When we adjourned last night, I was dwelling on the fact that we had had no indication from the Minister of the financial commitments which this Bill will entail to the local authorities. I can see that, when the measure becomes an Act and is put into operation, it will mean a very heavy charge on almost all local authorities, with corresponding increases in the rates, which have already reached peak point in almost every county of the 26. I was surprised that the Minister did not give some idea to the House of what was in store for us in that connection. The Bill is necessary and, so far as my Party is concerned, it will not meet with any wholesale opposition except in some respects which will be indicated when we are considering the next stage. I wonder if it would be out of order now for the Minister to give us an indication of the cost. I should be prepared to give way to him to enable him to do that.
Health Bill, 1947—Second Stage (Resumed).
The Minister cannot intervene now.
Even by leave of the House?
It would be contrary to the rules of the House for the Minister to intervene now. When concluding the debate, the Minister will, presumably, answer questions put to him and Deputies will have opportunities for eliciting information on other stages of the Bill.
It is regrettable that the Minister did not go into the question of cost. One of the first things a Government should take into consideration when introducing a Bill is its probable cost. It is all very well to tell us about the benefits which the measure will confer but we should like to hear what it will cost and how that cost will be distributed amongst the people—whether it will be met entirely out of rates or whether the Central Fund will help out. The health of the people, particularly the poor people, should be amongst the first cares of any Government. If we can succeed in improving the general health level by this Bill, we shall have done good work. The measure will also, as mentioned by other speakers, keep a number of excellent young women at home, as they will be training for the nursing profession. That is another good feature of the Bill. If we can succeed in stopping even a small bunch, who would otherwise have to emigrate, it will be a good thing. To a person without medical training, this Bill is vague and highly technical. That will not prevent us from discussing it and tabling amendments when the proper time comes. The Ceann Comhairle has decided that the Minister cannot now intervene——
The Minister could intervene to answer a question but the Deputy wants an exposition of the finances of the Bill and that would not be in order now.
All I wanted was a pretty short answer as to what burden it will place, if passed in its present form, on the rates.
That question is much too wide to be answered now.
Suppose the Minister stated in a few words the percentage of the cost which the local authorities will have to bear. I am sure the Ceann Comhairle will agree with me that the Minister has by-passed or sidestepped——
The Ceann Comhairle does not agree with the Deputy in that. It is not for the Ceann Comhairle to agree or to disagree.
The Minister never mentioned where the finance to meet this Bill would be found.
It is for the Deputy to say that.
I hope that the Minister, when replying to this debate, will give us that information, because it is one of the principal things on which we require information. It is a nice thing to propose such legislation, but there is another side of the matter to be considered. We might get into the position in which we would be living beyond our means. Apart from this Bill altogether, the country may at present be living beyond its means.
When one considers the way in which this Bill was introduced and the atmosphere in which it is being discussed, one feels rewarded for some of the gruelling days and nights which we put in here on the previous measure. I stated on that occasion that we were not objecting to a public health code. We welcome this Bill, although Deputy Briscoe may find it hard to reconcile that welcome with the statement that we hope either to pick holes in it or to close whatever holes are in it, on the Committee Stage. I do not think there is anything inconsistent in that.
I told the Deputy to pick the right holes and to put the right pegs in the proper holes.
We have been doing that or trying to do it in the last fortnight and have succeeded in closing a few of them. I welcome the Bill and I also welcome the speech and the manner of the speech with which the Second Stage was introduced. Every member of the House must have welcomed and listened with the greatest possible interest to the speech made by Deputy Dr. O'Higgins last night. In my opinion, it was a very constructive speech, one of the most constructive I have listened to here delivered on the Second Stage of a major measure. That speech was helpful to the House and I believe it will be helpful to the Minister and his advisers. It was delivered out of the practical experience gained by that Deputy during the past 30 years. That, of course, is the way in which a Public Health Bill, of all Bills, should be discussed. Deputy Briscoe was always a man of great temerity and had the temerity last night to put his head in between the doctors.
Just like the Deputy.
Faith, I am not; I am keeping far away from them, both at home and abroad.
The Deputy has his head right into them now.
This Bill is particularly welcome, because it does not contain—except in one or two sections —any of the dragooning or police clauses which were in the old Public Health Bill. Properly administered, it will do a great deal of good. No one will deny that there is need for a proper public health code in this country. Deputy Briscoe told us last night he had met some distinguished medical men in other countries and they had spoken with admiration of our health measures. I regret to hear that, as the only one about which they could have spoken to the Deputy with admiration was the measure which this House discarded. We speak here only as lay-men, as we know nothing about medicine; we can speak only from our own observations and from what we are told from time to time by our own constituents and occasionally by medical men.
Has the Deputy for-gotten the Mental Treatment Bill?
What has that to do with this??
Progressive medical development here.
It may be due to the fact that it is so early in the morning, or that I am peculiarly dense——
That is more like it.
——but it simply does not penetrate.
Is it not true——
Order! The Deputy is in possession.
I will give way with the greatest pleasure.
The Deputy stated he could not understand how medical men abroad could admire our development——
That is simply answering the Deputy's speech.
I am asking him if he has not heard about the Mental Treatment Bill or the Bill for tuberculosis treatment.
So early on Friday morning, let the Deputy not try to draw me on tuberculosis.
The Deputy need not be drawn by interruptions.
I am imploring the Deputy not to do it. I do not think we are keeping in line with most countries in medical science, in provision for public health or in any other aspect either of preventive or of curative medicine. I believe that we are far behind and that we have a lot of leeway to make up. This Bill will help us, to a large extent, to make up that leeway. We have, perhaps, more peculiar features than many other countries, features which are responsible for a lower standard of health and physical fitness in this country than in the average country. One of those features, which has a tremendously adverse effect—and I do not mention it for any political reason, good, bad or indifferent—is emigration. That must have a bad effect on the standard of health and of physical fitness of any race. As we know, whether they go in large numbers or in small numbers, it is usually the most fit and the youngest who go and those who are left behind are not the cream of the race. That in itself is bound to have a very big effect. I do not want to say any more about that.
One of the principal reasons why we need a Bill such as this, dealing with not merely medicine but ordinary human cleanliness as well, is that ordinary cleanliness is one of the things which should be taught and is not taught in our schools. I have stated that in this House before. The school programmes are taken up with other matters—and I am not now referring to Irish—and with other subjects which are not nearly of such importance, either to the pupils or to the nation as a whole. Children in the national schools are not taught even the elementary principles of hygiene or cleanliness. Without any costly machinery or any great effort or waste of time, a considerable amount could be done in a very effective way. In every school, the child from the day it goes in at six years of age should be taught just a few elementary principles. We are not by nature a dirty race. As far as that goes, we are probably as clean as any race on the face of the earth. In so far as there is dirt there, it is due to either or both of two causes—ignorance of the elementary principles and sheer want. There is going to be infestation so long as that ignorance and want remain. Let me repeat what I stated before, that we have people so much below the poverty line that they are living and sleeping in the same clothes.
Deputies who know the conditions under which the destitute in our poverty districts have to live, conditions which I am afraid still exist notwithstanding the efforts that have been made to remedy them, know quite well that what I am saying is true. It is particularly true now when it is almost impossible for the ordinary wage earner, much less a person dependent on State aid, to buy clothes.
I put this to Deputies who have to keep homes of their own and know the cost of household clothing, leaving aside altogether personal clothing. Is there any Deputy who will tell me that any working man at the present day, much less as I say a person dependent on State aid under one heading or another, can afford to buy bed clothing, sheets, blankets or quilts? People who are in what used to be called comfortable circumstances find it very difficult at the present time to buy that particular type of household requirement.
I hope this Bill is the first step towards a proper national health service. It does not provide a national health service, and I am sure the Minister would not claim that it does. I grant that it is an important step towards it, but it is only the first step. Deputy Blowick may make up his mind that, whether the money is to be provided by the citizens as taxpayers or ratepayers, or as both, to set up what will be worthy to be called health institutions will be very costly. We have in practically every county health institutions—county homes and district hospitals. They are buildings behind walls that have more the appearance and the atmosphere of prisons than either homes or health institutions. Is that not so? How many of our county homes are behind walls which are higher than the walls around Mountjoy or Portlaoighise prisons? We have in these county homes a large number of old and infirm people. I am not saying that they are not getting good treatment. I do not allege that for a moment, because I believe they are getting good food and sympathetic treatment, but they are incarcerated in buildings which are no different in appearance and atmosphere from prisons.
We come, then, to dispensaries. Deputy O'Higgins gave his opinion of dispensary buildings last night. I think every member of the House can subscribe to what he said about the buildings in which the dispensary doctors have to work and in which the patients have to be treated for every sort of ailment. There can be no question but that they are, in the main, a disgrace. There is the question of hospital accommodation. I am not going to suggest for a moment that the waiting lists in the case of hospitals of all sorts being so long is due entirely, or even largely, to a very substantial increase in disease. It is due to what I regard as a welcome change—to the fact that our people now realise that the proper place for the treatment and cure of disease is a well-equipped hospital. Our people, I am glad to say, have got away from the old ideas they had about hospitals. It was hard to blame them for that. At one time, when it was mentioned to people, particularly in rural Ireland, that it would be a good thing if they were to go to hospital, the feeling they had was that they were being sent to the poorhouse, and, therefore, would not go. Even with the best will in the world, I do not know if there is any possible chance of having adequate hospital accommodation for the people who require it provided within the next ten years. I think the Minister and his Department will be doing tremendously good work if, within the next ten years, they are able to have adequate hospital accommodation for our people.
There is more in that, of course, than the mere provision of buildings. There is the question of providing competent and well-trained staffs, particularly nurses. Deputies say we are short of nurses, that nurses are leaving the country and going elsewhere. Is it any wonder? Who have we to blame for that but ourselves? If there is one class in the country that was more scandalously treated as regards their wages and conditions of service than any other it was the class which comprises the members of the nursing profession. Even in facing up to a big measure like this we are not, so far as the nursing profession is concerned, facing up to it boldly. We are not making the conditions and hours of employment and the salaries sufficiently attractive to bring into the nursing profession the best types that the country can produce. The doctor is important, but I can say from my experience as a patient that good nursing is equally important, and I venture to say that nobody will admit that more readily than the doctors themselves.
That is all that I have to say except to repeat that we have here a Health Bill which we can welcome. It has been put before us in such a way and in such a manner that we can respond to it. The Minister will see, I hope, before it leaves the House that what we said 12 months ago on a Public Health Bill was quite true, namely, that we are only too anxious to give every possible help to put through this House a health measure that will be of real benefit to our people.
When we were small boys at school we read a little fable about a contest between the wind and the sun to find out which of the two was the stronger. The two set themselves to discover which of them could make the farmer take off his coat. The wind blew and blew, and the farmer buttoned his coat more tightly around him. Then the sun came and shone brightly and warmly with the result that the farmer quickly removed his coat. The moral to be drawn was that the rough way is not always the best. I think everybody now realises that the rough way of putting through legislation of a far-reaching nature is not the best. Yesterday and to-day, on the Second Reading of this Bill, we have had the sun shining warmly. The wind has retired into oblivion. It is right and proper that a Bill which sets out to improve the health of our people and to combat disease, to raise the standard of living conditions and of agricultural conditions in this country, should be welcomed and discussed in this House in a friendly and serious way.
It is sobering to think of the large sections of our people who are suffering from wasting diseases and painful diseases, the number who cannot find accommodation in the various hospital institutions and the number who are suffering in those institutions. When we think of them we are not inclined to score Party points on the question of public health. One must be deeply moved when one walks through a hospital ward where people are seriously ill or dying, and one is brought to a realisation of the fact that at any time that suffering may come to any individual.
Therefore, I welcome the manner in which the Minister introduced this Bill and explained it to the House. I welcome also the manner in which the Bill was reviewed and examined by Deputy Dr. O'Higgins. The House has given a fairly good lead in approaching this far-reaching and, in many ways, contentious Bill. Last year, when the Public Health Bill was introduced, while I disagreed very fundamentally with many sections, I could not bring myself to oppose the Second Reading because I was optimistic enough to believe that the Bill would be improved and amended very drastically. I have the same feeling with regard to this Bill. While it is an improvement on the Public Health Bill of last year, it contains many very contentious and some dangerous provisions which will require to be examined with great care and deliberation by the House.
Deputy Dr. O'Higgins appealed very strongly against compulsion in regard to the various provisions of the Bill. He appealed very strongly against compulsory examination of children and compulsory isolation of patients, wherever it could be avoided. We would all agree, I think, that compulsion is necessary in certain extreme cases, but we must bear in mind that it is a dangerous instrument to use in connection with private individuals. It is a dangerous thing to deprive, in a very widespread manner, citizens of their right to live in their own homes or under any conditions which they think fit. It is a very small step from the isolation of all persons suffering from certain infectious diseases to the deprivation of people of their ordinary rights.
It is in the administration of the Bill and the approach to it by the Minister that we will have to seek protection. I am quite sure that the present Minister for Health would be very slow to adopt compulsory measures in regard to the isolation or examination of patients. But this is legislation of a long-term and permanent nature and it is our duty as far as possible to look into the future and to see if we can provide safeguards for the citizen in the event of his being wrongly deprived of his liberty or being unfairly or unjustly treated. A person who is compulsorily isolated has under this Bill the right of appeal to the Minister. That is hardly sufficient protection. It is true that the Minister almost immediately upon his appointment as Minister for Health set up a consultative medical council. That shows his inclination to be reasonable and fair, and to consider every viewpoint, to step very carefully in regard to health matters, particularly in regard to compulsory enforcement of health regulations. I wonder would the Minister think it desirable, where people are isolated and where they feel they ought not to be isolated, where they feel they could effectively prevent the spread of the disease if they were allowed to remain in their own homes, to have appeals considered by the consultative council, thus giving a wider and a freer court of appeal to such people. The Minister is the head of a Department. He must, in a good many Departmental and administrative matters, be guided by the permanent officials of his Department. There will always be a tendency for permanent officials to be, perhaps, a little partial to the views of the permanent officials under them and I think a freer court of appeal such as the consultative council or some other council which the Minister might set up would be desirable. I am not speaking in regard to persons who are isolated under Section 34 of the Bill. I think there is provision there for compulsory isolation. One may find that a person may be unjustly isolated. All heads of hospital institutions are not perfect. We cannot expect them to be perfect. People who have to deal with sickness, suffering and disease, are inclined to be somewhat callous and somewhat hard and we may find that, eventually, the grievances of persons confined in an institution for a long time may be ignored and over-looked. I think that when we are extending, as I think we are, the power to isolate very considerable numbers of old people we ought to provide every possible safeguard for such people. This is a matter which I suppose will be further dealt with on the Committee Stage of the Bill. It is a matter which will require very careful consideration.
As in the previous Bill there are in this Bill fairly far-reaching provisions in regard to disinfestation. There again there is need to be careful not to trample upon the rights of the ordinary citizen. I think the Bill provides for such control as would prevent a person declared to be verminous from leaving his home. That is a fairly drastic provision. I think that with goodwill, with an earnest desire on the part of all concerned to avoid, except in the last extremity, the use of compulsory powers we may hope that those provisions may not be open to serious objection. It is well to remember that in this Bill, as in the previous Bill, fairly drastic powers are given to medical officers and to officers of the Minister's Department.
At the end of the Bill, under those sections which I have referred to, extensive powers are given to the Minister to make regulations. The nature of those regulations, of course, is not stated in the Bill. The list of headings under which they may be made is fairly lengthy and I notice it is given in very small type. Whether there is anything sinister in that or not, I am not prepared to say but it would look as if some of the drastic powers which the Minister seeks are tucked away very neatly in the last page of the Bill. Reference is made to the prohibition of parents of children suffering from infectious disease from sending their children to school; the restriction by the district medical officers of the attendance at school of children who are sources of infection and infectious diseases. A number of other powers are mentioned such as restrictions on the use of public conveyances by persons suffering from infectious disease. Regulations under all those headings could be very drastic and could interfere to a very serious extent with the rights of the ordinary citizen. It is, I think, right and proper that in considering this Bill we should consider all its implications and not wait until the Bill becomes law to find out that it is much more drastic than we anticipated. I am sure that more serious consideration will be given to all these matters on the Committee Stage of this Bill.
The most important issue facing the House is consideration of the financial sections of the Bill, or rather I should say consideration——
There is no financial section.
I want to correct myself, with your permission—or rather consideration of the manner in which the Bill will be financed. It is all very nice to set ourselves out to provide the most up-to-date system of health service that can be provided. The provision of free medical attention for mothers and for children up to 16 years will involve an enormous amount of public money. In addition to that, the maintenance and assistance of persons who will be confined to institutions —persons suffering from infectious diseases—will again involve enormous expenditure.
I think that it would be unfair and unwise from a national point of view and from a health point of view, to place 50 per cent. of the burden of financing health administration and services in this country upon the local authorities. The system of financing local authorities is antiquated. The whole division of the country into counties for administrative purposes, while it is desirable in many ways, presents serious defects as far as health administration is concerned. I think the Minister for Local Government announced some time ago that he would like to divide this country into counties of equal size and shape. He would probably find it necessary also to revise the shape of the whole country so that these square and round counties would fit into it properly. I think the Minister for Health will hardly be as ambitious. Anyhow, you cannot have a fair distribution of taxation under the regulations governing the financing of local authorities. You will have poor and rich counties; you will have counties where there is a large proportion of people depending upon assistance and counties where the proportion is not so large; you will have counties with a high rateable valuation, and counties where the rateable valuation is not so high. Taking it all over, I think that so far as the treatment of infectious diseases is concerned it should be a national charge.
Tuberculosis has been frequently discussed in this House. To fight and overcome that disease is a national problem, and I think it should be faced in a national way and financed nationally. There is no use in asking local authorities, struggling to make ends meet, to deal with a problem so vast as that of overcoming the inroads of tuberculosis. Therefore, when we are passing a Public Health Bill we should set ourselves out to provide a system of finance which will be national and comprehensive, not a system of patching up something established hundreds of years ago and which has become completely obsolete.
Most Rev. Dr. Dignan suggested one plan under which all would contribute in one way or another and in which the State would join. That plan, I think, will require more careful consideration than it has received. It may be the basis of a comprehensive scheme for financing public health administration. I believe that we shall never succeed in overcoming the inroads of disease, that we shall be merely beating the air, until we provide a better standard of living for our people, better housing accommodation, and better amenities for our people in their homes. Probably not more than 10 per cent. of the homes in this country possess sanitary accommodation or baths. Surely there is a need which must be supplied. Then, again, the crowding of our people in our towns and cities into one or two ill-ventilated rooms spreads disease and renders futile much of this vast expenditure which we incur under legislation such as this.
I believe it would be money well spent if public swimming pools and bathing facilities were provided in every area throughout the country. Everything that makes for healthy exercise and cleanliness should be encouraged. That, I think, will be one of the functions of the Minister for Health, as well as the spreading of useful health education so that our people will take adequate precautions for the preservation of their health. Above all, we must ensure that adequate hospital accommodation is provided. Here, again, I think there is need for facing the problem in a national way. While it is desirable that local authorities should contribute, we all know that the lay-out or geography of the country does not allow of hospitalisation on a county basis. Something on a regional basis is more desirable. You have towns situated on the borders of two or three counties and it is impossible to provide these large towns with the hospital accommodation required if the financing and administration of such institutions are confined to one particular county.
These are problems which the Minister will have to face up to and deal with. I think all Parties in this House will give at least qualified approval to the introduction of this Bill; but we will require, before the Bill becomes law, greater safeguards than it at present provides for the liberty of the citizen. We will require also some assurance that the burdens to be placed on the ratepayers will not be beyond their endurance. If you directly tax people of small means beyond their endurance in order to finance a Public Health Bill, you are not going the right way about improving public health. People who cannot meet their demands and pay their way are not in a position to avail of health treatment even if it is provided for them. Many small farmers have to suffer ill health even when told by their doctor that they ought to have hospital treatment. Even when they are assured that the hospital treatment would be free they still cannot spare the time away from their work in order to avail of it. Hundreds of cases come to the notice of Deputies of mothers of families going to their deaths because they cannot avail of hospital treatment in time. This condition of chronic poverty amongst a very large section of our people makes us less enthusiastic about a Public Health Bill than we would otherwise be. Nevertheless, this is permanent legislation and I hope that by the time its provisions for the establishment of hospitals, etc., are implemented, the standard of living of our people will have been raised so that our people can avail of these facilities.
Mr. P. Burke
While I find myself in agreement with the last speaker in certain speeches that he makes from time to time, I am sorry that he brought in a certain trend into his speech when he spoke about this Bill taking away the liberties of the individual. As representatives of the people we must be practical, and surely we have not reached a stage when we want to do anything affecting the people except it is definitely in the public interest. During the time the last Bill was going through the House I was approached by a number of committees and there was a certain feeling that it was meant to interfere with the liberty of the individual instead of being a Bill for the good of the community.
I definitely welcome this Bill. I look upon it as legislation for the benefit of most of our people and the Minister is to be congratulated on the very fine way in which he introduced it. Also, Deputy O'Higgins made one of the finest speeches I ever heard him make in this House; it was a very sensible speech, too. There is an awful lot to be said about trying to encourage people to go to hospital and using persuasive methods in order to get them to do so. Only two weeks ago I made four visits to a house trying to get the eldest girl to go to a sanatorium. There are nine other children in the house and we since found out that one of them also is afflicted, and possibly there might be more. What can you do in a case like that? We all know and these people should realise that it is in their own interest to be examined. The doctors are not anxious to do anything compulsorily, but it is obvious that it is in the interest of that family that the children should be taken away and examined. I agree that persuasive methods are the best, but sometimes you are faced with the position whether you will be cruel to be kind or be kind to be cruel.
An Leas-Cheann Comhairle took the Chair.
Mr. P. Burke
The tuberculosis problem is indeed a very big one. It is so big that the accommodation for patients in my constituency, and I expect in other constituencies, is totally inadequate. While we are waiting for sanatoria to be built, I should like to see patients isolated from their friends at home, so that they will not be responsible for spreading the contamination. One member of the family becomes affected and if he or she is left there for two or three years possibly every member of the family will become affected.
This Public Health Bill is definitely in the national interest and it deserves the wholehearted co-operation of every Deputy. Deputy Cogan referred to the cost of the Bill. It is a question of being penny wise or pound foolish. If we succeed in improving the health of our people for a specific number of years, the nation will reap the reward. We are out to do that.
I would like to see some provision in the Bill whereby more could be done for people who leave sanatoria. I know there are allowances envisaged in the Bill for sanatorium treatment and for the dependents of people in the institution. I welcome that, but when people leave sanatoria I think the allowance should be continued and as much as possible done for them in other ways. You see men and women leaving sanatoria and after a few years they have to go back again because they do not get sufficient nourishment and they tend to lapse into the old condition.
We have another problem. We have numbers of physically deformed children and I suggest the treatment of these should be made a national charge. Within the past two months I had experience of a child with its feet deformed. The mother and father are in modest circumstances, just struggling along on ten acres. They were told the child could get into the Orthopaedic Hospital for £1 a week. The child would need to be there for three or four years and might have to undergo an operation; it is only four years of age. Possibly with treatment the child could become a useful citizen and might not be a liability in some institution later on. I feel all cases of physical deformity, where the parents are in poor circumstances, should be made a national charge. It would be hard on parents with moderate means to pay £1 or 10/- a week, particularly when they have other children to rear. Only persons with good salaries could afford to pay for the treatment.
As to institutional treatment being made available for certain types of mental defectives—that is, to train them to be useful or fairly useful citizens—that is a rather big problem. I hope the Minister will give some consideration to the type of mental defective I have in mind, the person who might be good for doing messages and who might never need to go into an institution. With a little treatment, such persons might improve.
As to the dispensaries, I admit that in my constituency the authorities are doing their best with reference to the building of dispensaries. There are, however, some dispensaries in County Dublin that would seem to be away back in the Stone Age. I do not know how any medical officer works in some of them. This matter has been under review by the county commissioner and I know he is doing his best to bring about an improvement.
Hospital accommodation is one of the things we are up against and I think we must face that position nationally. Hospital accommodation throughout the country is not all that could be desired. It is regrettable that some of our people take such exception to being sent from County Dublin areas into St. Kevin's. I have visited St. Kevin's Hospital and I cannot understand why they object to going there. Perhaps it is because they think it is being kept by the rates and has that old taint of the workhouse. That is not true. It is a modern hospital with the most modern equipment and the treatment of patients is carried out under modernised conditions. Our people need to be educated a little in order to get them away from the feeling they have about those institutions. I know that the impression that exists in the minds of some of the people is quite wrong because St. Kevin's is a most up-to-date institution.
As regards cottage hospitals, I know these things mean additional expense and there is the feeling that, with the centralisation of hospitals, people get better treatment and they have a chance of being dealt with by a more up-to-date staff with modern equipment. But there is a lot to be said for the small cottage hospitals in counties. In other countries where they utilise cottage hospitals for maternity and other cases, they have been welcomed. I hope that in the course of time we shall have more cottage hospitals in our country. I know that in large counties they have them and in my own county, which is not so large, I feel that there are two portions where they could easily do with a cottage hospital. Of course, we are up against the question of expense, and as to how that will be got over. I suppose time is the best healer.
With reference to swimming pools and sewerage systems, these are very important factors in the life of any community. Whenever I got an opportunity I always advocated the establishment of swimming pools.
That scarcely arises under this Bill.
Mr. P. Burke
I shall not refer to it further. One other matter to which I should like to call attention is the inadequate staff provided for the county medical officer of health in County Dublin. Having regard to the amount of work which he is called upon to do, I think his present staff is entirely inadequate. I know that in this Bill, there are provisions under which the staff of a county medical officer of health can be increased. The county medical officer of health in Dublin has to deal with so many aspects of public health at the moment that I feel it is in the public interest that he should have his staff increased. If we are to have a proper health service, it is highly necessary that county medical officers should have a sufficient staff to deal with these matters.
With reference to the question of school medical inspection, I should like to see every father and mother in this country availing fully of this service, without any resort to compulsory methods because it is in the highest interest of their children that they should avail of the facilities provided for them in this regard. Again the provisions in this Bill in regard to child welfare are amongst the finest features of this measure, because if a mother and child are looked after until the child reaches the age of 16, the chance of their becoming affected by permanent disease is reduced to a minimum and the nation as a whole will benefit by such a policy. That is a proposal which I think will commend itself to anybody.
Deputy Blowick made the point that bad housing conditions are responsible for much of the tuberculosis that exists at present. I concede that bad housing conditions are responsible for a good deal of the tuberculosis that exists, but they are not responsible for all the tuberculosis because we know that there are many people in a good station in life who suffer from tuberculosis. We have heard a good deal about the repeal of the compulsory vaccination laws. I disagree with the views expressed by Deputy Dr. O'Higgins in that regard. Candidly, I am not in favour of vaccination against smallpox, because when the effects of that vaccination are completely wiped out after seven years, I do not see very much use in vaccination at all. That is only a personal opinion. I just do not like vaccination unless it is absolutely essential. Of course, it is essential if there is an immediate threat of smallpox.
With reference to the point raised by Deputy Coogan regarding the desirability of keeping at home school children infected with certain diseases, I am sure the Deputy did not mean what he said. Parents generally would not wish their children, when they are sent to school, to associate with others who are suffering from disease, and it is only reasonable that the parents of children suffering in that way should be asked to co-operate by keeping their children at home until they are cured from the disease. Of course, if it is a case of an infectious disease an entirely different question arises. I have never known a case, in County Dublin at least, where parents refused to have their children isolated or conveyed to hospitals where they could be isolated. The provisions in the Bill with regard to public conveyances are I think also reasonable. No person would like to use one of these conveyances immediately after it had been used by an infected person or until it had been properly disinfected. The provisions in that respect are reasonable safeguards in the public interest.
It was very gratifying to hear members of the Opposition say that they looked upon this Bill as a measure of national importance. The opening speech of Deputy Dr. O'Higgins and the speeches of other Deputies on that side who followed him, stressed that aspect of the matter. The raising of the health standards of our people is definitely a national problem. Every Deputy knows that we are faced with complaints every day in regard to lack of hospitalisation and the scarcity of accommodation for patients, especially those suffering from tuberculosis. I had almost forgotten to refer to the necessity for providing increased opportunities for the treatment of cancer. I have been associated with institutions which provide treatment for this scourge and I should like to see a greater effort made to provide accommodation for patients. I should like to see more encouragement given to cancer research because, with the possible exception of tuberculosis, it is a disease which claims the highest number of victims amongst our people. I know there is a certain number of hospitals which cater exclusively for cancer. I know that the medical men concerned are doing their best and that we have quacks down the country who try to cure it.
And can cure it.
Mr. P. Burke
I agree that cures have occurred in cases where the disease is external. I think anyone who realises the number of deaths due to this disease must appreciate the necessity for providing increased accommodation and increased opportunities for research. As I say, more people seem to be suffering from that disease than from any other disease with the exception of tuberculosis. The Minister has made provision for a consultative council to deal with all public health matters and I suppose the question of the treatment of cancer will be included. A number of patients are treated in Hume Street Hospital but I should like to see increased accommodation provided for patients. I ask the Minister also to consider the question of providing greater accommodation for research work. An increased number of clinics throughout the country would be desirable.
I would appeal, finally, to those people who think that this Bill has been brought in for any purpose other than to help them to reconsider their attitude. I would appeal specially to the Opposition not to stress so much the question of compulsory powers. No doctor in the country will assume dictatorial powers to carry out any of the provisions of this measure which he is able to carry through by persuasive methods. By creating a fear in the minds of the people that they are being compelled by this Bill to do something against their will, we are damaging a great national measure.
The most valuable and the most precious asset that a nation can possess is a healthy and virile people. In my opinion, a high standard of health cannot be provided by compulsion, dragooning and regimentation. In so far as the utilisation of whatever services are provided by the State are concerned, I feel that the community must, by education and by a proper appreciation of the value of these services, be induced to avail of them. When we talk about the health of the individual and about public health, we should appreciate, too, that the first prerequisite of good health is an adequate, nutritious, well-balanced diet for the whole community and I know, and I think the Minister also appreciates, that there are many people in our community who are not in a position to secure an adequate diet. Their incomes are too low and many of them have to exist on tea and bread. They are short of the substances essential for the preservation of good health, the vitamins, the proteins and the mineral substances, and, in relation to public health, we must also aim at providing the other essentials, good clothing and adequate housing accommodation.
The House appreciates that in this measure an effort has been made to meet the vigorous objection put forward to the previous measure. The Bill, in the form in which it was originally drafted, was highly provocative. As a matter of fact, some of its provisions may be embodied in this measure, but they are put in a different fashion and not so calculated to arouse objection. The purpose of the Bill, as the Minister told us, is to modernise and reform health services, to consolidate existing enactments and, I suppose, to provide better medical and nursing services to prevent the spread of infectious diseases, to control the handling and sale of food and drink and to provide a mother and child welfare service. The aims and purposes of the measure we all can welcome. I, too, must pay a tribute to the speech made by Deputy O'Higgins. It was most interesting and highly informative and the House certainly got information from him with regard to difficulties from the administrative and medical point of view.
It is true, as Deputy Morrissey said this morning, that our people are becoming more and more hospital-minded. The same objection does not exist to-day as existed 20, 30 or 40 years ago to availing of the hospital services that are there. Hospitals are no longer looked upon as prisons or places which ought to be shunned. In the past, people in this country chose to die rather than to enter an institution. That reaction is gone and the reaction of the community to-day is, more or less, to avail to the fullest extent of these institutions. I fully agree with Deputy O'Higgins in the view he put forward in his interesting account of his experiences, with regard to compulsory methods in the treatment of infectious disease, or the treatment of any form of sickness or disease, because, as he stressed, there is something very close and very personal between the doctor and the patient. The doctor must command the confidence of the patient and the patient must respond, if the doctor is to be of any use to him, and where, in order to treat a patient, force or compulsion must be used, it is not possible to have that confidence which is so essential.
Many provisions in the original Bill have been dropped, but I might say that, so far as the Second Schedule is concerned, the Minister can and may make rather objectionable regulations. From what I know of the Minister, I think he will do his best to avoid making objectionable regulations, but he has all the power to do so in the Second Schedule. It is true that, in the event of an outbreak of infectious disease, if one meets a stubborn individual who refuses to do what is essential in the circumstances, that is, to avail of the institutional services and to allow himself to be isolated for the protection of the community, if he presents difficulties, one is inclined to lose patience with him, but Deputy O'Higgins gave us one example of his experience when he spoke of having, after several attempts, with the assistance of other people, such as the local clergymen, prevailed on a particular patient to go to an institution. The result of that patience and tact on the part of Deputy O'Higgins was that that patient was eventually quite pleased to avail of the institutional facilities and his family approved of what was being done and, I am sure, appreciated that it was in their interest and in the interest of the patient that the doctor had so advised. In practical experience, it is only in very exceptional cases that the persuasive powers and tact of the medical man will fail to have the desired effect and, for that reason, I, too, am very slow to approve of any compulsory provisions.
The Minister asked us to express our views on the deletion of a clause in Section 34 dealing with compulsory surgical treatment. I do not think he has any hope of getting the House to approve of the deletion of that clause. There is one thing more important, when we speak about health, than mere animal cleanliness. There are things more important than the health of the individual. There are some things very precious to the individual so far as his personal liberties are concerned. No Minister and no doctor should be given authority to interfere with a person's body without his consent. It would be a gross infringement of his rights if this House were to provide that a person could be compulsorily operated upon, that an organ could be removed from his body without his consent or that a surgeon could use a knife on his body without his consent. The Minister indicated that he was anxious to rescind, with the approval of the House, that clause. So far as this Party is concerned, he will not get the approval of the House.
I am glad the Minister has made provision in Section 39 for maintenance of patients suffering from infectious disease who have to go to institutions. If the provision can be increased, it would be well, because, as already pointed out, so far as payments and costs under this Bill are concerned, the people who have to bear the brunt are the agricultural community. The Minister is aware that about 80 per cent. of the local finances are directly provided by the agricultural community. Two-thirds of the wealth of the country is produced by that community but the wealth of the country is not distributed on that basis. For that reason, a higher percentage than 50 should come from the Exchequer. The cost of the services under this Bill will be thrown back on the agricultural community and the incomes of that community are not sufficient to bear those heavy burdens. There is provision in the measure for isolation in the home provided the county medical officer is satisfied that adequate accommodation and treatment are available.
The Minister told us that, in his opinion, the service provided for mother and child is the most important provision in this Bill. I agree with him. He did not make clear, nor does the Bill make clear, what medical officer is to be responsible for providing the service. In the last Bill, the district medical officer was designated as the responsible officer. Whether it is the intention to continue that or not, I do not know. In a service of this sort, a choice of medical officer should be afforded, if at all possible. It would be of tremendous importance if the mother in this case had choice of a medical officer. Confidence in the doctor and appreciation of his services are essential in a service of this sort. I think that it would be possible to bring in medical officers who are in private practice in the areas concerned. It might be necessary to introduce a panel so as to provide a choice. If the matter is fully examined, the Minister will find that it will be possible to give a choice of medical man. As nobody is designated in the Bill, perhaps the Minister intends to make that provision. However, he made no reference to it and, perhaps, he would indicate in his reply what his intentions are. A tremendous amount of work will be involved by this measure and a considerable increase in the number of medical men available for these services will be required. The Minister has indicated that a national survey is being made of dispensaries— not merely the clinics but the dispensary districts themselves—with a view, amongst other things, I presume, to adjustment of the areas. In making any increase in the number of medical men necessary, the Minister should bear in mind the importance of providing a choice so far as this service is concerned.
I agree with Deputy O'Higgins that the school medical service is a very valuable one. I think that the country appreciates its value and the necessity of attending to the health of the child. The country will also appreciate the value of the mother and child welfare service to be provided under this Bill— a service which will ensure that early treatment is applied to disease in the child and preventive measures taken. If the necessary precautions are taken to ensure sound health in the child during its growing period, it will probably enjoy a substantial measure of good health right through life. My experience is that the public are anxious to avail of the school medical service but I feel that the inspection is not frequent or regular enough. After the inspection, possibly enough attention is not given to whatever defects are found or whatever treatment is necessary. It may be that, in some counties, the medical officers are overworked and are not in a position to attend to whatever defects are present. I think that the county medical officer is called upon to do a great many things that are not necessary. He is responsible for the selection of tenants of houses. He has to examine the reports of all the dispensary doctors concerned in regard to those applicants for houses and it sometimes throws on him the responsibility of making an individual inspection of applicants. I know some county medical officers spend a lot of time on this particular work. That should not be their responsibility at all. If he has to spend so much time on that—it must be attended to and cannot be postponed, as if there is a house idle you must find a tenant, especially nowadays, when there is such a dearth of houses—he very often has to neglect this important work of school medical inspection. That is a matter the Minister might take an early opportunity to look into.
In regard to the compulsory examination of children, I was most interested to hear what Deputy O'Higgins had to say last night and his experience of trying to operate the law compulsorily in other directions. He gave the example of a school of 225 pupils, where only 200 attended and he told what would have to be done to put the law in motion against the people who failed to attend and the difficulties of bringing proof in certain matters. Here again, it is a matter of education, a matter of making the people appreciate the importance of attending to their health and a matter of teaching in the schools some appreciation of the value of hygiene, cleanliness, proper standard of diet, and so on.
The provision relating to the control of food and drink is a very important one. We all appreciate that, where certain articles are produced and processed here, some of them are handled under conditions far from ideal. It is essential that control should be exercised and that information be given to the public, on the label of the particular article, setting out its components. As the Minister pointed out in his address, there are many articles offered that are almost worthless and it is right and proper that precautions should be taken to ensure that the public are fully informed on these matters and that the articles offered for sale are of some value to the community, and that perishable commodities that are to be processed are processed within a definite period and not allowed to deteriorate.
It is unfortunate that the Minister omitted to deal with the financial aspects of the measure. The cost of putting it into operation in all its implications will be very substantial, and I am afraid I could not be as optimistic as Deputy Burke when he feels it will be put into operation almost immediately. It will be many years before these provisions are fully implemented. The staffs of medical men and nurses which will be necessary will involve a very substantial increase. Those staffs may not be there for some considerable time, as it will require a good deal of preparation to qualify and recruit them. Section 70 provides for health inspectors and the inspection necessary to carry out the various proposals in the measure for the control of food and drink and so on. That will require very substantial financial commitments. It may throw back very heavy burdens on the ratepaying community, so the maximum provision should be made from the Exchequer so far as a number of those services is concerned.
The Bill is mainly a measure that can be discussed in far greater detail in committee. Its aims and objects are essential ones and the House as a whole can subscribe to the proposals. Whatever adjustments and objections we have to compulsion can be discussed in greater detail on the Committee Stage.
This Bill has been discussed in an atmosphere of sweet reasonableness, and I am very sure that the Minister will give the utmost consideration to the suggestions made by the Opposition speakers, particularly by Deputy O'Higgins, whose speech was very interesting. I take it that the Opposition speakers themselves will also give due regard to points made by speakers who are in conflict with them on certain matters. I refer particularly to compulsion. It seemed to me to be inconsistent that the case for compulsion should have been put so strongly in respect to vaccination and then that the Minister should have been requested to drop it in regard to other infectious diseases.
I would not have risen at all but for one occurrence of which I have personal knowledge. In this particular case, the county medical officer brought to bear on a particular outbreak of fever the compulsory powers with which he was equipped and his application of the powers in that particular case led to serious trouble. In my opinion, the trouble was caused not so much by the existence of the powers or their application as by the fact that a group of lay people, organised for a specific and good purpose, took it upon themselves to diagnose an outbreak of fever as an attack of influenza. The reason was that, if it were allowed to go to the world that fever existed in the district, it might injure the interests of the district in a certain direction. People who were not qualified to diagnose any particular disease caused trouble for the health authorities in the district and made the job much more difficult than it would have been otherwise. The fact in this case was that there was a serious outbreak of typhus. Hundreds of miles away from the origin of the outbreak, the disease spread and one industry had to close down, as carriers of the disease had spread it there. That is a concrete example in respect of typhus, of the sort Deputy O'Higgins pictured for us last night in regard to smallpox. Our experience of fevers is a much more lively one than of smallpox, as least in recent years.
I know that, in the west of Ireland, one hears very little about smallpox. People do not seem to have the apprehensions about it that they have about typhus and typhoid. I think that not only should compulsory powers be there, but that it would be wise for the health authorities, in view of the difficulties which they have had in dealing with epidemics, to publicise them from time to time. I think if that had been done in the case in question that, possibly, the group of lay people who diagnosed typhus as influenza, even though their motive in doing so was good, would not have done so. They would not have been betrayed into aggravating a position which was already very serious. It has been suggested that these compulsory powers might, as has been said, be provided in an adaptive sort of way. I think that would be entirely ineffective because the powers would not be adopted. The diagnosis would, first of all, be made by the proper authority, but then by the time the health authorities had adopted the compulsory powers very considerable damage would be done. There would be objections, I am afraid, by the members of the health authority—by the elected council—to adopt the compulsory powers. The same objection would operate in their minds as operated in the case of the lay body to which I have referred—that is to acknowledge that typhus or any serious fever existed. My fear is that the thing would be too slow and that damage would be done before the necessary measures could be taken. In any event, it would be an ineffective way of dealing with the matter.
I think it would be bound to lead to the same sort of results as we saw occur under the town planning regulations. We had a Town Planning Act which was not mandatory on local authorities throughout the country. A local authority was free to adopt the Act or not. Unfortunately, in the areas where an Act of the kind was most required, and in which you had a lot of old areas that needed attention, building development was carried out in a most unregulated way. When compulsory regulations were eventually adopted the damage already done was so great it was found impossible to repair it. That experience has been sufficient to convince me as to what my attitude should be in regard to compulsory powers under this Bill in so far as they apply to infectious diseases. I think that the Opposition speakers who have suggested soft-pedalling in regard to this matter are foolish in their view-point. If the public in any affected area know that the health authorities have powers which are fairly drastic, I think that very fact in itself will go a long way to secure co-operation with them in preventing the spread of an outbreak.
There are one or two other matters that I desire to bring to the Minister's attention. One is the recruitment of Irish-speaking nurses. It is becoming fashionable to throw cold water on regulations which require a knowledge of Irish for persons seeking public appointments. I would like to impress on the Minister and on the House that it is of vital importance that the nurses who are supplied to our Irish-speaking districts should have a competent knowledge of Irish. If there is one thing that the people in the Gaeltacht cannot do adequately it is to explain their ailments to a doctor or a nurse through the medium of the English language.
As a matter of fact, the absence of a competent knowledge of Irish, in the case of people holding public appointments in the Gaeltacht, may lead to very serious consequences. The use of a wrong term or a wrong expression may create difficulties for the doctor or the nurse that may prove insoluble. So far as the nursing profession is concerned there is, I think, plenty of good material available to supply the Irish-speaking districts with an adequate number of nurses. In this respect the Minister will have to deal with voluntary nursing organisations like the Lady Dudley Nursing Scheme or the Jubilee Nurses but I am quite sure that the co-operation of these bodies could easily be obtained by the Minister.
The difficulties of getting into hospitals in Ireland for training are much greater than they are in England. Something ought to be done to enable poor girls who cannot pay the fees required by Irish hospitals to have their fees paid on the basis adopted by the Department of Education in respect of girls entering the preparatory colleges. In certain selected cases the school fees are paid and the pupil contracts to repay the fees when she is in a position to earn a salary. The girls from these Irish-speaking districts would be quite prepared to enter into such an arrangement, to repay the hospital fees when they would be earning salaries. Girls from the West must perforce go to England and it is largely because of that difficulty. They would prefer to stay at home but they cannot find the fees. I understand that in some hospitals, there are distinctions in respect of the educational qualifications required. Some hospitals have a higher standard than others but I do not think that is the real difficulty.
I wish to point out to the Minister that my experience of the Gaeltacht nursing scheme already in existence is not too happy. I do not think it has been operated with the full spirit of goodwill and co-operation on the part of the local authorities which it requires to make it a success. The Department selects applicants who have subsequently to undergo the ordinary examination of the local authority for entrance to the hospital selected. The scheme depends on the goodwill of the local authorities and on their willingness to make a number of places available. Having made a number of places available, it is rather inconsistent to set the standard of education required so high—Intermediate or Leaving Certificate standard—that these girls cannot possibly pass it. The adoption of such a standard for the subsequent examination has the effect of nullifying the previous co-operation of the local authority.
I think the Minister ought to establish something in the nature of visiting committees for hospitals. Since the boards of health were abolished a real want has been felt in this respect and the managerial system has not been able to fill it. If it is not possible to have the boards re-established, some body akin to it ought to be devised by the Minister. If the Minister does that, a great many of the difficulties that have cropped up will possibly be ironed out. School medical inspection should be compulsory for all children attending school. This is not my own point of view—I have an open mind on the matter—but it has been represented to me that it would be an unwise arrangement to allow children to be attended privately under arrangements made between their parents and the family doctor.
A doctor, as a matter of fact, pointed out to me that if you do that you will create in the minds of the poorer children a sense of inferiority, that distinctions will be made in the school between the rich and the poor, and that that is undesirable where children are expected to put themselves on the same level, in any event, during school hours, and have to submit to the same discipline and the same instruction. If this distinction is made it will create a barrier betweeen the rich and the poor. According to modern ideas, that is undesirable and ought to be avoided. I think that well-to-do people who consider this matter will not wish to have their children favoured in school as compared with the children of poorer parents. I would ask the Minister to take advice on that matter. I believe that all fair-minded people will agree that these distinctions ought not to be made.
The mother and child service will be greatly welcomed in the West of Ireland. I have only one case in mind and that one case, in my opinion, justifies the introduction of a mother and child welfare scheme. The case was brought to my notice some years ago of a man who was so poor that he was unable to engage a doctor. It may be said that he could have got a red ticket but I would point out to the House that the idea has grown up in the West of Ireland that you cannot or, in any event, that you should not, that it is undesirable, to get a red ticket for a maternity case and the very poorest people will not ask for a red ticket for such cases. That is the position in any event in the rural areas. They will not get a red ticket to bring the doctor to the mother in confinement. One case was brought to my notice where the mother died because of inattention and the reason why the man would not send for the doctor was that he was too poor to pay the doctor and would not get a red ticket. Any scheme that can be devised to prevent occurrences of that kind would be welcomed on all sides.
I join with the other speakers who have congratulated the Minister on, this Bill. He is fortunate in having a very reasonable atmosphere for its introduction and I am quite sure that that will be maintained to the Final Stage.
Deputy Burke complimented the Minister on the full statement he made when introducing this measure. I have no desire to derogate from that tribute but I do want to say that I was disappointed at the brevity of the statement and its lack of vital information. I am not so much concerned with what this Bill contains as I am with what the Bill does not contain. It does contain 100 sections and in about half of those sections—I do not know the actual number—the Minister is taking power to make regulations of one kind or another. Personally, I have always held that legislation by regulation is objectionable and unsatisfactory, especially in legislation of this character. We do not know who is going to be responsible for helping the Minister to draft these regulations. Are these regulations to be drafted solely by the Minister's officials, just as this Bill has been drafted solely by the Minister's officials? Will there be consultation with any outside bodies?
It is mentioned in the Bill that a national health council will be established. Will the national health council be consulted in the drafting of these regulations under approximately 50 sections of this measure? Will the views of the medical profession be obtained in the drafting of the regulations? Will the local health authorities be consulted in the drafting of these regulations? When these regulations have been drafted, will they be placed on the Table of this House so that Deputies will have an opportunity of examining them before they are put into operation?
In my experience, this is the first measure introduced into this Dáil which provides for the making of regulations in almost half the sections. I cannot understand why it was necessary to draft these sections in this particular form. Surely the Minister could have embodied the regulations under some of the sections in the measure and thus have given the Dáil an opportunity of discussing the Bill intelligently. That is the one thing I dislike about the measure—the power which the Minister has to make regulations under almost 50 per cent. of the sections. We do not know what these regulations will be or who is going to draft them. Is the Minister to be the sole authority or are the regulations to be drafted by his officials or will medical councils be taken into consultation in the drafting of these regulations?
Deputy Blowick asked the Minister to tell him if he had obtained any figures from his officials as to the actual cost of putting a measure of this character into operation. While I agree that this country is entitled to the best service we can afford, nevertheless, I maintain that we certainly cannot afford the type of health services which they have in other more prosperous countries. The scheme that was drafted by the Most Reverend Dr. Dignan was discarded and thrown into the wastepaper basket by the Minister for Local Government because there was no reference in it to the actual financial implications of the scheme. Yet here we are discussing a measure which may cost far and away more than the Dr. Dignan scheme and the Minister did not say a word about the financial implications in his introductory statement. Finance has a very important bearing on the whole of this question.
As I have already said, the country is entitled to the best health services we can afford but it may be that the country may not be able to afford the type of health services this Bill contemplates. The Bill provides that the health authority shall have power to spend money on the erection, renovation and repair of institutions. If the health authority refuses to repair, to renovate, or to build the health institution the Minister may order a local inquiry for the purpose of ascertaining the need for such an institution and he himself can order the erection, renovation or repair of such an institution.
The Bill provides for the erection of clinics to deal with the Child Welfare Scheme. The Minister is taking powers in a number of sections of this Bill for the purpose of spending money for all kinds of purposes. We do not know and apparently, the Minister does not know, nor has he taken any trouble to get any estimate prepared of what the cost to implement them will be. The House is entitled to know what this Bill is gong to cost the tax-payers and the rate-payers of this country. The rates are soaring in every county because of the fact that the costs and the prices of provisions are soaring and they have soared to such a point that, if they go any higher, I am afraid there will be serious reaction from the rate-payers. Taxation is soaring. Yet in this Bill we propose to add, possibly, very considerably to the burdens of both the tax-payers and the rate-payers. The Bill may cost £1,000,000, £2,000,000, only £500,000, £250,000 or £3,000,000, £4,000,000, £5,000,000. I admit, of course, that all this cost is not going to be incurred in one, two, three, four, five or six years. Nevertheless it is a cost which will be incurred some time when this Bill becomes law.
The Dáil is entitled to know now if the Minister has arrived at any estimate of what the eventual total cost will be. Not only is money to be spent on institutions, etc., but money is to be spent on the provision of medical services—on medical officers of health, on assistant medical officers of health, on nurses, bacteriologists, health officials, and so on. Under the Bill there will be a whole army of new officials—new doctors, new county medical officers of health, new bacteriologists, new health officials, and so on. All these will cost money. Yet the Dáil has not been given any information at all as to what the eventual cost may be. I think Deputy Blowick's request for that information was very proper. I submit that the Minister, in his introductory statement, should have given the Dáil some idea of what the cost of implementing this measure will be. We cannot hope to ape or to follow or to imitate the standards of other countries. I know that many people in this country follow with a great deal of interest the health schemes adopted in Britain, France, America, and so on. I know, as a matter of fact, that many of our officials follow these schemes very closely and that some of them are quite enthusiastic about introducing them in this country. But the question arises—can we afford these schemes? Britain, after all, is a wealthy industrial country. America is a still more wealthy, more populous and a larger country in every way. They can afford these luxuries. If we in this country are going to have such services they will have to be measured according to the means and the abilities of the people who are going to pay for them. I think the officials did not take cognizance when some of the recent legislation was being prepared of the ability or capacity of the people to meet these services.
The Minister in this Bill has discarded some of the more objectionable sections in the Public Health Bill which was introduced by his predecessor. His predecessor was inclined to use the mailed fist. The Minister may be using the kid glove method. After all, we have compulsion here in a disguised form. We are in this difficulty. We do not know how much further the Minister may carry that element of compulsion when he comes to make the regulations under the different sections of this measure. The Minister displayed, yesterday at all events, a very reasonable attitude and I am certain that the members of the Dáil on this side of the House will meet and discuss the provisions of this Bill with him in a reasonable way. We feel, however, that as the Bill stands at the moment, it is a rather mysterious blend, for the simple reason that we do not know what regulations the Minister proposes to make on this Bill. We do not know who will devise and prepare these regulations and what bodies the Minister will consult when he is devising these regulations.
I suggested when we were discussing the Bill introduced by the Minister's predecessor that we have failed to make use of propaganda in connection with health services in this country. I think that a judicious use of health propaganda would save the ratepayers and the taxpayers of this country perhaps a considerable sum of money. After all, successful propaganda was carried out in recent years by the Red Cross Society for the purpose of making people alive to the danger of tuberculosis, how easily they could become infected and so on. That propaganda had a very good effect. It certainly made the people very much alive to the dangers of that dread disease. I suggest that societies like the Red Cross Society, public bodies, Radio Éireann and other institutions could be utilised very successfully and very effectively for the purpose of carrying out health propaganda. I imagine that that propaganda, if done in a skilful, planned way, would have a very good effect, that it would probably save the State a considerable amount of money, and that it would relieve the Minister of the necessity and the obligation of introducing the element of compulsion into the health legislation we have heard so much of in this House in recent years. I suggest he should seriously consider propaganda for the purpose I have named. If the Minister seriously devotes his attention to it he will find that he can devise ways and means for some of the objects he has no doubt in mind. He will find there will be better appreciation of our health problems and that, eventually, the people will react and respond to that type of propaganda.
The public health authorities for the future will be the county councils and the county borough councils. Hitherto, of course, the public health authorities were the corporations and the urban councils. I take it the functions exercised by the corporations, as distinct from the county boroughs, will be discontinued when this Bill comes into operation. I make the plea that the public health functions exercised by the corporation in my constituency should be continued, because the corporation has succeeded in building up a very good and effective organisation. I think it would be a pity to disintegrate that organisation now because, by transferring it to another health authority, it may lose some of its effectiveness. The Minister might consider the case of local councils and corporations. The Sligo Corporation and other kindred bodies throughout the country over a long period of years have built up an effective health organisation, and by transferring that organisation, to another authority it may lose something of its usefulness and effectiveness.
The Minister, like his predecessor, continually uses the phrase that the Minister may make regulations in relation to anything referred to in this Bill, etc. I suggest that that phrase in itself is suggestive and has the flavour of compulsion. I suggest that the Minister might vary that phraseology in a number of sections and say that he may make regulations in consultation with or after consultation with the health authorities. It appears to me that in quite a number of sections in which the phrase is used the Minister would be wise in his own interest and in the interests of public health to bring the health authority into consultation with him in drafting whatever regulations have to be drafted to implement the particular sections. After all, this measure, if it is to operate successfully, can only do so by the fullest co-operation between the local health authority, the officials of that body, the Minister and his officials in Dublin. I suggest seriously to him that he should consider the advisability of bringing the health authority as much as possible into the legislation we are discussing. I believe that such a step would help to make the legislation more useful and effective, and it would be an aid to its implementation.
An Ceann Comhairle took the Chair.
In reading the Bill, I notice a curious contradiction between two sections relating to the same subject. For instance, in Section 15 it is provided that persons getting treatment in institutions shall be charged a reasonable sum. When we come to Section 34 we find that the chief medical officer can order the detention of a person suspected of suffering from infectious disease. But, if the person is detained in these circumstances, no charge whatever is made. You may rest assured that there are quite a number of clever people who will gladly avail of that section if the Minister insists on Section 15 being passed in its present form. I submit for the Minister's consideration that there should be no charge made for any person suffering from infectious disease who is treated in any of our institutions. It is to the advantage of the community as a whole that that person should be isolated in that institution, and there seems to be no good reason for making a charge in a case of that kind. I suggest to the Minister that it would be advisable in equity and fairness to the persons themselves that they should be all treated alike. Where one is compulsorily isolated and the other voluntarily enters an institution, they should be all treated on the same basis. I suggest that he might give that matter consideration between now and the Committee Stage.
Deputy O'Higgins referred last evening to the question of vaccination. Mention was made of the number of people entering the country by air, but no mention was made of the number of holiday-makers who came over here last year. The Minister for Industry and Commerce stated recently that 500,000 people entered this country from abroad. While we may not have the same number of visitors this year, nevertheless it is probable that a couple of hundred thousand people will spend their holidays here this year. There is a danger that many of these will be bearers of disease. For that reason, I think it would be most unfortunate that the Minister should amend the law with regard to vaccination in the manner proposed. So long as present world conditions remain, it is likely that we shall have an abnormal number of visitors for many years, and I think it would be a retrograde step for the Minister to alter the existing legislation in regard to vaccination in any way in the existing circumstances. I do not propose to discuss any of the other details of the Bill, because a layman is scarcely competent to enter into the domain of the medical man. I propose to leave that until we reach the Committee Stage.
Deputy Bartley made one very interesting point to which I wish to refer, and that is with regard to the training of nurses. He suggested that provision should be made, if not in this measure, in some other measure to help country girls financially in their training course. I think that is a very appropriate sugma gestion. At present those girls are obliged to go to England in order to get that training. I realise that there will be a difficulty in this country in regard to that because of lack of accommodation, but some hospitals, on occasions at all events, could accommodate more girls than at present. Some of those girls who are obliged to go to England go very reluctantly, but the parents have not the means to provide them with the deposits necessary if they are to undergo a training in one of the hospitals in this country. I suggest to the Minister that he might give consideration to that question later on, and see if he cannot devise some ways and means to assist these girls who are anxious to obtain their nursing training in this country. After this Bill becomes law, there will be a big demand for nurses in the course of time, and I imagine that the Minister will be obliged to do something like this in order to keep up the supply of nurses.
I think it would be very difficult to make an accurate financial computation in relation to this Bill. I do not think that was a reasonable question to put, because in the long run the question of first importance is whether this Health Bill is necessary or not. If it is then the financial consideration is of secondary importance and it can be worked out later whether the financial implications will be met by general or local taxation. I welcome this Bill because I see in it the possibility of a great measure of co-operation. I have had considerable experience on hospital boards and indirectly I have been in contact with the medical profession. I see in this Bill more than a happy augury for the future. If this Bill is indicative of the Minister's mind as to how he intends to act in the future, as between the hospitals and the medical profession, then I think he deserves from this House the highest congratulations.
There are a few aspects of this measure with which I would like to deal, particularly from the point of view of Dublin City. I would like to stress what Deputy Roddy has said. I think when a person is removed to an institution suffering from an infectious disease, there should not be any means test applied. Every day I am in contact with people in the City of Dublin whose children have been removed to Cork Street Hospital. These people are in various walks of life, but the majority would be from the casual labouring classes or tradesmen. The child may have gone in for observation for a week or two and remained for ten or 12 weeks. At the end of that period the parents are presented with a bill. Possibly, in the first instance, they intimated their intention to pay a certain amount. They have no hope of paying the bill and subsequently they receive from the commissioner acting for the Cork Street Board a notice that the matter will in due course be placed in the hands of a solicitor. I would like the Minister to note that people with a weekly salary are not in a position to pay for treatment in Cork Street or any other hospital.
In this city we have the Royal Hospital for Incurables. I think in this year 1947 it is ludicrous that an incurable patient must seek election to enter the hospital. That patient cannot get a bed in an ordinary hospital because there are not sufficient beds for ordinary cases. It is easy to see why an ordinary hospital cannot provide for incurable patients. For these patients there is the Royal Hospital for Incurables, an excellent and exemplary institution, but I wonder how many people in the city and the country are aware that an incurable patient must be elected in order to get into that hospital; in other words, persons seeking admission must go, as people very often do who are seeking posts, where a post will be filled by election to a board, to considerable expense—very often the money is put up by charitably-minded people—canvassing persons to vote for them so that they may be allowed to enter the hospital. I think the Minister should direct his attention to that matter and ensure that, however the accommodation can be provided, it will be provided. The matter is an urgent one.
As regards mental defectives, Deputy Brennan last night made a plea to the Minister that in respect of mentally-defective children the means test should not apply. We have in Dublin City—I speak of it because I know more about the Dublin problem—many children who should be admitted to homes for the mentally defective and they are not because their people cannot pay for them. An article written recently mentioned a specific case where a man earning £4 10s. 0d. a week was expected to contribute 25/- a week on behalf of his mentally-defective child. Medical opinion indicated that if that child could get treatment it would probably be cured within six months. That child is still at home and the commissioners acting for the Dublin Board of Assistance could not see their way within the regulations to make an allowance sufficient to give the child the necessary treatment.
There is another matter that I would like to touch upon and that is in relation to local opinion—the opinion of corporations or councils. Deputy Roddy said he would like to see the utmost co-operation. From my experience in the past as a member of a public health committee, as vice-chairman of the public health committee of the Dublin Corporation, I cannot say that we have received the co-operation we should receive. We had one most farcical example—I hope it never recurs—in reference to Ballyowen Sanatorium. We advertised world-widely, as a matter of fact, a competition in connection with that sanatorium. The competition was duly decided and won by two Dublin architects. A sum of £6,500 was spent. One day when we were in committee we got from the Department a note telling us that the Minister did not think we should go ahead with it. I think that is the result of non co-operation. After all, we were members of the corporation public health committee, people giving voluntary service. We were elected representatives of the people and if we were thought competent to sit there and deal with these questions we should have been consulted. I believe that that would make for better management all round.
I have every confidence in the new Minister for Health. Everybody asked what would the consultative councils do in relation to national health. If the Minister says consultative councils, he means consultative councils; he means that he will sit down with that consultative council and take the informed opinions of the members, the opinions of specialists, of people in a position to know; he will be prepared to weigh their opinions and, while he might not agree with them and they might not agree fully with him, nevertheless some solution will be arrived at that will be perhaps agreeable to all. I hope the Minister will take the local bodies into consultation and cooperate fully with them.
Deputy Dr. Lynch last night dealt with one other question in relation to the additional duties imposed on dispensary doctors, to which I should also like to refer. I am not speaking particularly of conditions in Dublin. In my opinion, many dispensary doctors throughout the country are not sufficiently reimbursed for the duties they have to perform. Some people may suggest that a dispensary doctor in a particular area is not treated badly because we all know that the position of dispensary doctor is analogous in many respects to that of a sub-postmaster. A person gets a sub-post office and is paid some inconsiderable sum for the running of that office, but his salary as sub-postmaster does not represent the full value of the post office to him. There is also the consideration of the custom which the post office brings him for other branches of business which he carries on in the same building. Similarly, a dispensary doctor may have a very good district in which he has a large private practice but, on the other hand, he may have a wretchedly poor district. I should, therefore, like to see dispensary doctors fully reimbursed for whatever additional work may be imposed upon them under the provisions of this Bill, and I think that the Minister should apply himself immediately to the question of the revision of the salaries and allowances of dispensary doctors generally.
The question of hospitalisation is a separate matter and while I think this Bill represents a distinct advance on existing conditions, I am one who is a die-hard in the opinion that hospital treatment in this country should be afforded on the basis of a contributory scheme. We need a proper contributory health scheme here. A working man cannot afford to be sick, and, if he goes to hospital, he cannot afford to pay under present conditions. The benefits provided under the national health scheme which run approximately for nine months are totally inadequate to meet the needs of a man and his family while he is ill. However, these are wider problems. The main consideration, as far as I am concerned, is that this Bill is a good Bill because, as I stated at the outset, it is an indication, to me at any rate, of the Minister's mind on the matter and an indication that we shall have that close co-operation as between the Department, the hospitals and the medical profession in the future, which can only be of advantage to the general community.
The fact that the Minister has had the good sense to take note of the discussion on the 1945 Bill ensures for him the co-operation of the House on this occasion and ensures also that such improvements as are necessary in this Bill will be duly incorporated in it. There is one aspect of the Minister's statement in which I was interested and which will form the burden of my remarks to-day. He made reference to the question of allowances for the dependents of tubercular patients. That is a matter which has been agitating the mind of public representatives, even for some years before the 1945 Bill was introduced. It was looked upon as the first step towards the solution of the tuberculosis problem, not only in this city but throughout the country. Under the conditions that obtained up to the present, an individual suffering from the disease carried on as best he could until he was stricken down and had to go to a sanatorium. He then had the additional worry of not knowing what was to become of his wife and children. The law provided only one remedy for that and that was to resort to the most objectionable form of public assistance. That system was maintained in the 1945 Bill despite protests from all sides of the House. Despite repeated protests, we were able to make no impression on the Parliamentary Secretary who was then in charge of the Bill in our efforts to have a different system introduced.
I am glad that the Minister has sensed the atmosphere of the House and approached the solution of the problem from a different standpoint. He now proposes to give a 50 per cent. recoupment of any sums provided by local authorities to assist such patients. He is taking the wise precaution of seeing that public authorities will not bring in a scale of allowances that will be either too low or too high. I am not concerned with the second category because I do not think allowances will be granted on that particular scale. It is to be feared, however, that some authorities, even though they are getting 50 per cent. recoupment, may fix a scale that would be grossly inadequate and to that extent I agree that the Minister should have powers to ensure that a sufficiently high scale will be allowed.
I also suggest to the Minister that these allowances should be paid in a form which will remove any suggestion of stigma of poor law relief from them. I suggest that they might be paid from the Department through the Post Office in the same way as other benefits such as children's allowances are paid. Patients and their dependents will then feel that they are getting something to which they have a legitimate claim rather than something which is paid to them in the form of relief. Further, I would suggest that the allowances should be payable from the time the disease is diagnosed so as to ensure that patients will have an opportunity of entering hospital at the earliest possible stage. If we can bring this system into operation at an early date, there is only one other thing lacking, in my opinion, to ensure complete success, so far as the treatment of tuberculosis is concerned. That is the question of hospital treatment itself. I should like to hear from the Minister what steps he is taking in regard to hospital accommodation, which is a desperately acute problem and has been such for a number of years. We have a programme of regional sanatoria and reference has been made to the fact that a sanatorium was to be built at Santry but the matter has latterly been the subject of some doubt. I am not quite sure whether a final decision has been taken in that matter and I think the Minister should intimate to the House what the position is.
At the moment we have a scheme of radiography operated under the Dublin Corporation. While that is an excellent scheme in itself, it is like starting at the wrong end of the problem. Very often you may cause a tremendous amount of suspense in the minds of people by the results of an initial examination and I think that very little purpose can be served, unless you provide, as a necessary corollary, hospital treatment. I am sure the Minister will readily appreciate the defects of the present system. The question of hospital treatment is growing very urgent so far as Dublin is concerned. There are hundreds of patients who have very little chance of getting into hospitals for months to come. Many of these patients are in homes, the conditions of which are in no way conducive to the improvement of the health of patients. The patient is not in a position to have a private room and the question of danger to his children is ever present. I should like the Minister to give some indication as to when this problem will be tackled in a really practical form. I want particularly to express my personal pleasure, as one who devoted his whole attention in relation to the previous Bill, to this problem of allowances, that at long last we are being met in a way which the House will appreciate.
With regard to the matter touched on by Deputy McCann, there has been an agitation for a good many years for an extension of the dispensary system —call it by any name you like; I believe there is a suggestion that the name should be altered and perhaps it would be as well if it were—so that working-class patients will be able to avail of the dispensary services in the evening. That is a demand which has been made in this city for a considerable time by people who understand the problem, and it rests with the Minister to ensure that it is brought about by any regulation he desires to make. During the day, for obvious reasons, because of the domestic setup of the working-man's home, he is not in a position to take advantage of the dispensary system as we now see it. An alteration is necessary and such a reform, which I strongly suggest to the Minister, would be a progressive reform. There are other aspects of the Bill which can best be dealt with in Committee, when some of us will have observations to make, but, at this point, I should like to assure the Minister that he will have no rancorous debate on this Bill but a helpful discussion designed to improve the Bill, in so far as we feel it necessary to suggest improvements.
Before discussing the Bill, I should like to refer to the matter of which Deputy McCann spoke. He dealt with the Royal Hospital for Incurables and I think he misunderstands the position somewhat. For that reason, I should like to put this viewpoint before the Minister. That institution caters for people who are dying, who are incurable. They are not hospital cases, nor is the institution a hospital, in the accepted sense of the word. When a person goes there, it is equivalent to saying that there is no hope for him, that existing medical knowledge has said that he is an incurable case. I agree that any election system to an ordinary hospital would be intolerable, but when one considers that this is not a hospital within the meaning of the word, one must view it from a different angle.
I do not know anything about the finances and so on of this hospital, but I should imagine that, when the hospital was founded, the election system was inaugurated to encourage people to give annual and life subscriptions. I know that one can pay so much and become a life governor. That election system gave charitably-minded people an interest in the hospital, and I should say that, if you interfered with the elective system obtaining there, the hospital would inevitably lose a large portion of its revenue, because people who have not the right to put forward names and vote for them will inevitably not have the same interest in the hospital. That is an aspect of the matter I should like to put to the Minister and I shall have pleasure in putting it to my friend, the Lord Mayor, when next I see him.
In company with other members of my Party, and I think I may say with all Deputies, I welcome this measure very much, but I wonder are we always quite clear on what we mean by public health. I think public health falls into two sections—what I might call public good health and public ill health. We are trying in this Bill to deal with public ill health and to promote public good health, and I wonder will the day come when the distinction between these two aspects will be so clear that we will perhaps bring in a public good health and a public ill health Bill. I mention that because I welcome very much the consultative council which the Minister proposes to set up. That has in it the germs of a good deal of education for the general public. I also welcome very much the mother and child service, and, in the working of Section 20, I see great possibilities for the dissemination of what an earlier speaker called propaganda regarding public health. I also see possibilities in that section of facilities being given for local and school authorities to take even more care than they do of the health of the children, and it is primarily to the children and the youth of the country that I look in connection with this Bill.
We here in Dublin, and especially the members of the Dublin Corporation, have realised something which perhaps is not so apparent in rural Ireland, that is, that the health of our people depends primarily upon food, and that is why I mention the good health aspect of the public health problem. Every doctor in any hospital in Dublin will tell you that again and again children, and indeed, even more so, the unfortunate mothers, come there for medical treatment for something which has arisen mainly from lack of nutrition. They are treated and perhaps cured temporarily, and then back they come again in a few months because they go back to the bad conditions and the bad food in the home. That does not seem to hit the male element of the population to quite the same extent, because the male element being the wage earner, it is realised in the home that the man of the house must somehow be given enough food to enable him to carry out his job. Otherwise, the whole family will come down in the social scale and will be reduced in the amount of food they can buy. That is a very difficult matter for a Minister for Health to deal with in a Bill, but, to my mind, it is really at the root of a great deal of the ill-health in this country. That is not to say that we suffer abnormally from ill-health. We do not. But, like every other community, we have our submerged section. That, we have, to a great extent, in the City of Dublin. I know that we have food schemes and other schemes to cater for our people. They are paying their way at the moment and they will pay increasing dividends in the form of good health in the future.
A number of Deputies have raised the question of compulsion. The great difference between this Bill and the last Health Bill we had before us is that a great deal of the compulsion has been cut out. I think that we shall have to move carefully regarding this question of compulsion. As it appears to me, we must arm the Minister or the Government with the power necessary to deal with the person who will wantonly infect other people. I emphasise the word "wantonly." The public health authorities must be given power to deal with that type of person. But it is another question when you proceed to deal with a person compulsorily for the purpose of increasing knowledge or perhaps for "crank" reasons. These two forms of compulsion fall into different categories. I should have very little hesitation in giving the Minister powers compulsorily to prevent the spread of infection. I should be very hesitant and chary about giving the other form of compulsory power to anybody. To do the Minister justice, I do not think he desires a great deal of this power of compulsion. When we get down to the Committee Stage of this Bill, I think we shall find that this question of compulsion, in its various forms, will fall into its proper category.
In Section 41, the Minister has taken powers to deal with infestations. In view of the problem which persists from time to time regarding these matters, I wonder whether the Minister will be able to handle the position adequately in the event of an out-break. On this whole question of public health, I pin my hope to edu-cation. That is the slowest way but it is the easiest way, and, incidentally, it is the cheapest way. I do not think you can, by law, make people clean or make them careful regarding the infection of other people. You may try to do it but you will not wholly succeed. It can best be done by getting at the mothers and children and educating them. It is the experience of those who have to do with these prenatal and post-natal clinics and child welfare schemes, that the poorer section of our population in Dublin show, in the vast majority of cases, pathetic eagerness to carry out the advice they are given at those clinics. Very few mothers are not anxious to do the very best for their children. In fact, one of the problems at those clinics is that the mothers, through poverty, will take the food which is given to them and transfer it to their children, to the detriment of their own health. There is a very widespread desire amongst that population to do the best for their children and for the people around. The Minister's emphasis on that aspect of our people's desire is a very wise one and I heartily commend it. I trust that this Bill will do all we hope it will do.
I welcome this Bill which, in my opinion, is a necessary measure. A large section of the population will be affected by the services provided for in the Bill. There are a few points which I was desirous of raising. One has reference to school medical inspection. Prevention can best be effected through the medium of the schools. We have, of course, a scheme of medical inspection in operation but its operation is very slow. It is very difficult, with the amount of attention that can be given to the different schools, to make it effective. A doctor may inspect a national school. Before he has all the schools in his area inspected, 12 months or more may have passed. In the meantime, anything may have happened in the case of a child suspected of disease at the first school visited. The disease may have developed seriously by the time the school is inspected again. If something in the nature of a register were kept in the schools, prevention might be more effective. I should not like to put extra work on the teacher but the teacher would probably have knowledge of the parents of the children attending school. He might have long service in the school and might have a good knowledge of the family history of his pupils. If a register were kept by the teacher and were available to the medical inspector, it might render his task easier by indicating weaknesses in a particular family. Weakness of sight, tonsils and adenoids may have dangerous results. Some of these may be family troubles and, if they were shown on the register, it would be very easy to have the children on the list for examination at the next medical inspection. Something like that would help to prevent the troubles which may arise in the early stages of those children attending school.
The provision of regional sanatoria is being done too slowly and something should be done to speed it up. There is growing need for these sanatoria and there should not be so much delay. In many a county there is no accommodation for those requiring urgent hospital treatment. In counties like Mayo, there are many cases on the waiting list for tuberculosis treatment, but there is not a bed available, nor is there any hope of one. In some cases, people have to wait six, nine and 12 months. Where there is a suspected case of tuberculosis and the patient is left without hospital treatment, there is grave danger that, by the time the patient reaches his turn for the hospital, hope may be very far off. Where a young person shows symptoms of tuberculosis and it is brought to the notice of the doctor, he has to wait to be taken to a tuberculosis hospital. As far as I know, he is not allowed into a general hospital at all, but has to wait for a bed in a hospital suited to the disease from which he suffers. There is a growing need for this treatment and some effort should be made to speed up the provision of the sanatoria.
I agree with Deputy Roddy that the introduction of the Bill was welcome. I would have liked to see some reference to the cost. I do not say that the Minister could give an accurate figure, but he should tell us approximately what the whole scheme will cost. That would be very helpful to Deputies in doing their part in making comments on the Bill. As it is, we do not know what it will cost and I hope that we will be given some information on that point. I wish to emphasise, finally, that a lot of the troubles which arise at present could be remedied if a more rigid system of school medical inspection were put into operation.
There are many parts of the Bill with which I am in agreement, but I am satisfied that a good part of it could be dropped completely. I see two things in it which I never stood for—one is spoon-feeding and the other is compulsion. These should be cut out of the country. The Bill looks all right on its face value, but if carried out in full to its logical conclusion it will be very costly and will be an immense burden. The money could be better spent in providing better and more up-to-date hospitals and sanatoria and in the school inspection work. We always start at the wrong end. The first thing is to educate our people to a sense of their own responsibility. We never started that and it should be done first and foremost. I believe that 80 per cent. of the doctors' bills could be wiped out if we wiped out malnutrition, which is the cause of all the trouble. We see people going to the doctor every other week, in queues out-side the dispensaries, and you could pick out almost everyone as being underfed and undernourished. They are clamouring for a bottle and they are given a bottle. I do not know what is in it, but it is not much good.
The family wage is too small. We should give our people a living wage, no matter how we do it, so that they may be able to buy proper food and clothing for themselves and their children. We need a properly adjusted family budget and then we should see there are good houses. It would be better to start on that, before bringing in medical Bills. School inspection is one of the things I stand for as being of immense importance. It should be carried out properly twice a year. That would need a fairly large staff and would be expensive, but it should be done. Then you can keep your eye on the family history of the children and bring them up in a healthy way, dealing with tonsils, adenoids, teeth, chest troubles, and so on. If the people have decent family wages, they will do a good deal themselves and there will be no need for compulsion. In every home, there should be a good bar of carbolic soap, a good scrubbing brush, a tin of D.D.T., a bottle of Jeyes' Fluid and some salts. If those things were properly applied in their own spheres, we would wipe out a good deal of the disease in the country. Unfortunately, very few of those things are used, though they should be used.
We have here a proposal for free medical aid for all. There is no clamour for that and I do not like it, as it will turn into a racket. What people want is cheap medical aid. They do not want anything free. The farmers are willing to pay a doctor for treating the ills of the family and are proud to pay, but they do not want anything free. In the end, it is not free. What the farmer and labourer have to pay in the end, to get what we call free treatment, will be far more than they would have to pay if they called in the doctor directly. It will not be free, but very costly. It will be a real racket, with everyone running to the doctor morning and night with sore toes, cut fingers, gumboils, toothaches, and so on, and the doctor must attend them or lose his job. These could be attended to at home by the parents, instead of making molly-coddles of the children. We will see them in queues to get a gumboil or a cut finger looked after. I do not stand for that, as it is a type of spoon-feeding the nation and we do not want it.
Our medical officers should be paid salaries in keeping with the importance of their mission. The salary at present is a despicable, mean one and only for the way they have to charge highly to farmers for medical attention they could not live at all. I want to see them put above that and paid a wage in keeping with the dignity of their mission. Instead of getting £400 or £500, medical officers in dispensaries should be getting £1,000 a year. He is entitled to it, and if he had a good salary he would be able to attend the farmer and the members of his family for perhaps a fee of 10/- or 15/-. As it is, every call that a doctor makes to your house costs about £2 2s. 0d. That is a bit too high. I do not blame the doctor for that because the salary he has is very small. But, if what I suggest were done, we would want no such thing as free medical attention in the country. The doctor would probably be satisfied with a fee of 10/- or 12/-when called in by a farmer or a labourer.
What I complain about is that we have compulsion at one end and spoon-feeding at the other. I do not like that because it is becoming a racket and the sooner we realise that the better. I would like also to see cheaper hospital treatment provided. I know that those in charge of many hospitals are very generous and decent with people when they know they are not able to meet the recognised charges. In many cases, they are prepared to cut these down by 40 or 50 per cent., and will give a patient's relatives a year or two years to pay. At the same time, I would as I say like to see cheaper hospital treatment available so that families would not be greatly embarrassed when any member had to go into hospital for a major or even a minor operation. At the present time that can be very costly to the ordinary countryman if the patient has to remain in hospital for four or five weeks. I would provide nothing free except for old people, for sick people and the infirm.
The general mass of legislation in this country is more or less pagan. We are going in too much altogether for this class of highfalutin legislation. They do that in England where they do not care twopence about Christianity and you have the same thing in Russia and in other countries. Sickness and death, no matter how we may try to attack them, will be with us for ever, because that is the decree of the Almighty. Suffering, when looked upon in the proper way, can be a good thing for a nation. If the ordinary people in this country had not a little suffering, and did not experience something of the ills of life, I do not think that Christianity would continue very long here, but we simply want to wipe out everything and to take up the position of the Almighty Himself. A little suffering for our people can be a very good thing.
A man who does not know what a good splitting headache is, or who has not had a few weeks' illness, is just a proper bombast and nothing else, while a man who knows what suffering is is generally a gentle soul with a good heart. He can have sympathy with another person who is suffering. But meet a bounder of a man who has never had a day's illness in his life and who has tons of money and what do you find? He is absolutely the greatest brute that God could make. He does not know anything about suffering and cannot sympathise with his neighbour when he is suffering. He has plenty of everything, he has a good time and does not know what suffering is, and so he is a proper beast and nothing more. Sickness and suffering are part and parcel of the fall of man and we ought to take them as such.
As regards tuberculosis, I am satisfied that there is not the slightest need for alarm with regard to it. First-class medical treatment for the eradication of tuberculosis was carried out in the County Meath over a period of 15 or 20 years and, as Deputy O'Higgins said last night, it produced very good effects. In 1939 we had practically wiped out tuberculosis in the County Meath—it was of very little significance—but then the war came and as a result of the war and of malnutrition it started on the upgrade again. I move the adjournment of the debate.