is now constituted. These extra duties and responsibilities will arise not only in respect of the mental hospital services administered by the local authorities but also of the private mental institutions. Hitherto, these institutions have been licensed by the Circuit Courts. Henceforward, they must be registered annually by the Minister. Similar provisions have been made also in relation to charitable institutions which hitherto have not been licensed by any authority. The new Act will also involve the organisation of the existing services so as to provide for the treatment of temporary patients and voluntary patients, including "addicts," for whom special arrangements have not been made hitherto.

The approval of the Minister will be required for new institutions in which these two classes of patients may be received and a considerable amount of new investigation and supervision will thus arise.

General Mulcahy

Does that apply to a new private charitable institution?

Mr. MacEntee

I have said so.

General Mulcahy

They must get Ministerial permission in the future to establish private charitable institutions?

Mr. MacEntee

Certainly, if they are going to treat persons who, by reason of mental defect, are unable to safeguard their own interests. May I say this, before I leave the point which the leader of the Opposition has raised? The Act under which that will be done was discussed fully by this House, was approved in every quarter of the House, and has been approved outside the House by all those competent to express an opinion on these matters, so that the Deputy, if he has any objections on the ground which he has indicated, shares collective responsibility with everybody here.

The Act furthermore contains a new and complicated superannuation scheme for employees of mental hospital authorities under which the Minister will be the deciding authority on a wide range of questions. Many of these questions, as some of us know from experience, are very thorny and difficult, and to most of them the Minister will be called upon, in due course, to give personal consideration.

The Minister for Local Government and Public Health is also responsible for the General Register Office, which supervises the registration of births, deaths and marriages, and arranges for the compilation of vital statistics.

Then come his duties under the National Health Insurance Acts and the Widows' and Orphans' Pensions Acts. These involve the control and management of the National Health Insurance Fund, National Health Insurance Reserve Fund and the Widows' and Orphans' Pensions Fund; the determination of insurability and the enforcement of compliance; the exercise of statutory functions in relation to administration by Cumann an Árachais Náisiúnta ar Shláinte (including the administration of medical treatment schemes of additional benefit); issue of funds; supervision of expenditure on administration; investigation of complaints; decisions of disputes between insured persons and the society and the determination of capacity for work; making agreements with doctors for medical certification; the formulation of reciprocal arrangements with the insurance authorities of other countries; decision on claims to pensions and the management and supervision of pensions in course of payment.

Now, the duties and responsibilities which I have outlined do not represent even one-half of the burden that falls at the moment on the Minister for Local Government and Public Health. Not only is he the Minister responsible for the health, vital statistics and insurance services, but he is also responsible for the supervision of slum clearance, of local authorities' housing schemes, of the grant of assistance to private persons and societies for the erection or reconstruction of dwellings, and for the direction and control of town and regional planning, water supply and sewerage schemes and the provision of playgrounds, parks and open spaces, and other such matters and for the construction, repair and maintenance of roads and bridges and the collection, management and distribution of the Road Fund, the administration of grants for the relief of unemployment and numerous matters relating to road traffic. The Minister also acts in the role of appeals body in connection with the grant of old age and blind pensions.

He is responsible for the administration of the law relating to parliamentary and local elections, for general local administration, the recruitment of staff, collection of rates, and the complex questions of local finance, including local borrowings and the administration of the numerous and diversified grants in aid of local expenditure.

He is also responsible for the auditing of the accounts of public bodies and for ensuring that such defects in control or administration as these audits may disclose will be quickly remedied. He has furthermore to arrange for grouped purchasing by local authorities through a system of centrally-made contracts, and since the start of the emergency period and up to the present time he has directed the part taken by the local authorities in the turf production drive, and the distribution of free and cheap fuel.

It will be evident from this review that the Department of Local Government and Public Health has become overloaded with a multiplicity of functions and that a continuous process of growth has reached a stage where effective control by one Minister over such a wide variety of disparate services is no longer possible. A cleavage is essential and, of course, the cleavage should be made along the line which lends itself most appropriately to division. I submit it will be equally evident, from the general review which I have made of the services, that the services relating to the health of the citizen and the community have in themselves attained a size and importance which demand the whole-time attention of a Minister.

The provision of health services in a modern community presents a series of complex problems involving technology and organisation which demand a new and specialised approach. It is becoming increasingly recognised that it is the duty of the State, not only to supervise generally the existing health activities of local authorities, but also to lead and direct these activities in accordance with the advances which are being made in medical knowledge and experience the world over. Such advances have now attained a rate of accleration never experienced before. Scientific discoveries have led to great developments in the efficacy and scope of preventive and curative medicine.

The Minister responsible for health services must, therefore, be in a position to give a considerable proportion of his attention to the import of these scientific achievements and to prepare from the specialised study of them a planned course of general action for the promotion of the public health, the prevention of disease, the cure of ill-health and the mitigation and alleviation of its consequences.

Advances in medical technology give grounds for greater hope than ever before that such a general action may achieve signal success, but, if results of these advances are to become readily accessible to the people, they must be accompanied by similar advances on the side of organisation and administration. The inter-relationship is so intimate that the close co-ordination of the administrative and scientific arms is essential to the successful conduct of any war against disease.

Apart from those special measures which must be undertaken for the provision of a new and better organised and more scientific approach to health problems in general, the normal departmental work of the new Minister for Health will be voluminous, urgent and of prime national importance. Health services are assuming a new significance to-day, both because of the unwonted virulence now attaching to certain diseases, the danger from which is aggravated by the freedom of movement and of intercourse which is being so rapidly developed.

General Mulcahy

And by malnutrition.

Mr. MacEntee

And, of course, because of the general decline in population which is threatening the countries of Western Europe. It is true that the case, for instance, for the intensification of the campaign against tuberculosis has already been conceded, but there are also other diseases whose incidence here is heavier than elsewhere. I refer, in particular, to diseases such as diphtheria and gastroenteritis which take particular toll of child life. I have already indicated, in various public statements and in reply to questions in this House, the steps which are being taken to prevent the spread of these scourges.

The best general mode of attack will be found in the introduction of a comprehensive health service scheme. The Minister for Health would naturally address himself first to the establishment of comprehensive and co-ordinated schemes for mother and child welfare, a complete tuberculosis service, including the payment, where necessary, of maintenance allowances to families of persons undergoing treatment or who are unable to carry on their ordinary occupations, and to the provision of new and improved health clinics and county and district hospitals. He would integrate all these with specialist and regional hospital services and with the undertakings in the same fields of numerous public and voluntary bodies, so that no person who needs it will lack anything that medical skill can do to make him well or to keep him well.

The second portion of the new Minister's tasks will be related to the modern scientific and technical developments to which I have referred. For instance, the laboratory facilities for essential biological and bacteriological work in the realm of public health are inadequate to meet the full needs of the field services and they fail to provide adequate opportunities for research. This matter and the corresponding need for stepping up the standard of medical education, including post - graduate training and research, represent essential prerequisites to the health reforms which are being formulated. Without adequate numbers of trained medical and nursing personnel and specialists, our plans would be useless. It will be the task of the new Minister to decide whether the higher training and research and the specialist services to which I have referred can be provided within the existing framework or whether new organistions such as State institutes will have to be created to provide them.

In brief, I may sum up what I have said by remarking that we have now in existence the blueprints of a health structure completely divorced from the old public assistance system, based upon a greatly improved family doctor service, and providing for every scientific agent that may be utilised for the preservation of health and the prolongation of life. The Government hopes that, under the aegis of the new Minister, the execution of these plans will afford every inducement to the most distinguished graduates of our medical and scientific schools to stay in their own land, and to devote their talents to the welfare of their own people and the maintenance of the traditional repute of Irish medicine.

Now, perhaps, I should say a word as to the proposed division of functions as between health authorities and sanitary authorities and the corresponding allocation of duties and responsibilities between the Ministers concerned. As indicated in the explanatory memorandum which has been circulated to Deputies, the intention is that the Minister for Health should be made responsible for the co-ordination and development of all the direct preventive and curative public health services. All these services will be administered locally by county and county borough health authorities. County councils and county borough councils, acting as health authorities, administer a number of the direct medical services already, but other duties touching these are performed in the more restricted and more numerous administrative sanitary districts by the urban and rural sanitary authorities. The present sanitary authorities, urban and rural, would remain under the supervision of the Minister for Local Government. Their functions relate to what may be termed the environmental sanitary services, such as waterworks and sewerage schemes; street cleansing and scavenging works; the management and control of fairs and markets; public lighting; the provision of public parks, playgrounds, open spaces, baths, washhouses and swimming pools. The local authorities responsible at present for these services would continue to provide them in addition to fulfilling their other obligations in regard to housing, roads, etc.

General Mulcahy

So they will do housing as well?

Mr. MacEntee

Yes. Deputies will recall that the Public Health Bill, 1945, which has already been discussed in the House, contains several parts devoted to a number of these environmental services. Moreover, the title of the Minister as defined in the Bill is, of course, the Minister for Local Government and Public Health. The Act of 1939 to which I referred in the opening part of my statement last night, gives power to adapt enactments and references to Departments of State, but the provisions of the Public Health Bill cannot be adapted seeing that it has not become law and it would be anomalous to proceed with it in its present form after this Bill has been enacted. It is, therefore, proposed to withdraw the Public Health Bill and to allocate its responsibilities between the two Ministers according to their respective functions. Then two new measures will be introduced instead, with the relevant amendments for Report and other appropriate and consequential amendments embodied therein. The Bill to be sponsored by the Minister for Local Government will deal with what we shall call "sanitary services" and the other Bill to be sponsored by the Minister for Health will relate to the health services as I have defined and described them here to-day. I turn now to the Department of Social Welfare.

General Mulcahy

Will the Minister tell us a little more about the death of the Public Health Bill, if we are setting up a Ministry of Health? Is the Minister aware that as recently——

Mr. MacEntee

I am not giving way to the Deputy.

General Mulcahy

Very well. It was very urgent at Easter.

Mr. MacEntee

If the Deputy has any difficulty in understanding what I have said, I may repeat that the Public Health Bill, as now before the House, will be withdrawn, that it will be divided into separate measures. Those provisions of it which relate to health services will be embodied in a Health Bill with appropriate and consequential amendments thereto, while the others will be introduced as a Local Government Bill dealing with the sanitary services and will be taken by the Minister for Local Government.

Surely, it is not beyond the capacity of the Leader of the Opposition to comprehend the consequences that flow from that, the first of them being that the House will have an opportunity of discussing these two measures again.

General Mulcahy

I am asking the Minister whether, in view of the fact that the Public Health Bill was so urgent in its entirety last Easter, we could have some explanation of the change of view. We are now being asked to set up a Ministry of Public Health.

Mr. MacEntee

I have given the Deputy a full explanation of the change. If he is not in a position to appreciate what I have said, I regret it very much but I submit that it is not my fault. I was saying that I proposed to refer to the projected institution of a Department of Social Welfare. The establishment of this Department will present a less complex task than that of the Department of Health, inasmuch as the functions proposed to be assigned to it will, with few exceptions, relate to the services which can be transferred in globo. The existing services which may be so transferred include children's allowances, food allowances, national health insurance, unemployment insurance and unemployment (intermittent) insurance, unemployment assistance, widows' and orphans' pensions, pensions for blind persons and old age pensions. Each of these services, as most Deputies are aware, was designed and established at different times to meet particular social defects—to provide against the consequences of loss of income arising from sickness, unemployment, old age or death of the wage-earner. The latest scheme, children's allowances, is in essence a non-contributory social assistance scheme for necessitous persons with families of more than two young children, inasmuch as the absence of a means tests in that scheme is offset by the reduction of the income-tax concession for children eligible for the allowances. Each of these schemes, according as it was introduced, was assigned to whatever Department of State seemed best able to handle it. Expediency rather than principle seemed to have been the governing factor. The old age pensions service, for example, is administered by the Office of the Revenue Commissioners, subject to appeal to the Minister for Local Government and Public Health, although, in fact, the service is not one properly referable to the Revenue Commissioners.

Again, the national health insurance scheme is now administered by a unified society under the supervision of the Minister for Local Government and Public Health, while the widows' and orphans' pensions scheme is administered directly by the same Minister, but is associated with the national health insurance—a single stamp being used to collect contributions under both services. Unemployment insurance and unemployment assistance are administered by the Department of Industry and Commerce, but in determining questions of scope under the Unemployment Insurance Acts, liaison is maintained with the national health section of the Department of Local Government and Public Health on matters common to national health and unemployment insurance.

Moreover, the national health inspectors are responsible for securing compliance with the Unemployment Insurance Acts and the Insurance (Intermittent Unemployment) Act, 1942. In the assessment of eligibility for old age pensions, widows' and orphans' pensions and unemployment assistance, claims are investigated by investigation officers of the Revenue Commissioners, while, in connection with all the social services I have reviewed, the Department of Posts and Telegraphs provides facilities at post offices for the sale of contribution stamps and the cashing of pensions and allowances. Repeated demands have emanated from various sections of the Dáil for the association of these services in a single Department. In deference to these demands, the Government has had an examination instituted by the Departments concerned as to whether it was practicable and desirable to assign them to a single Minister. As a result, the conclusion has been arrived at that the Department should have at its disposal the specialist advice of a Minister and a Department established for that purpose. In coming to this decision the growing demands for the development and expansion of social services were reverted to. A consideration of the problems to which the concession of these demands would give rise indicated that the Government should have a Minister who would become the centre of informed opinion on social policy, and be able to analyse and advise on such demands and, should our circumstances warrant it, prepare and administer the legislation necessary to meet them.

It has been claimed that better co-ordination of effort and certain economies in staff were anticipated as a result of the merger but I cannot recommend the proposal on this score because, as I have already shown, staff of one Department in relation to the social services administered by it have been generally availed of by other Departments which likewise have been concerned with social services. We have had a system whereby the staffs which appeared to be most suitable for one purpose have been utilised, where they appeared to be equally suitable, for other purposes, so that I cannot see that any great economies will be secured as a result of the co-ordination. Furthermore, I should say that it is possible that the development and merger of these social services will bring into being an organisation which may not be quite as economical as the organisations which administer the services at present. I am prepared to concede, however, that we may have a social code which will be better co-ordinated and more uniform in the benefits and advantages which those who come within its scope will derive from it.

I have mentioned that the Minister for Social Welfare will advise the Government in regard to certain of the social services. "Social services" is an expression which has a wide connotation. In the present context, I should emphasise that the expression, "social services" means the income-maintenance services which it is now proposed to assign to the Minister for Social Welfare. The term "income-maintenance service" and the term "social welfare" have been adopted as being more accurately descriptive of the functions of the new Department, which will be only one of several Departments which are concerned with "social services" in the wider meaning of that term.

I should say also that it is the intention to transfer to the Minister for Social Welfare the responsibility for the supervision of home assistance. He will also have responsibility for those other public assistance functions, which relate to the maintenance in institutions or otherwise, of the destitute, aged and infirm and generally for the residuum of necessitous classes who are not covered by any of the other contributory or non-contributory social assistance schemes.

Perhaps I should say a word about the special position of the national health insurance schemes. When this scheme was first introduced in Great Britain, it was intended to provide not only for insurance against loss of health but also for the prevention and cure of disease. While the first part of this programme was immediately implemented, the development of the preventive and curative health services continued to proceed on different lines and through the medium of other agencies, namely the local sanitary and public assistance authorities and the voluntary hospitals and voluntary nursing bodies. The additional benefits scheme administered by Cumann an Árachais Náisiúnta ar Shláinte, whereby certain dental, optical, hospital and specialist services are provided for eligible members of the society, is a recent development arising out of a change in the law which released for distribution the surplus income which in the past had been carried to reserve. Pending the implementing of the Health Department's plan for a comprehensive medical service, this "additional benefits" scheme performs a very useful service for such members of the society as are deemed eligible and the continuance of the scheme is desirable until it can be adapted, or replaced on possibly a more expanded form, by the health authorities.

When this temporary link between national health insurance and the preventive and curative medical services to be supervised by the Minister for Health has been severed and when that Minister succeeds in providing a comprehensive medical service, there will be no direct material connection between national health insurance and the health services.

National health insurance must be regarded as an income-maintenance service and an essential constituent of a Department of Social Welfare. Without national health insurance that Department would be incomplete and its establishment unjustifiable.

General Mulcahy

An income-maintenance service of 15/- a week.

Mr. MacEntee

The Deputy ought to grow up. He is surely a mature person now. Why did he not increase the 15/- a week when he was Minister for Local Government? He had control of Parliament and there was but one Party in it.

General Mulcahy

The cost of living had not gone up then.

Mr. MacEntee

Why did the Deputy and his Government not do everything they are demanding now and remedy all the defects against which he is now cavilling? The Deputy must think that people have a very short memory in this country. Not so long ago the Deputy was crying out against the burden of taxation.

General Mulcahy

And I still do.

Mr. MacEntee

Now he is asking us to provide for all the things he failed to do during the ten years he was in office. Before I leave this question of national health insurance, I should say that a great deal of consideration has already been given—and this touches the interruption of the Deputy—to the problems involved in recasting the whole national health insurance scheme so as to secure that the benefits under it will be more commensurate with the loss of income which an employee suffers when he falls ill. No doubt the Minister for Social Welfare will review the progress which has been made in examining this problem and will formulate his proposals in regard to it at an early date.

Lastly, perhaps again I should emphasise that careful consideration was given to the setting up of one Department comprising both public health and social welfare, but it was soon evident that a Department concerned with the ever-widening functions associated with public health, which I have sketched to the House already, and also with the similarly expanding problems of individual income and family welfare would present far too wide a task for a single Minister. The House will therefore realise that it is only after the most mature consideration of all relevant factors and close advertence to the best design for the future care of the two most necessary physical needs of our people, health and sustenance, that the Government asks the Dáil to give effect to the proposal to establish two new Ministers.

General Mulcahy

The Ministry in dealing with what the Minister calls the two most necessary needs for the physical well-being of our people, proposes to put the new Ministry of Public Health and the new Ministry of Social Welfare on an equal footing with the Ministry of Agriculture and the Ministry of Industry and Commerce upon which everything in the country must be sustained, including our social services. We are offered here, in the draft of the measure before us, in the explanatory memorandum, coloured white, that has gone with it and in the Minister's statement, just the results of the incompetency and the indolence which have characterised the Department of Local Government and Public Health for such a long period. We have the Government like bad workmen, complaining about their tools, complaining about the tools they have destroyed and off which they have taken the edge, and which they have failed to put into effective use. In their picture of what the effect on the lives of the people as a whole will be, they tell us nothing about that. They tell us nothing but that two new Ministries, new experts of a political kind under the control of the Government to direct two new sets of machinery, will be set up. We are told, in the face of statements that have been made on behalf of the Government both by the Taoiseach and other Ministers during the last 12 months at any rate, to confine ourselves to that. I think, from the impression the Minister's statement has conveyed to me, that his imagination seems to have lost its delicacy. If he had not blunted his literary talents so badly by the hack work he had to carry on as a very important part of his Departmental work in writing to the editors of the Dublin daily Press letters to be published over the name of his private secretary, he would have approached the introduction of this measure in a clearer, simpler, and more artistic way. He could have called the measure something like an Act to recall and then embody the great Twin Brethren who are going to save the mob of this State from all dangers that may arise in every possible way. He recalls days long ago when people were prepared to accept things without examining them. The great Twin Brethren—"and none who saw their bearing durst ask their name or race"; and looking to the future as to what the supposed effect of this measure will be, we can recall the effect the great Twin Brethren had long ago.

"Back comes the Chief in triumph

Who in the hour of fight

Hath seen the great Twin Brethren

In harness on his right.

Safe comes the ship to haven

Through billows and through gales

If once the great Twin Brethren

Sit shining on the sails."

And the mob of this country who are effective enough, intelligent enough and active enough, in their own way and through their voluntary organisations, to set up a Parliament here are being asked, without explanation of any kind, to accept a Ministry of Health and a Ministry of Social Services to look after everything with regard to their health in the most up-to-date way and to secure that their incomes will be properly maintained.

The Minister last night read a statement delivered by the Taoiseach in the Seanad in April last, and, when he came to the end of his reading, he said he had read far more than he had intended. He did, because he read the end of a statement by the Taoiseach which indicated that the idea of a Ministry of Health was born out of the fact that a Parliamentary Secretary to whom powers were transmitted had got out of hand, and it had to be explained by the Taoiseach to the Seanad that a Parliamentary Secretary, once he got the bit in his teeth, was almost completely independent of the Executive and could do things and take a stand which a Minister ordinarily would not do or take.

I asked the Minister in relation to his proposal here and his statement that the present Public Health Bill is being dropped to explain why, in April this year, at a time when the Taoiseach was making his statement in the Seanad, it was considered so important that that Public Health Bill, which is now lying on the political beaches of this country as big a wreck as anything on the beaches of France, should be proceeded with. In the most important financial period not only in this House but in the general history of our country, as we were getting out of the atmosphere and the circumstances of a ghastly world war, when the House was considering its financial business, down on top of that business was thrown the Public Health Bill, and, in Committee alone, or in two-thirds of the Committee period alone, the House was asked to spend 15 days discussing the matter.

We did give our services in the House to discussing the matter, up and down and inside out, and, with only two-thirds of the work on that Bill done, when we came to Holy Week and Easter Week, the House was taken by the throat by the Government, through the hands of the Parliamentary Secretary, and told that the matter was so urgent that the House had to spend Holy Week and, if necessary, Easter Week, in order to finish that Bill. This House sat every week from about 28th January this year until the end of July. There were only two short weeks in which any respite was given to members to enable them to lay aside their parliamentary duties or to attend in a systematic way to business at home and that period had to be eaten into by an ugly trick on the part of the Government.

It will be recalled that we, objecting to these tactics, left the discussion of the Bill after 15 days in Committee, and the Bill was simply pushed through the House. More than 100 amendments had to be discussed and it was slapped through in a few hours, simply because the Opposition were driven out of the House by the Government's tactics. It was urgent then and now it is thrown on the scrap-heap. We want a Minister for Health instead and we get a long list of the tremendous things the Minister for Local Government has to do and of the great advances which have been made in science in the world and we are told how important it is to have an expert, a political expert, with a new and costly machine under him to keep the country abreast of all the things that require to be done for health.

"Make no mistake about it—the root and primeval cause of all infectious disease, whether you think about the typhus that swept the country in the '40's or the gastroenteritis which decimates the population of the Dublin slums in our own time, is malnutrition."

That is a statement made comparatively recently by a very prominent medical expert in the City of Dublin, and while new Ministries and new expenses are being set up here so that our health may be safeguarded, the real work of the country which will sustain the health of the country is being neglected and left undone.

The Minister details in various ways what requires to be done in order that the health of this country may be safeguarded. He tells us that the social services can be co-ordinated, but we have pleaded, argued and spoken, year in and year out, for the doing of that, and we cannot understand an approach to the discussion of this measure by which the Minister can say that, in the remnants of the Public Health Bill now being cleared off the Order Paper, the Government has subscribed to the idea that if a person gets, say, tuberculosis or some infectious disease of one kind or another, he and his family will be maintained entirely at the public expense. But if a man breaks his leg, he has to exist on 15/- a week from national health insurance funds.

Mr. MacEntee

Is the Public Health Bill now under discussion?

An Ceann Comhairle

The matter before the House is the advisability or otherwise of setting up two new Ministries.

Mr. MacEntee

The Deputy would seem to be addressing himself to the provisions of the Public Health Bill.

General Mulcahy

If I understand the Minister to suggest that, in asking us to set up a Ministry of Health, he does not want the House to discuss public health, the Minister goes further than even I thought he could go. I ask if you, Sir, are ruling that I cannot discuss the principles upon which the Public Health Bill was framed?

An Ceann Comhairle

The Public Health Bill is not before the House. The matter before the House is whether it is advisable or not to set up two new Ministries. Surely the entire provision made for public health does not arise on that. It will arise later on other measures.

General Mulcahy

Am I not entitled to discuss here what the Ministry of Health is wanted for and what it will do? I realise, Sir, that I cannot put questions to you that are not ad hoc. I propose to talk to the best of my ability, at any rate, about the principles enshrined in such statements or documents as we are able to get from the Ministry on the question of public health. When we are asked to go to the expense of setting up another public Department, particularly a public Department which the Minister said was going to do such tremendous things, I want to get discussed in the House by the various Deputies who are interested in the matter what this Public Health Department could do if it were set up and whether it is worth having it set up. The Minister rides away on a general suggestion that there has been a very widespread demand for a Ministry of Public Health. There has been a widespread demand to take nearly every branch of administration connected in any way with any vital need of the country out of the hands of the Ministry of Local Government and Public Health. But that is entirely a reflection on the Department and the way in which it has broken down.

On 3rd April, 1946, there was a motion before the Seanad proposed by Senator Sir John Keane in the following terms:-

"That the Seanad takes note of the intention of the Government to appoint two new Ministers within the Department of Local Government and Public Health, and requests the Government to issue a paper embodying the principles of the proposed change and further to afford the House an opportunity to debate the matter before the actual legislation is introduced."

It is reported in column 1226 of the Official Reports. In relation to that the Taoiseach said at column 1246:-

"I have already told you that the Senator's demand is being met and that a White Paper will be circulated. How long it will be circulated before the Bill appears, I cannot say at the moment."

As reported in column 1247, the Taoiseach went on to say:—

"The procedure which the Senator principally requests is to be adopted in this particular case. It was indicated in advance that it would be adopted. That is why I think it rather strange that the Senator did not give a little more thought to the way in which he drafted the motion."

The Senator in his motion asked for a White Paper. The Taoiseach promised a White Paper and we have not got the White Paper. All that was stated on the 3rd April, 1946. At that particular time we were discussing the Public Health Bill in the Dáil. The White Paper promised cannot have referred to the Public Health Bill. It must have referred to what Senator Sir John Keane deals with there, namely, the principles of the proposed change. What is wrong that we could not have had the White Paper which the Taoiseach spoke about before this Bill was introduced and before we were asked to discuss it here?

The Minister for Local Government is simply treating the House in the kind of way in which the House has too often recently been treated by the Government generally. Yesterday, the Tánaiste suggested that the whole business would be passed through that day with very little talk. As this matter was discussed on a motion by Deputy Everett in this House in November last and in the Seanad in April, and as the Minister has gone back to 1942 in discussing all these various problems, why can we not have a statement of what this Ministry proposes to do in order to preserve and maintain the health of the country?

The Minister referred to the tuberculosis plans. The rate of mortality from tuberculosis was falling substantially and regularly practically from the time this State was set up until 1934, at any rate. Then it started to go up and down. In 1942-43 it went up in such a way that the Minister speaks very alarmingly about it and very elaborate schemes are being organised to examine early symptoms of tuberculosis when they appear amongst our people. A Tuberculosis Bill was passed to give the Department of Local Government full authority to choke down the activity of every hospital, whether private or public, in the country in relation to tuberculosis until they got the very big scheme of three major hospitals put into operation throughout the country. Now we find that none of these plans has yet appeared, that developments were held up for some time past in relation to Peamount——

Mr. MacEntee

There is no foundation in fact for the statements which the Deputy is making.

General Mulcahy

Does the Minister suggest that the Department did not take full power to deal with the tuberculosis menace, that they did not stop a lot of activity on the part of other people?

Mr. MacEntee

We stopped no well-considered activity on the part of anybody.

General Mulcahy

The Minister and his Department not only did so, but they are taking almost complete control of some of the private hospitals which were dealing particularly with tuberculosis. I suggest to the Minister that he is putting the heavy hand of the State completely down on the Peamount institution and probably on the Newcastle institution, that he has prevented Peamount from developing plans for providing extra beds which they could have readily done and were anxious to do. They were told to wait until the great new developments with regard to the three new regional hospitals were gone ahead with. Now we find that probably the great scheme for Santry Court sanatorium is not going to go ahead and that we are to have an extension of the airport.

Mr. MacEntee

I shall take the opportunity, when replying, to traverse every statement that the Deputy has made and to show that they are without foundation in relation to any well-considered plans.

General Mulcahy

I agree that the Minister may have a lot to say in replying, particularly when we take into consideration that during the 15 days we were in Committee on the Public Health Bill, we could not get the Minister for Local Government and Public Health to come into the House to discuss any aspect of the measure. So far from discussing or appearing in the House to discuss any aspect of the measure, when two Financial Resolutions had to be moved by a Minister, it not being possible under the procedure of the House to have them moved by a Parliamentary Secretary, we could not get the Minister to come into the House to move these resolutions, and they had to be moved by other Ministers. The Minister for Lands had to come in on one occasion and the Minister for Posts and Telegraphs on the other. But we are asked to pass a Bill to set up a Minister for Public Health here, with the wrecks of the Public Health Bill there. We are being told that it is being wiped out and that it is not going to be pursued. We are not being told why or what particular principles are going to be embodied in the new measure the Minister speaks about and we have not been given a White Paper on the general principles that would be involved in such proposals, as was promised in the Seanad by the Taoiseach.

The Minister is concerned with the maintenance of income and the general social service. The Taoiseach told the Seanad, in column 1247:—

"The next question is concerned with the social services. Any members of the Seanad who read the remarks I made on that subject on more than one occasion in the Dáil, will understand what our position is in that regard. We do not believe that there is any substance in the case which has been presented to us for the co-ordination of the social services as they stand at present."

That was April, 1946. So that, in the proposals to set up a Ministry of Social Welfare on the grounds that that Ministry will co-ordinate the social services, the Government have somersaulted as completely in respect of the social services as they have somersaulted in regard to the Public Health Bill. "But," he said, "we are going to set up a separate Ministry for a different reason"—and the reason is given in column 1248:—

"Consequently, we want to have a member of the Government who will be in a position of authority, and who will know the mind of the Government, to take those services as a whole under his control."

So that we are going to get a social services manager and he is going to be called an expert. I could see some reason for establishing a Ministry of Social Welfare that would help to gather the various threads of the social services machinery in the country together under a person who would discuss with the House and encourage discussion in the House on matters affecting every aspect of our social services. I could understand that, but I cannot understand a Ministry being set up to control the social services, particularly when we realise what control means in the phraseology of the Government. Therefore, in connection with that matter, I would ask whether any consideration has been given and I would ask the Minister for Local Government and Public Health, who professes to be so full of determination to tell us things when he is replying, without being so disposed when opening the matter, to tell us, when he is replying, how the principles that he has in mind in relation to the social services and their organisation compare with the recommendations and suggestions that have been made by the Commission on Vocational Organisation. At page 434, column 691, of their report, the commission say:—

"As described in Part III, Chapter VIII, social services such as medical care, unemployment assistance, old age pensions and poor relief are administered by central or local government agencies, by vocational bodies and by other voluntary organisations. Different parts of these schemes are administered by different organisations, which, moreover, have varying degrees of responsibility for them. This variety of treatment may not appeal to the type of mind which likes everything to be on a uniform and tidy pattern, but we consider that it is socially sound and should be maintained.

The benefits provided by trade unions and professional benevolent societies for their members constitute a very large and valuable form of assistance and one which is very efficiently and economically administered. There is a natural tendency in every organised profession or trade to develop such forms of practical benevolence and brotherhood, and it is obviously more in the public interest to encourage this tendency than to stifle it. Men give more freely and generously for the assistance of those bound to them by ties of professional loyalty and comradeship. Moreover, they can administer such schemes more efficiently and economically when they know the recipients and have immediate personal interest in avoiding waste or abuse. Where employers wish to make special provision out of profits for pensions or other social benefits they should be encouraged by the State to do so. The present system of old age pensions does not encourage such persons or companies to promote or develop pension schemes for their workers."

I would ask the Minister what is the attitude of the Government to the spirit of the recommendations and suggestions and approval contained in that paragraph. I ask him to tell us what is meant by the Taoiseach when he says, "to take these services as a whole under his control," and I particularly ask him what examination has taken place and what departmental or inter-departmental discussions have taken place on the various services that are mentioned here and whether it would not have been reasonable, before any proposals were put before the House to set up a Ministry of Social Welfare, that an outline should have been made in a White Paper, however detailed, showing exactly the extent to which these various services that are mentioned were out of keeping with one another. Surely we ought to discuss whether it is reasonable that a man with a broken leg would be expected to exist and maintain his family on 15/- a week from an insurance policy plus home assistance; and a person who had contracted tuberculosis or some infectious disease would be cared for completely through the local authorities and outside the poor law system completely because he was not able to maintain his family as a result of his contracting an infectious disease. Surely there should be some examination of whether unemployment insurance, health insurance, and so on, could not be put together in a general insurance scheme, and surely the time is ripe, when this particular measure is moved here, to have a more satisfactory review of the proposals put before the public generally by Dr. Dignan in his paper—a review which was promised from the Government.

The Minister is treating the House in an absurd and most unsatisfactory way. We are discussing measures that are largely going to be operated through local authorities—if they can be called such any longer. At present the county manager takes complete supersedence over the local representative in most of the work that is mentioned here. These proposals mean that the county manager will now be the servant of three Ministries—the Ministry of Local Government, the Ministry of Health and the Ministry of Social Welfare. I ask the Minister to discuss the position of the county manager as the servant of three particular Ministries. The attitude of the Government has been, up to the present, to centralise as much as possible with regard to local administration. They have centralised very much in the powers they gave the Minister for Local Government and Public Health. Now they are decentralising him. I submit that they are only decentralising the Minister for Local Government because of the inefficiency that has characterised his administration, and because of the disruption which his inefficiency has created in his Department.

There is another matter that ought to be discussed when the Government are proposing these measures to us. It arises out of the principles enshrined in Most Rev. Dr. Dignan's report as to how all this is going to be related to the principle that families can only be maintained on a sound income by getting productive work in the country. The Minister is simply piling on an additional piece of taxation and giving an additional amount of political grip into the hands of Ministers whose whole concern is for the prestige of their Party—for the way in which they can hold up their Party prestige and power by gripping every scrap and bit of machinery in the country and cow the ordinary people as a mob. We have the extraordinary position that in the last 12 months, when public health matters have been discussed, the medical fraternity were, until very recently, completely unlistened to by the Department that was putting a measure together. That system is broken down now. The condition to which the medical profession were reduced by the attitude of the Government was such that they were afraid to open their mouths in public, and even to-day, although I understand some medical organisations have made representation to the Government with regard to the drafting of new public health legislation, no group of the organised medical profession in the country has thought fit to address its ideas or its counter-proposals to any other Party in the House. They are still in the cowed position that they were in when public health was being discussed.

Mr. MacEntee

Perhaps they remember the Deputy as Minister for Local Government and Public Health.

General Mulcahy

I do not think they ever had to complain that they were not listened to when I had anything to say.

Mr. MacEntee

Listened to with deaf ears.

General Mulcahy

I do not think that any of them were ever afraid to make their proposals public. Again, when the Minister is asking for a Ministry of Public Health I want to ask, in relation to the report on Vocational Organisation, par. 543, why a council of health cannot be heard on the general matter of public health before we go to the expense of setting up a new Ministry?

Mr. Norton

If the Chair wishes, I will move the adjournment of the debate.

An Leas-Cheann Comhairle

It is not 12 o'clock yet.

Mr. Norton

Perhaps the Taoiseach would fill the five minutes that remain.

Mr. MacEntee

I think the Chair must put the motion if there is no Deputy prepared or anxious to speak.

An Leas-Cheann Comhairle

I shall have to ask the Minister to conclude if there is no one to continue the debate.

Mr. Norton

I do not mind padding it out for five minutes, but perhaps I had better not, as I may not be here on Wednesday to resume.

An Leas-Cheann Comhairle

If there is no one to continue the debate I shall have to call on the Minister to conclude.

Mr. Everett

I welcome the Bill. It is the fulfilment of a promise that was made in the House last year by the Taoiseach when we had a motion down dealing with the social services. Naturally we require first of all Ministers for these Departments. It will then be their duty to introduce measures to carry out the wishes of the majority of the members of the House. The Minister for Social Welfare will, I see, have duties relating to unemployment assistance, widows and orphans, and national health, but I observe one serious omission, and that is the Workmen's Compensation Act. My experience of the working of that Act is that the insurance companies continue to pay an allowance to an injured workman for probably six months, but they always watch the period in which the Circuit Court will be holding a sitting. About a fortnight after the court has sat the injured workman receives notice that the payment of his compensation is suspended, with the result that he may then have to seek home assistance from the local authority for the support of his family and himself, pending a settlement with the insurance company. My experience is that there will be no settlement until notice is served to bring on the case at the following Circuit Court. That will take three months. It will often happen that before the court is held the workman will make a settlement which will not provide for anything, except perhaps enable him to pay his bills. The settlement will make no provision for his detention or cure in hospital. I think it is a serious omission that nothing is to be done under this legislation to prevent insurance companies from carrying on the practices that I have referred to. They should be compelled to make provision for the detention and care of an injured person in hospital as well as making a compensation payment. Even where a man receives £200 or £300 he sometimes becomes a charge on the public purse within a year. I hope that the Minister will deal with this matter when he is replying. This question of workmen's compensation—dealing with insurance companies as regard their treatment of injured workmen—should be the responsibility of the Minister for Social Welfare. I take it that the Minister for Health will have full charge with regard to home assistance matters.

Mr. MacEntee

The Minister for Social Welfare will do that.

Mr. Everett

I take it that he will act on the instructions of the county manager. Will that service be carried on as it is at present?

Mr. MacEntee

I cannot answer that. There are several proposals in relation to that matter which the Minister for Social Welfare will have to consider, and which he will, perhaps, embody in legislation.

Mr. Everett

We all recognise the amount of work that is carried out by the Department of Local Government. Practically the whole machinery of the State is controlled by that Department. While we may not all agree with the Minister, we recognise that he gives his full time to the work of the Department. I advocated on many occasions that a number of the services under the Department at present should be dealt with by a separate Ministry, because of the impossibility of one man doing all the work that is to be done. I think as regards the social services, and the care and welfare of the sick that it is well worth while taking the risk of appointing a Minister who will give his whole time to that work.

I move the adjournment of the debate.

Debate adjourned.