Supplementary Estimate, 1947-48. - Health Bill, 1947—Fifth Stage.

Question proposed: "That the Bill do now pass."

All that has happened with regard to this Health Bill from the time it appeared in its original garb as the Public Health Bill, 1945, is, to my mind, a warning and a challenge, not only to the people generally but also to a certain number of various classes of people in the country. I say it is a warning and a challenge. I think, also, it ought to be a source of encouragement to them. When the Public Health Bill of 1945 was first introduced there was a certain amount of welcome for it from the Press. Under the light of the examination it got here in this House it disclosed itself to be a very different measure from the measure the public thought it was going to be. I think that those in this House who were responsible for destroying the Public Health Bill of 1945 and getting the Health Bill of to-day substituted for it should be gratified to feel that they have struck a blow against the development of what might be called the police stage in this country, where the health institutions of the State and the medical fraternity as an organisation were to be regimented and developed into a kind of constabulary to dominate and interfere with the lives of the people. I say we have interrupted an attempt to develop the police stage in this country in relation to health on the medical side. I am not quite sure that we have completely exorcised the mind that was behind the Public Health Bill of 1945, or that we have completely protected the people from any remnant of that mind that may be left there. But there are bodies whom we rely upon to see that the work that was done by a small body in Parliament with very little help from outside will be taken up and continued, not for the purpose of destroying anything but for the purpose of building up the type of institutions we require in this country to improve the health of our people.

I would like to say that those who interrupted the steam-rolling process of the Public Health Bill of 1945 have got very little assistance from any organised body in the country. If we got assistance from anybody it was from a small group of individual people who were interested in a particular Catholic outlook on life, in the personal dignity of the individual and who had a certain Christian outlook on sociology. However, except for a small group of individuals expressing themselves through a weekly newspaper calledThe Standard there was no help of any kind given in an organised or in an individual way from outside, and particularly from the organised medical profession, to the work that was carried on here by a small group to hold up and break down the intent that was behind the Public Health Bill of 1945.

Certain progress has been made. One of the things that appears in the measure before us is the setting up of a Council of Health to advise the Minister. The Minister, as already indicated, appointed a certain number of representatives chosen by certain medical nominated bodies to act on an advisory council to advise him. The council is composed of nominees of the Medical Registration Council, of the Royal Academy of Medicine in Ireland, of the Medical Association, and of the Society of Medical Officers of Health. A statutory obligation has been imposed upon the Minister to have such a council but beyond that the Minister was not prepared to go. He was not prepared to accept an amendment to the Bill that the powers, functions, and duties of this body would be prescribed by statute. In discussing the matter on the Report Stage I agreed that a certain amount of experience by the council of their work and a certain amount of examination of the problems that required to be dealt with by the council, as a council, would be required before, perhaps, they would be able to indicate what powers, functions and duties defined by statute for such a body ought to be. When I pressed the Minister to accept an amendment to the Bill under which the council would give an actual report the Minister hesitated to accept an amendment of that kind and, in fact, an amendment to do that was negatived. It strikes me as somewhat ominous that where we set up an Advisory Health Council as a statutory body the Minister resists an amendment to the measure that that body would give an actual report.

However, there is now a statutory requirement that there shall be a national health council. As the Minister has indicated, that council will be a body, not nominated by himself but one which will have nominees on it of the various sections of the medical profession. What has happened should be a warning and an encouragement to certain classes in the country and we will be depending on the medical profession, acting in a representative way on that council, to see that nothing is left, in the administration of this Bill, of the mentality that expressed itself so often and so vigorously and in so many ways in 15 days of Committee that were spent by us in the beginning of last year in opposing the repressive and tyrannical elements in the Public Health Bill of 1945. Therefore, I say to the medical profession that there is, in all that has happened, a challenge to them. They have to work and to be watchful, as, if they allow themselves through the empowering machinery of this Bill, to be moulded into a State regimented service, they will be doing a very great disservice both to medicine and to our ordinary democratic Christian life.

Another class of people who should be warned and encouraged by what has happened is that large number of talented and influential people who were asked by the Taoiseach to sit as a committee to inquire into vocational organisation and who reported so unanimously and so fully on every aspect of vocationalism in this country and who made recommendations that only by the encouragement of vocationalism and the welding of the various representative vocational bodies into the economic and political life of the country in a suitable way would our work be specially well carried on. I have not seen any activity on the part of any of those people, either individually or as a body, since the Report was signed, to indicate that they were still pressing their ideas or still holding the hope that the Government would take active steps to develop vocationalism. They should be encouraged, on the one hand, by the Minister's action and they should be challenged, on the other hand, by the things that went before, to begin to take a very active interest in this and to watch what is going to happen under this Bill.

There is another class of people who ought to be interested at once in what might happen under this Bill, that is, those persons who welcomed with a certain amount of enthusiasm and hope the outline by the Most Reverend Dr. Dignan of his ideas for developing a social security scheme and, particularly, a scheme of national health. If the empowering provisions of this Bill are developed in the way in which I think an attempt is likely to be made to develop them, any chance of building up anything like a national health scheme on an insurance foundation and divorced from the poor law and the dispensary system will be killed. Therefore, those who are interested in a national health scheme for our people, divorced from the poor law system, should watch very closely what is going to happen under this Bill. Another class who ought to feel challenged by all that has happened are those who consider our national life here from the point of view of Catholic sociology. It has been made perfectly manifest to the House that the original Bill was a serious attack on the integrity and the privacy of the family and that that attack has not been entirely removed. The possibility of an attack of that kind still lies in this new Bill as it is.

The Bill as it stands now is a very peculiar type of Bill and we do not know what it may mean in actual practice. We have in it the proposed development throughout the country of a public health system to cover the mother and the child, for rich and poor, yet by an extraordinary change in the new Bill under Section 27, the Minister arranges whatever may be done in that particular manner. He may differentiate between the various health authorities and may deal with a health authority of a particular class, or in a different manner and to a different extent with the various health authorities. We do not know what we are to expect out of the measure, but we do know that there is a very considerable volume of opinion that regards it as unreasonable that a State medical service would be set up and the taxpayers asked to pay for it and that free medical attendance would be given to the mother and child of every class in the country. Certain aspects of that are criticised and it has been pointed out that the setting up of a State system of that kind, in our circumstances, will undermine the position and the livelihood of the private medical practitioner.

Another element in the Bill is that the Government seem intent on relying on compulsion in this matter, as against education. They rely upon dipping their hands into the public pocket and spending large sums of money, both from the rates and from the taxes, on institutions of various kinds. At the same time, there is no serious move on the part of the Government to deal with the preventive side of those things that are injurious to the general health of the people. We have had quoted here enormous figures in regard to the amount of money to be spent on the setting up of various institutions for the treatment of disease, but on the other hand very many voices have been raised among the medical profession and those in close touch with social circumstances in the country, to point out that what is really undermining the health of the people is bad nutrition.

There are very many other ways in which Government activity would be welcome to safeguard the health of the people and that would be much better than many of the things planned in this Bill. We could have physical education in the schools, a national food policy, a reduction in the cost of living in regard to those articles necessary for proper nutrition, a housing policy and a school policy, particularly to prevent overcrowding in the schools. It is an astounding state of things that we were here developing a somewhat ruthless machinery for improving the public health, while infants of six, seven and eight years of age are crowded into classes of 80, 90 and 100 to receive the beginning of their primary education. I would like the new Ministry of Health to consider to what extent the foundation of ill-health in early adolescent and adult life is laid by reason of the fact that infants, particularly in the city, are crowded into close classrooms and herded together for the purpose of the early part of their education.

These are matters for the future but I just want to emphasise the point that, while the Minister is preparing and planning to spend an enormous amount of money from the rates and taxes for the improvement of the personal health of our people, nothing seems to be done in a systematic way either with regard to physical education, nutrition, housing or schools. However, the Minister is now taking from the House a Bill which is empowering more than anything else and we will be looking forward with considerable eagerness to see what kind of regulations will be made under it.

The Minister has insisted on taking powers that will enable him to require parents, whose children are not sent for examination when ordered by the appropriate medical officer to be sent for examination by him, to provide a medical certificate that they have been examined by some other doctor. They may have to provide such a certificate twice a year and he has included in the Bill substantial penalties in money to be recovered from parents who do not provide a certificate for each of their children, perhaps twice a year, that they have been examined by a doctor. I think that that is a complete condemnation of the whole manner of approach of the Ministry to this problem, and if it is attempted to be put into operation I think the Minister will find himself up against difficulties that may very well wreck his scheme from this point of view, that the people generally will regard it that their liberties and their private lives are being invaded and that compulsion is being applied to them in matters, whereas if a different approach were made they would be only too ready to respond, and if services were offered they would be only too ready to accept them. The compulsory element in the Public Health Bill of 1945 has not been completely eliminated and I think it has been allowed to remain in this present Bill in a very vital way. I would look forward to the Minister reviewing that matter between this and the time it leaves the Seanad and making such an amendment to that part of the Bill as would make it perfectly clear that the medical examination that was provided for young children was a service offered to the people and not something thrust on them and imposed on them by way of medical inspection from a State machine.

Mr. Morrissey

My principal fear in relation to this Bill is that, somewhat like the Drainage Bill, it will be passed through the House as a magnificent scheme in itself but will take about 30 years before it is operated fully. If this Bill is to be of benefit from a health point of view to the nation, it is imperative that it should be put into operation with the least possible delay. We know that the health of the community in this country is anything but what it should be. We know that disease is growing in this country. We know we are not able to provide either the preventive or curative remedies that are needed. The Minister has taken to himself in this Bill all the powers which he thinks he needs to meet the present situation. I only want to urge on him, now that he has got these powers, that they will be used without delay.

Deputy Mulcahy spoke of what I must regard as some vague powers that should not be given to the Minister but, as far as I could grasp his argument, he was drawing to a great extent on his imagination. He spoke then of getting very little assistance in this House or outside this House in the very valiant fight they made against this Bill since 1945.

Mr. Morrissey

Not this Bill.

Another Bill.

The predecessor to that Bill and this Bill. I do not mind that so much but I think it is rather regrettable that he should try to give the impression to this House and, I suppose, outside this House if it is published, that he and his cohorts were burdened with the responsibility of maintaining Catholic principles and Catholic teaching in this Bill. He complained that the only organ he got to support him wasThe Standard, which I am not surprised supported him, because it generally mixes its Catholicism with Fine Gael policy. I am glad to see that none of the other Catholic papers thought it wise to support him in his campaign. He mentioned the Health Council. The Health Council was in the first Bill. It was not brought into this Bill.

It was pushed into the first Bill.

It was in the first Bill.

It was, when it was pushed into it.

The Deputy pushed all the good things in and pushed all the bad things out.

Mr. Morrissey

Pushed the Bill out, and the Minister.

It was not the Deputy who pushed him out.

It was the Taoiseach who pushed him out.

I am glad that Deputies are able to enjoy themselves. We ought, I suppose, be thankful to have Deputy Mulcahy and Deputy Morrissey and the others here to work these very great improvements in the Bills that come along, and it is a pity that they cannot get the Press outside, or the medical profession, or anybody else, to support them.

Mr. Morrissey

There is a big change in the medical profession since the last Bill.

The medical profession, I have no doubt, will be watchful as Deputy Mulcahy has appealed to them but, again, is it necessary to appeal to the medical profession, against a Department like the Department of Health or any other Government Department, to watch and see that Catholic principles are maintained? Does Deputy Mulcahy really feel like that because, if he does, I have the greatest pity for him. If he does not feel like that, it is obvious why he says it. It is only to get support from a certain section of the population outside which indeed he may not get at all, after all his trouble. He talks about Catholic sociology. He says the Bill is an attack on the family. I read that the other day, from what one might call a theological doctor, that it was an attack on the family. I do not know, but neither he nor Deputy Mulcahy pointed out where the attack is.

Deputy Mulcahy has complained more or less about the huge expenditure that is to go on under this Bill. Then he complains that we are taking power to say that a child must be presented for medical inspection or the parent will suffer a very severe penalty. Well, we may spend a lot of money under this Bill, but it might be all lost if there were some hidden sources of disease which we would not have power to get after. We are taking power under the Bill to see that children are presented for examination so that, as far as possible, we may discover diseases at an early age and may try to prevent them. I think Deputy Mulcahy agrees with that. He also says that we are spending too much on treatment under the Bill and not enough on prevention.

When I was introducing the Bill, I stated what I believed to be a fact, that this Bill is a departure from previous Bills dealing with sanitary services and with medical services in the direction that it lays more stress on prevention than it does upon treatment. There is no doubt that the Bill is going in that direction. I know, of course, that there are things that we have not mentioned in this Bill—that we should try to see that children are more scientifically and more properly nourished. It was not necessary to put that into the Bill because I do not see that there are any powers necessary to carry out that object. We have made some attempt to improve the nourishment of children through milk and in other ways.

Deputy Mulcahy talked about physical education. We are providing for the education of children with regard to health including, of course, physical education. On the Committee Stage, and again on the Report Stage, Deputy Mulcahy did his very best to nullify that by making it possible for any parent to object if a doctor, or anybody else, attempted to teach his child good lessons on health and so on. Then Deputy Mulcahy talked about better housing. I quite agree that we should have better housing. I can admire Deputy Mulcahy's audacity in lecturing this Government on housing. We should, also, as far as possible, improve the schools. I hope that will be done.

With regard to the point raised by Deputy Morrissey, I think I explained both on the Second Reading and on the other stages that this is an enabling Bill. It enables local authorities to do quite a number of things. I did explain that there is no possibility of getting the Bill fully implemented everywhere and immediately. We have not got the personnel to do it, and we have not got the equipment to do it. That is why, for instance, Section 27, which was quoted by Deputy Mulcahy, is drafted in such a way that we can make different regulations for different local authorities. That is done in order that we may be able to make regulations for some local authorities which are more advanced in personnel and equipment than others, and in order that we may be able to bring them all as quickly as we can into the full implementation of all the measures that are covered by this Bill.

What about sanatoria for tubercular cases? There is not a bed vacant to-day.

The question of sanatoria can more properly be raised on the Estimate which is to come on after this Bill. What we require even more than buildings—we could carry on with the old buildings like clinics and so on—is to get the necessary personnel, nurses, midwives and all the staff that will be necessary to carry out this mother and child welfare service to the full. It will take some time before these staffs will be there. I agree with Deputy Morrissey that it will take some time. I do not know whether it will take many years or not, but it will take some time before the Bill is fully implemented everywhere.

May I ask the Minister, in view of the information lately received, with regard to multiple outbreaks of smallpox in Great Britain, if he still thinks it is wise to repeal the Vaccination Acts?

I told the Deputy on some stage of the Bill that I was quite prepared to do whatever seemed to be the consensus of opinion amongst medical men on that issue—that is with regard to continuing vaccination under the new Bill. The repeal of the present Acts does not make a lot of difference. I told the Deputy that as far as I knew at that time—and the same holds still —any medical men that I had discussed it with—the great majority of the medical men—appeared to think that we should continue vaccination against smallpox.

Question put and agreed to.