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Dáil Éireann debate -
Tuesday, 5 Jul 1949

Vol. 117 No. 1

Committee on Finance. - Vote 68—Health (Resumed).

I am rather disappointed that the building of sanatoria, for which provision had been made under the previous Government, has been delayed. While the Minister for Health has been trying to procure buildings to accommodate patients suffering from tuberculosis, I feel that the urgent need for the building of up-to-date sanatoria to facilitate the treatment of tuberculosis generally should be considered. The treatment of tubercular patients is better done in up-to-date hospitals and up-to-date sanatoria. It is essential to remove tubercular patients from their homes as a precautionary measure against the spread of infection. I am very disappointed with the Government's delay in building the up-to-date sanatoria for which provision was made by the Fianna Fáil Administration. We heard very often about our delay in building hospitals. In the Sanatoria Bill provision was made for three regional sanatoria. We had advanced a good deal of the way in my constituency in County Dublin.

Santry Court.

If Deputy Dunne wants interruptions, I will give them to him in a few moments.

I am just reminding you.

That was an awkward one.

A very fine site was acquired at Blanchardstown and we were told that the building would be expedited but nothing has been done about it and it is still at the stage of being under consideration and possibly will be carried out in the near future. I am greatly disappointed that this work has not been expedited. There is a number of old buildings that have been acquired from time to time and a number of old hospitals that I would like to see razed to the ground and up-to-date hospitals built. The Minister and a number of his colleagues, prior to their advent to this House, stressed the need for hospitalisation very strongly but they have failed to carry out the work. They are in office in a most favourable period. They have not been hampered, as we were hampered as a Government, with wars, economic wars and emergency circumstances. The Department of Health was established under the wise and judicious leadership of the Fianna Fáil Government and the machinery was all there. Possibly, if the Minister could get the money to go ahead with the building of these sanatoria, he would do it but the present position is most disappointing. I hope the Minister will let us know how soon he will carry out that important work.

One other point that I want to deal with is the after-care treatment of tubercular patients. We are a bit in the air as to what type of after-care treatment is to be carried on. We know that the local authorities allow so much money for the after-care treatment of tubercular patients and that there are some small subsidies. However, I understand that, under the Public Health Bill, when it was initiated, it was decided that the Red Cross Society and organisations such as the St. John Ambulance and the Knights of Malta, probably, were to get a subsidy or a grant to help with the after-care treatment of patients. I am dealing now with patients who have been sent to their homes and, in some cases, with patients before they are sent to their homes. I was associated with the Post-Sanatoria League some years ago. That league is still in operation but its functions are too narrow and they are not able to carry out the work which it is most desirable they should be able to carry out in helping these unfortunate tubercular patients. I should like the Minister to make an announcement on that subject and, if possible, to encourage societies such as those which I have named, or people associated with charitable organisations, to assist a bit more in the after-care treatment of tubercular patients. I know that the Minister is very sympathetic in that respect and that is why I ask him, if it is at all possible, to make a grant towards that work.

A disease which is responsible for the death of more people in this country year after year, possibly, than tuberculosis is cancer. We are only tinkering with that problem. We have two hospitals in the city known as cancer hospitals—Hume Street hospital and the cancer hospital in Northbrook Road—and, of course, cancer cases have been operated on in all our major hospitals. However, we have not a central cancer hospital in this country to deal exclusively with cancer, as such. Cancer is one of the major diseases in this country and, to tackle the problem properly, there should be a central cancer hospital for the people of this country, be it in Dublin or some other place. In that way the greatest specialists not alone in this country but in every other country in the world could be procured in an effort to reduce the number of deaths from that disease every year. When Dr. Charles and others like him started in Hume Street Hospital it was thought that that disease was not curable, but very fine work has been carried out in that hospital and also in the general hospitals. Nevertheless, we have now reached the time when there is a definite public demand for a central cancer hospital. Only last week I was asked to go to see a man suffering from cancer and to try to get him into a hospital, but the bed position in the hospitals is bad and none was available for him although the treatment is most urgent. I would ask the Minister for Health to ask the liberal-minded Minister for Finance if there is any possibility of getting money to build a central cancer hospital and thus deal adequately with this public necessity, as I hold it to be. The Minister might also arrange for the provision of clinical treatment in the country in that connection and advise our people of the necessity for early diagnosis and early cure. That, too, would, in its own way, be responsible for reducing the number of deaths.

I am frequently asked to try to get people who are suffering from rheumatism into hospitals. A number of very young people in this country are crippled with rheumatism and, if you try to get them into hospitals, you will be told that they are chronic cases, notwithstanding the fact that they are very young. It should be possible for such people to get some treatment in an up-to-date hospital. I am aware that we have a rheumatism clinic in Dublin and that certain treatments are given for rheumatism all over the country but, again, there is a necessity for looking after a disease of that kind —if we can call it a disease, as it is— in a general centralised way. We have only one or two clinics, which give short treatment, and, as I have said, when one tries to get such patients into hospitals one is told that such cases are chronic cases and that they have a number of acute cases. That is definitely true and we must agree that they are telling the truth. It is up to us in Dáil Éireann, as far as it is humanly possible to do so, to see that some definite step is taken to deal with this matter. My information is that more than 300,000 people in this country are suffering from rheumatism of one form or another. I am personally aware of some young people who are suffering from the disease and who cannot get the required treatment. They are in bed, confirmed invalids. Some of them are being treated by doctors and others by quack doctors. Some of them, when they find they cannot get into a hospital, lose hope and become very despondent. I am deeply concerned about this matter and I feel that I cannot impress on the House too much the urgent necessity there is for the Minister to take cognisance of that fact.

Some time ago I was asked by the Superior of the St. John of God Institution to visit their three institutions in this country. I was informed some time ago that over 1,000 mental defectives are on the waiting lists of such institutions in this country. Some days after, through the Government Information Bureau and the newspapers, the Minister for Health informed me that his Department was aware of the fact and that they were going to give a grant for the provision of more accommodation for children of that kind. Adequate provision for children of low mentality or mental defectives has been made in England and in Scotland and, if there are 1,000 on the waiting lists of such institutions in this country, I hold that there is urgent need to expedite the matter. The Order of St. John of God, which Order looks after such children, deserves the thanks of this House for their great work.

I deplore the number of young children of three or four years of age who are patients in our public institutions and who mix with adults. There is an urgent need that such children should be kept to themselves. They should be graded, as far as their mental disease is concerned, and looked after in a proper and humane way. Other countries are able to do that and have grappled with the problem. Now that we have a Department of Health, which was established for the sole purpose of looking after the health of our people in general, every help and encouragement should be given to voluntary organisations to grapple with the position and to try and segregate, as far as possible, the children from the other inmates in public institutions throughout the country and to try and bring them to some place or some home or some institution where they will be properly segregated and where occupational therapy and other treatment that will, perhaps, be responsible for an improvement can be carried out. As they are things are haphazard.

I would like the Minister for Health to make a statement on the mother and child welfare scheme as cited in the Public Health Act passed by Fianna Fáil.

I want to go back on one point again and that is how very hard it is for certain individuals who have applied to build tuberculosis rooms on to their homes. A lot of difficulty has been put in their way. Sometimes the town planning authority will come along and say that the place is not suitable. I wonder could the Minister take grievances of that kind into consideration, particularly where people go back to their homes where there are two or three rooms or two rooms and a small kitchen. There is an urgent necessity, particularly in country districts, for the carrying out of the scheme initiated by Deputy Seán MacEntee as Minister for Local Government for building extra rooms. I very much welcome the extension of the tuberculosis allowance as far as mothers are concerned and I think it is very welcome to us all.

I have to deal with workers employed in certain hospitals and institutions throughout the country. I have here a letter from some workers employed in Peamount Sanatorium and I am very sorry to say that they are working for a mere pittance. If we are to have an improvement in the health services in this country, I say definitely that we should see that workers in places of that kind get a reasonable remuneration to live on and not a mere pittance or existence. As it is, their health breaks down and they are not able to look after their families if they are unfortunate enough to get married on that mere pittance. The hours of duty in these institutions are to be deplored and the conditions under which employees work. I take this opportunity of appealing to the authorities who carry on the old hateful system of driving young people who go into the nursing service. I am surprised, even in these days when people have a more intelligent outlook, that this old system of shouting and roaring at young nurses before the patients goes on in many general hospitals I know, instead of taking the intelligent view and using discretion, which is often the better part of valour, and trying to inculcate into them the loyalty which is so essential in the nursing service rather than sending them out soured with their superiors. I appeal to these authorities through the Dáil to change that outlook generally. The same applies to certain nurses in private homes, and the hours there are abominable.

Another matter to which I want to refer is the public health dispensaries all over the country. In County Dublin we have made an effort to improve our dispensary service and while I am dealing with the subject I would ask the Minister for Health to do everything possible to expedite them. In the case of certain dispensaries I know in this country I would think it very hard to bring an animal into them not to mind a human being. The people who go there have to line up outside in all weathers without shelter and when they go to a doctor to be treated you feel that there is a pauper air about it. Having had our freedom in this country for some time now, I feel that an honest to God effort should be made to get rid of that system. We have small dispensaries where the doctor can hardly turn around. The previous Minister for Local Government got a number of dispensaries built in County Dublin and I want the present Minister for Health to see that the good work is carried on of building proper up-to-date clinics. When a man, woman or child goes to a dispensary or clinic they should feel that they have the backing of the people of the country, not that they are paupers, and until these things are changed we are going to be in a very bad way. While I am on that matter, I want to refer to St. Kevin's Hospital. I made a statement about it already and I would like to see every stone of it taken down and a new hospital built with the resources of the nation if they could afford it, but when the resources of the nation cannot do everything we will have to deal with the situation as it is. During the past five or six years there has been an improvement in St. Kevin's but I know that a number of people have an animosity towards it. They will not go there as they feel it is the old union building when they see the same old black stones, the same old building and the same dismal outlook that were there during the centuries of oppression before we got our own Government. It is a big national matter and I hope to live to see the day when it is taken down stone by stone and when we will have more up-to-date, cheery hospitals for the people.

People who go into hospitals kept up by local authorities or Government grants have a feeling that they are friendless and homeless and the Minister for Health could appeal to the various charitable societies. We have a number of charitable societies in our cities and counties which visit these friendless souls who feel that nobody minds whether they live or die, but I feel that a word from the Minister for Health in appealing to these charitable societies to pay these people an odd visit and if they are intelligent enough to read to bring them a book would be a great help. I have long experience of these friendless souls; they are left there and nobody minds whether they live or die and I feel from a human point of view we should take it up and help them as it might be our own end yet.

If there was one system which I was delighted to see going it was the red ticket system. I would like the Minister in replying to give us a better explanation of the red ticket system generally. I did not catch fully his statement dealing with it. I have received complaints generally. I am not going to make a specific charge against anybody's house, but I have heard that when people of humble means, married men in receipt of small salaries with large families, go to the doctor they are refused without the red ticket. The people in charge of the red ticket might be absent. An urgent case has come to my notice and I spoke to the individuals concerned; the doctor did not want to treat these people unless they got the red ticket. Any system that is going to be brought in to get rid of that one will be welcome and I ask the Minister to make a further statement on that.

Blood transfusion has been responsible for saving many lives in recent times. I see that the Minister has established a company to deal with the whole question of national blood transfusion services and that step would be welcome.

It has been brought to my notice that certain minerals which have been made in this country are of inferior quality. I think that the Minister should take cognisance of that fact and should establish some system of a test in these matters. In saying that I do not suggest that there should be a certain grade in all minerals, but it has been brought to my notice that certain of them are of a very low standard.

That surely comes under the Sale of Food and Drugs Act, which is another Minister's Department.

All right, a Chinn Comhairle, I will leave that matter.

I wonder will the Minister for Health consider recommending that school managers provide a small room where examinations by dentists and nurses of pupils could be carried out. The present system is not satisfactory. I know it is going to be difficult to provide such accommodation in small schools, but the matter could be more easily dealt with in the larger schools.

I do not think anybody who has listened to the mournful speech of Deputy Burke would enjoy good health. He seems to attribute all the things which have been done in the last few months to the policy of Fianna Fáil over the last 16 years.

In referring to some grievances in South Kerry in the matter of hospitalisation I am not inferring that these are the responsibility of the present Minister. For many years attempts have been made to build a new hospital in Cahirciveen to replace the present institution, which is in such a deplorable state as to be almost primitive. Efforts have been made for some time to find a suitable site and it was only quite recently that one was decided upon. I understand that all the preliminary work has been done and that the plans have been sent by the architect to the Kerry County Council. I would ask the Minister to urge on that body the great necessity for starting the work of building a new Cahirciveen hospital.

The establishment of the mobile X-ray unit in Kerry is another matter of urgency. Whilst there may be a possibility that the centre of such a unit would be in Tralee, I would suggest to the Minister the possibility of having it placed in the centre of the county and of making Killarney the centre. In any case, I do hope that the unit will be established in the very near future.

The question of dispensaries has been referred to by Deputy Burke. I agree that in most cases they are in a very dilapidated condition and are the most dilapidated buildings in the areas in which they are situated. They are certainly no incentive to good health or to the people to keep their homes and their surroundings clean. It would be necessary, in my opinion, to erect new buildings in all cases.

The question of salaries and responsibility for jubilee nursing services is another matter calling for attention. In years gone by there were various societies in this country and outside of it, particularly in London, which gave grants to help in the payment of the salaries of these nurses. If the Minister has power he should see that these jubilee nurses, who are doing invaluable work in their areas, are taken over as a State responsibility and that the State shall be responsible for their salaries.

Many years back the health authorities established a sanatorium in Kerry known as Edenburn and certainly whoever was responsible for that building will not be remembered with any gladness in Kerry. Situated in the centre of a marsh, the main building was only useful as a nurses' home and two other buildings had to be put up for the patients. It was certainly most unfair to the people of Kerry that patients should have to go to a place like that. It is in such a state that when tubercular patients hear that they are being sent to Edenburn they feel that they are being sentenced to death. I think that if anybody was improvident enough to set blaze to the whole building, after, of course, the nurses and patients had been removed, it would be a blessing to the people of Kerry. The Minister should consider urging the responsible body to find a suitable site away from the marshes for the proper equipment of a building to deal with tubercular patients in Kerry.

I would like if the Minister for Health, when replying, would give the House some definite particulars as to the position he has reached with regard to the scheme for hospitalisation for the whole country, with particulars in relation to the capital moneys available to him under the Hospitals' Trust scheme and the extent to which he anticipates these moneys will build up in the years to come, together with the interest on invested moneys. I would like the Minister to indicate these things so that those in the House and on local bodies interested in the matter will know whether we can give money to the different schemes for the advancement of hospitalisation and will know, in fact, whether there is available money to provide for these schemes. The Minister, when replying to a question in that connection, was not quite clear. I quite understand that my supplementary to him may not have been very clear, but I should like him to answer it in as detailed and specific a form as possible.

He did mention that further schemes would have to be subsidised by the promoters and I am afraid that that would mean that further schemes of hospitalisation, schemes in addition to those already envisaged and sanctioned, would mean a very heavy additional burden on the already overburdened rates. We need to know now, however, what the position is, and, if we find that there is likely to be difficulty in regard to the sanctioning of additional schemes, many of which are being considered, and if the only alternative is to have the cost put directly on the ratepayers, we shall have to approach the problem from another angle and see to what extent we can make the present hospitalisation do, with certain improvements. I understand from the Minister that not only is the amount of money at present available already earmarked but that for some years to come—for seven years, I think—the anticipated income plus the interest has been, in a sense, used up. The Minister will, I hope, give us some clear details on that matter, so that those people who are busy thinking out new schemes of hospitalisation will not be wasting his time, in view of the fact that they cannot be considered for another seven or eight years.

Is the Minister prepared to consider assisting local authorities who have to provide housing in excess of the normal housing for what are called priority cases, that is, sufferers from tuberculosis? We can build houses only at a certain rate, depending upon the availability of materials and skilled labour, but we must also relate our plans to the income of the local authority and the possibility of its being able to carry further burdens. I understand that, in the City of Dublin, there is a sum of approximately 3/- in the £ on the rates at the moment in respect of the corporation's subsidy for houses. When the rate of building increases, as it is increasing, that 3/- will very rapidly double itself and people will not understand that it is because of the urgent need for increased housing that the corporation subsidy is being used to such an extent as to impose this burden on the rates.

On top of this, we have in Dublin over 1,000 cases of certified tubercular patients who are awaiting suitable accommodation, families where tuberculosis has been certified to exist, and we have to supply these people with houses, as distinct from ordinary family needs. Up to recently, we had to try to provide houses in cases where there were as many as eight living in a single room. We have got away from that now, thank goodness, and are down to a much lower figure, but the tubercular case has to be considered separately and specially, and I should like to know whether the Minister, in connection with his general policy of trying to alleviate the sufferings of these people and to eradicate the disease, would consider giving additional assistance to local authorities in the shape of a subsidy by the State in respect of houses specially set aside for certified tubercular cases. It is a very big and a very serious problem and I should like the House to understand the great difficulties which have to be overcome by a local authority, such as the Dublin Corporation. I am sure that the Cork Corporation has similar problems.

Bigger problems.

Bigger problems but a similar situation. As a local authority, we want to try to house our people as best we can. We want to provide reasonably decent houses for ordinary sized families. At present we are trying to deal with the larger families, but, in addition, we have these tubercular cases which it is imperative should be dealt with on a priority basis, and, in view of the approach by the Minister and the Government to the problem, would the Minister be prepared to consider taking over, as a national charge, the subsidy payable by the local authority in respect of such houses as are allocated to certified tubercular cases?

The Minister recently announced that he considered part of the treatment of these cases in institutions the visits paid to patients by members of their families. I think he indicated that he regarded these visits as something desirable and as part of the treatment. I wonder if he is aware that some institutions make it very difficult for patients to have frequent visits by members of their families. In the case of Rialto Hospital, there is only one visiting day per week, and, in Crooksling Sanatorium, visiting days are also limited. I understand that the people running these institutions say that visitors coming there create difficulties for them, but, nevertheless, I should like the Minister to consider the possibility of drawing up regulations with regard to the method to be adopted universally by institutions in connection with the patients there. It is very unfair that each institution should make its own rules and regulations in regard to visits to suit its own convenience and not the convenience of the patients or their relatives.

Under the Health Act, the State gives very valuable assistance to families in the shape of allowances where working members of the family have to go into an institution and families are given the means of sustenance to a great extent, if not altogether, while that member of the family is in the institution, but I feel that tubercular patients and their relatives have very serious grievances in the matter of visits, and I ask the Minister to consider drawing up regulations for institutions of this kind, as has been done in the case of mental hospitals. In the management of mental hospitals, every member of the board and every patient, if he is capable of understanding, knows the rights he has and what the position is with regard to visits, but the position is quite different in these institutions for tubercular patients. As we are all anxious to deal with this scourge in a way which will enable us to make some progress towards eliminating it, the Minister ought to consider drawing up these regulations and saying that these institutions must conform to them, as drawn up on the basis of his own opinion and the advice of those concerned as to the best thing to do. I would also suggest to the Minister that, in connection with these institutions, he should have the diet that is provided in them examined.

Hear, hear.

I am glad Deputy Hickey agrees with me because I imagine that he also has some knowledge of the complaints that I have had. In view of the difficulty of keeping within certain allowances and so on I do not believe that the food position is properly considered at all in the case of some of these institutions. I think that the Minister should get his Department to lay down regulations as to what the diet provided should be.

Why not have a dietician?

The Minister, through his Department, should lay down the class of diet which he would regard as the minimum for the patients in these institutions. From my knowledge of Crooksling, and other institutions, I am not satisfied that the diet is satisfactory, particularly where you are dealing with the types of patients to be found in them. I am not competent to say what is the best thing to be done. We are all in agreement that bad housing is one of the things which retards the cure of tuberculosis. Another is under-nourishment. Where you are trying to restore the health of tubercular patients, the two things which I have mentioned are of great importance. These are points that should get the Minister's attention without delay. If there is a diet laid down by the Minister, it should apply universally, because, even at the present time, you will find that the food provided is not the same in any two institutions. I think, too, that the method of preparing and serving the food could, in many cases, be improved. I hope the Minister will be able to indicate that he is prepared to give this matter consideration. I do not expect him to be able to do that to-day or to-morrow. It will satisfy me if he indicates to the House that this matter has been brought to his attention, and that he is prepared to give it consideration. I think he will find, if he does that, that something will have to be done.

There is another matter which I want to bring to the Minister's attention, and it is that there seems to be a great need for the co-ordination of all the services which are concerned with this particular idea of general welfare and general health. I hope the Minister will be able to find means of bringing about that co-ordination. Take a tubercular case in a family. In a case of that sort, various benefits are available, but, in my opinion, there should be a co-ordination of them. There should not be overlapping or a shortage of one thing or another. Housing, treatment and nourishment should be examined together. You very often find a case like this. There is a member of a family suffering from tuberculosis and a house is made available for it, but when you visit that family in the new house you often find that they have not enough food. When you make an inquiry you are told that some other organisation deals with that aspect of the case. That sort of thing could not happen if there was a proper co-ordination of all the services which are available for the treatment of tubercular cases.

I am particularly anxious to know what position is likely to be reached with regard to Dublin within the next five or ten years, particularly in the matter of general hospitalisation. We know that, at one time, a scheme was envisaged for the amalgamation of all the hospitals, and for the building of new big hospitals in certain centres, and that all the requirements that could be normally considered were brought into consideration. We know now that the scheme of amalgamation for the Dublin hospitals has been abandoned, and that we have to carry on with the existing hospitals in which certain alterations and improvements are to be carried out. I should like to hear from the Minister what, he thinks, the final position will be in, say, five years from now. Take the new, built-up areas in places like Crumlin and Drimnagh which have no hospital in their immediate vicinity. In these areas, when a woman has to go to the Rotunda, Holles Street or the Coombe for the birth of a child she has to be brought in a taxi.

The extraordinary thing is that if she were going to hospital by ordinary transport and were to take ill on the way, transport would be provided for her without any charge to the family. If, however, her husband were to ring up for a conveyance to take her, he would have to pay for it, irrespective of whether he could afford to do so or not. I think that, in places like Crumlin and Drimnagh, centres should be set up as soon as possible for treatment before and after birth. People should be able to get immediate attention, and should not be left to feel that the nearest hospital was so many miles away from them. Even in the City of Dublin, three or four miles can sometimes be a long distance when a patient is in urgent need of attention.

I should like the Minister to relate what I am now saying to my opening remarks. The Minister knows to what extent commitments have been made with regard to the money that is available, or that is likely to be available, for hospitals all over the country. He must know what the possibilities are likely to be in Dublin over the next five or six years. If he relates the matters that I have just been dealing with to what I said at the outset, he will, I think, understand the point I am stressing. If the general hospitals in Dublin could know what is likely to happen to them they could reconsider their position.

I should like to say that the Minister has been quite reasonable in connection with Baggot Street Hospital. I happen to be a member of the board there. When we discovered that this amalgamation scheme was abandoned we had to point out that our out-patients section was not up to date. The Minister has agreed, having come there himself and examined the matter, to allow us to make certain alterations and undertake certain expenditure so that we may be able to cater more adequately for the patients who come to the clinics attached to the hospital. There are, however, other hospitals that need to be brought up to date if there is not going to be, what was originally envisaged, the demolition of the existing voluntary hospitals and the creation of a scheme for the building of big new hospitals to cater for the requirements of Dublin.

I wonder whether the Minister is prepared to take away from some of the general hospitals the care of fever cases. If, in a general hospital, you have a fever ward with only one patient in it that whole section of the hospital has, so to speak, to be isolated from the remainder of the hospital, so that on many occasions you find that, while there are beds available in the hospital, with many applicants for them, they cannot be availed of. I suggest that there should be a large central hospital for the treatment of fever cases and that the general hospitals should be reserved for the treatment of ordinary cases of illness.

I do not know whether the Minister has received any report, so far as the City of Dublin is concerned, dealing with the question of finding beds for urgent cases. I know from the few hospitals, in connection with which I have the honour to represent the Dublin Corporation, that the question of beds being utilised to the fullest capacity is kept very much under observation and every month the boards of the hospitals know to what extent beds have been idle—in other words, on how many bed days a bed has been idle. We all have had complaints by doctors pointing out the difficulty of getting patients into hospitals for treatment at short notice. I should like to know if the Minister has received any report as to the inadequacy of beds in our hospitals and to what extent additional beds are necessary, particularly in the voluntary hospitals.

I do not propose to delay the time of the House with criticisms of the Minister or the Department. Anybody charged with the responsibility of looking after the health of our people has an onerous task. The main reason why I have brought those matters to the attention of the House is because they are causing us some thought on the various public boards to which we belong, and I should like the Minister to give them his serious consideration.

Last week I listened to some Deputies speaking about our dispensaries. So far as County Kerry is concerned, I should like to draw the Minister's attention to the dispensary accommodation there. The dispensaries in Kerry are not up to standard. They require immediate attention from the Department, in co-operation with the local authorities, or else there should be some scheme which would provide adequate grants to enable the dispensaries to deal more adequately with the requirements of the people.

I will instance one case in an isolated rural district where there is not an adequate supply of medicine in the local dispensary and the poor people have to purchase the medicines they require in Killarney or Killorglin. To do so some of them have to travel a distance of 20 miles. The fact is that those people are entitled to get their medicine from the local medical officer. All he does now is to prescribe and direct them to obtain it in some other district. That practice has been going on for some time. Whether it is the fault of the local authority or not, I do not know. I will name the district for the Minister later.

The most important point I would like to mention has reference to the administration of the Infectious Diseases Act. I had occasion to mention this to the Minister last year. I will instance two cases to indicate how the Act works in our county. There is a sanatorium down there. It was described by Deputy Palmer as unsuitable but, nevertheless, we have to utilise it. A man whose wife is detained there is unemployed and he has to look after their four children. Under the Act as it stands that man cannot get assistance. If the position were reversed and if he were in the sanatorium, his wife would get an allowance. Under the relevant section the only provision that is made is 15/- per week for the employment of a maid to nurse the children. This man has done everything in his power to provide this assistance. He has tried to find a girl to work for the 15/- a week and take care of the four children. He cannot get anybody to do it. The section provides for a person other than a relative to act as maid. I understand the Minister altered that recently so that a relative could be employed, but, even so, what could any poor man in any part of the country do with 15/- a week?

It would not feed the maid.

Mr. Flynn

It would not. It is my opinion that that section should be amended.

The Deputy is putting himself out of order. He must not suggest legislation on an Estimate.

Mr. Flynn

That particular Act should be amended to provide an adequate allowance for a case like that. That man has to stay in minding the children and he cannot go out to work. Before his wife became ill he worked hard. He has to take care of these poor children now.

I will mention another case, a case of infantile paralysis. The medical officer certified that this girl, who is 15 years of age, is definitely affected with infantile paralysis, but simply because she is not 16 years old she cannot get this allowance. I will give the names and addresses in these cases to the Minister later. I am merely making the point that as soon as possible the Minister should amend the Act.

The Deputy is not entitled to advocate legislation on an Estimate. He has done so very successfully up to now.

Mr. Flynn

I am sorry if I am going too far, but this matter is so urgent and important that I find it necessary to make the best case I can. Deputy Palmer referred to the Cahirciveen hospital. I paid a tribute last year to the Minister in this connection and I will pay him another tribute now. We have been agitating for that hospital for 25 years. Various efforts were made until April of last year, when the Minister gave his sanction. We appreciate what he has done for the people of South Kerry: they will appreciate his action for the rest of their lives. I heard Deputy Briscoe taking about the Dublin hospitals and the conveyance of patients two or three miles. When you compare that with what we have to contend with—when patients are conveyed a distance of 52 miles over mountain roads to hospitals in Tralee or Killarney—you will visualise what it means to us to have this splendid hospital at Cahirciveen. Deputy Palmer mentioned about the Kerry County Council being urged to expedite their end of the job. At our last meeting we dealt with that matter and the suggestions submitted by Mr. Tyndall, the architect, have been attended to and this matter has been referred to the Department for a final survey. Last year I asked the Minister about the provision of a mobile X-ray unit. The Minister informed me then that such a service would be provided with headquarters in Cork. I regret to say that nothing has so far been done with regard to the matter.

Another point to which I would draw the Minister's attention is to the fact that we always have occasion to send patients to the Dublin hospitals. We find great difficulty in finding accommodation for them. It is practically impossible to get beds. Deputy Briscoe referred to the distance travelled by some people here in Dublin. I suppose he was making the best case he could but, after all, there are alternative hospitals here.

Unfortunately they cannot get into those either.

Mr. Flynn

There are plenty of specialists here and there is alternative accommodation. If we have a patient who requires specialist treatment we have no alternative but to try to get that patient into some Dublin hospital. There is a waiting list for these hospitals in Dublin and our patient may be held up for weeks or months. Sometimes the patient dies before hospital accommodation can be obtained. We are up against that every second day. I am sure every Deputy in my constituency has had the experience of being asked to approach the matron, the medical officer or the directors in order to try to get beds made available.

In conclusion, I would repeat that I appreciate everything the Minister has done for us during the past year. I merely comment on the Infectious Diseases Act in a spirit of helpful criticism. As a local authority we have certain difficulties and the only thing we can do is to make representations to the Minister and his Department. In general, it is our intention to be as helpful as possible both here and on the local authority to assist in the good work the Minister is carrying out.

It appears to me that sufficient thought has not been given in the Health Bill to what is, after all, the corner-stone of the entire scheme. I refer to the nursing personnel. I am informed on very reliable authority that there is a grave scarcity of nurses in the country at the moment. Unless conditions are improved and unless salaries are made attractive far more of our nurses will leave the country to seek better and more remunerative employment elsewhere. The salaries offered to nurses in sanatoria are completely inadequate. I understand that, with general training followed by specialised tuberculosis training, it takes about six years to train a girl for sanatoria nursing. I have been told that the salary offered to such a nurse is only £20 more than that given to a cook in the same institution. I am not casting any reflection on cooks but it must be remembered that a cook does not spend the same amount of time and money on her training as a nurse does. I do not think such conditions could be conducive to either the contentment or happiness of nursing personnel. The former Minister recommended an increase in nurses' salaries. Some institutions made that increase effective but, on the other hand, they cut down travelling expenses. Such petty economies should not be indulged in where nursing staff are concerned.

I think that nurses have been too long neglected. Anyone who has any experience of nursing knows what a trying occupation it is. Even the best of us who may have to nurse a patient in our own homes will get irritable at times. People have often complained about nurses in hospitals, forgetting that those who nurse a patient in their own homes often get just as irritable as nurses do. Sick people very often are unreasonable, but they must be tolerated. Such criticism of nurses should not be made. They do their best for everybody. They are as kind as they can possibly be to the patients. They have a certain amount of work to do and that work must be done within a certain limit of time.

In that connection, I might mention that in very few institutions is the regulation governing the 96-hour fortnight carried out. Most nurses have to work a 56-hour week. That is most unreasonable. One can well understand why girls will not take up nursing at home and why they are going to England in such numbers. Most of them would prefer to remain at home working under congenial conditions even at a lower rate of salary than they are paid abroad. I would appeal to the Minister to do anything within his power to remedy the present situation.

Most employed people at the present time are entitled to 14 days' annual leave with pay. Nurses do not obtain the same treatment. In regard to temporarily employed nurses the system is to take them on for three months, dismiss them at the end of that period and re-employ them for another three months. In that way they can never qualify for 14 days' annual leave. That is taking a rather mean advantage of the members of this very important and noble profession. They have never been given the cost-of-living bonus which was permitted during the emergency; at least, they have never reached the highest point that was permitted where increases were granted in other cases.

I do not think the Health Bill will ever be a workable proposition unless conditions are improved where nurses are concerned. I suggest that a commission of inquiry should be set up to investigate the conditions of employment, salaries and holidays. A pension scheme should also be brought into operation. I cannot understand why nurses should not enjoy the same facilities as do other workers. Nurses should be a contented body of women carrying out the work entrusted to them under proper conditions of employment and with appropriate remuneration. If no improvement is made the present scarcity will continue and our young girls will seek employment elsewhere. It is not to-day or yesterday that this position has arisen. All down the years nurses have suffered. I think they are the worst treated people in the State and I hope the Minister will give sympathetic consideration to my remarks.

I notice the Minister made a tour of the county homes. I visited county homes in Donegal, Clare, Mayo and Galway. The type of institution is the same in every county. It is a legacy from the British Government. Why human beings were ever housed in these buildings I cannot understand. They are more like fortresses. Certainly they never could have been intended for occupation by people with souls. They have not changed. They are not prefabricated buildings. They are strong stone buildings and a lot could be done to improve them. They could be distempered in bright colours instead of having these dreadful whitewashed walls and flagged floors. The surroundings are certainly not pleasant for those who have to occupy them. Some of the inmates have never known any other kind of home. Something should be done to make them more pleasant for the inmates, the nurses and the religious sisters who run them. It is a sad reflection on our civilisation that our aged people should have to live in such homes. I know it is difficult for the Minister to carry out all the building that is necessary. A great deal of building has been done in the past 25 years.

The problem of building proper homes for the aged and the poor is, I admit, a big one but I think a lot could be done by distempering the walls of the present buildings with pleasing colours and covering the old flagged floors with linoleum or even matting. Anyone who has visited a county home in winter time or even in summer time knows that the conditions are appalling. The people there have nothing to look at but grey bare walls and it must be a dreadful ordeal for the Sisters and nurses who have to attend these old people. These are a few of the matters which I should like to bring to the attention of the Minister. I hope he will be successful in his endeavours to improve the health of the people generally. He certainly will be entitled to the congratulations of members of every Party if he carries out the great work which he is undertaking.

I should like to support the remarks of previous speakers in regard to the necessity for improving conditions under which nurses are employed. I think that it is too bad that we have so long ignored the privations of the nurses in the various hospitals. With a view to doing something practical towards the amelioration of their conditions, I would suggest that the Minister should introduce a Bill under which he would make it compulsory on everybody employing nurses to observe certain working conditions as well as wages. While the hours of present work by nurses, 96 per fortnight, are entirely too long, there is nobody but must admit that a large number of nurses work more than 96 hours per fortnight. When I suggest that legislation should be introduced to regulate these matters, I have in mind the number of nurses employed in private nursing homes, and many important nursing homes, where they are very much exploited so far as wages and hours are concerned. Unless legislation is brought in to cover these nurses, they will continue to be exploited as most of them have been in these places in the past.

I wish to congratulate the Minister on his efforts to improve the health of our people. I am sure that he will agree with me when I say that the problem of public ill-health is largely an economic one. If the rate of progress in the improvement of the health of the people is slow—and I think it is —I think the explanation for that can be found in the conditions in which our people have had to live for the past 20 years or more. When one reads the reports of the different county and city medical officers of health, one gets an idea immediately of how little progress has been made as regards health matters. I shall first deal with the area with which I am most familiar, namely, Cork City. In 1928 the infant mortality rate in Cork City was 76 per 1,000—that is 20 years ago—while in 1947 it was 87 per 1,000. Surely there is evidence that we are making no progress, notwithstanding all that has been said. The number of deaths of infants under one month in 1931 was 41; in 1941 it was 52, and in 1947 it was 87.

The number of deaths from tuberculosis of all forms in 1936 in Cork was 1.29; in 1946 it was 1.34 and in 1947 it was 1.95, which figure the Cork Medical Officer of Health stated was depressing. Of the 4,478 children inspected by the school medical officer in Cork for the year ending the 31st December, 1947, 9.7 per cent. suffered from malnutrition. Of the 112,284 children examined in 1947 in the school medical services of the State, 2,919 were suffering from malnutrition. Apart from the number so classed, small numbers were classed as being under-nourished or of poor nutrition, fair nutrition, sub-nutrition, defective nutrition or below average nutrition. Malnutrition is a fashionable word but to me it is a 12-letter word for starvation. Malnutrition, to me, is a social evil that can only be eradicated by a bold social policy. Any policy that may be devised to deal with it must be based on the inalienable right of every person in the community to an adequate supply of food. I think the Minister will admit from the figures I have given that they show little or no progress during the past 20 years, that improvement in the health of the people is no longer possible in terms of medical attention and care, and that the way to public health is along the road to improved social and economic conditions.

I would suggest that the Minister should appoint a committee of medical men and experts with the necessary knowledge with a view to determining the weekly expenditure which must be incurred by families of varying sizes, if health and working capacity are to be maintained. No doubt we shall be told that to provide every man, woman and child with a sufficiency of food of a proper standard would cost a large sum of money. I admit that that is so but it would be well-spent money because it would enable the people to maintain their health and to preserve their working capacity. It would save the State a very big financial burden in the way of providing social services and trying to cure ill-health amongst our people.

Another matter which I should like to mention is the question of our food supplies, particularly our supplies of milk. With a view to bringing the matter more forcibly home to the Minister, I should like to give a quotation from the report of the medical officer of health for Cork City for 1947. He stated that as a result of bacteriological tests, 5.2 of the milk supplies examined contained tubercle bacilli. It was also stated that 22.2 per cent. of the samples of milk examined in 1947 were classified as dirty. I think it is an appalling state of affairs that milk is allowed to be sold at the present time in our cities in that condition. The Cork District Milk Board, who are responsible for the price of milk, should also be made in some way responsible for the quality of the milk. One of the difficulties encountered in that direction is that the veterinary officers who discover dirty milk or milk which is below standard, and which is being supplied to the people, cannot carry out investigations where the producer of the milk lives outside the Cork City boundary, whereas the area covered by the Milk Board extends for five miles outside the city. These are matters that should be dealt with very quickly because the supply of milk to Cork is in a very bad state.

I do not want to repeat what has been said by other Deputies about dispensaries. That is a matter which, I am sure, will have the very sympathetic consideration of the Minister. I do not expect that the Minister can, within a very short time, do all the things that are calling for attention over such a long lapse of years, but there is no doubt that there are dispensaries in Cork City and surrounding districts that are a very bad blot on our medical services. So far as county homes are concerned, at the moment we have a number of old age pensioners and semi-invalid people in the county home. We feel that that is not the place for them. If they could be taken out of these institutions and put into homes like the Nazareth home in Mallow or the home of the Sisters of the Poor in Cork it would be very much appreciated.

I listened to Deputy Briscoe dealing with the question of food in hospitals. I would appeal to the Minister to have that most necessary official, a dietician, appointed for the different hospitals. Instead of trying to provide certain food for people by injections, it should be done in the natural way by having due regard to the class of food that should be given to them. I think it is very necessary that there should be regulations about the food supplied in hospitals and that these should come from the Minister or any medical men who are in charge.

As to hospitalisation for the City of Cork, I have the greatest sympathy with the Minister if he is still dealing with the matter by means of the same machine, as I call it, that I happened to know between 1932 and 1943. If that machine is still operating in his Department I do not see much hope of hospitalisation in the City of Cork or indeed anywhere else. A site was provided for a regional hospital in Cork, architects were appointed, and a building was to be erected at a cost of £300,000. We asked the architects to proceed with the building of a hospital according to the amount of money available and we got plans for a hospital which was to cost £451,000. That hospital, I am informed, is now going to cost over £1,000,000. When I hear of these figures I am at a loss as to where the Minister is ultimately going to find the money for building these huge hospitals and the cost of maintaining them when they are built. I saw recently where the money of the Hospitals' Trust was invested. I do not want to discourage anybody, but I hope it will be realisable. The money is invested everywhere from Ceylon to Newfoundland. From 1932 to 1939, if blame could be placed on anybody, it could be placed on the people in charge of the building of hospitals in those years.

We were to have a regional hospital, a maternity hospital and a fever hospital in the City of Cork. They were supposed to be under way since 1932 but a sod has not yet been turned in connection with them. I am quite sure that it is not necessary to plead with the Minister in connection with these matters. I feel that there should be architects under the control of the Minister who would be told to build hospitals according to the amount of money available, rather than depending on architects who will probably design hospitals costing £1,500,000 or £1,750,000. I understand that architects are paid a percentage on the outlay on the hospitals. As I say, there has not been a stone put upon a stone during all these years for the hospitals required in Cork.

We worry about the effects rather than the causes of tuberculosis and other diseases of our people. I remember seeing a quotation from a paper read by the chief medical officer of the Minister's Department, Dr. Deeney, in Dublin in 1940, in which he stated that the medical profession had been concerned with disease far too much and had neglected the social and economic causes of ill-health. I am quite satisfied that much of the disease which we are trying to deal with now is due to housing conditions and the lack of nourishing food. If we do not deal with the ground work of health by seeing that there is a sufficiency of nourishing food provided, we will be building hospitals without bringing about any improvement in the health of our people.

One of the main criticisms I have to make with regard to the administration of the Minister over the last 16 months is that he does not appear to have done anything in a fundamental way with regard to what you might call the prevention of disease. Deputy Hickey spoke about housing and nourishment, but they are not within the province of the Minister for Health. I take it that the Minister for Local Government will be responsible for the housing. What I am referring to is the building up of the health of the mother and the child. We brought in a Bill in 1947 which was put through the Oireachtas. The central part of that Bill was the part which dealt with mother and child welfare. It was claimed by me at the time that it would take a few months to prepare the regulations under which the scheme could be operated for dealing with mother and child welfare, but I do not think any Minister could claim that the delay which has taken place since that is in any way justified. Everybody will admit that you cannot expect to have a healthy people unless you make sure, first of all, that you have healthy mothers. The mother should be looked after in the pre-natal period and during confinement and the child should be looked after in infancy and all through the school period. That Bill was brought in to enable local authorities to set up the machinery for the provision of clinics for mothers and also for the free treatment of infants and then for a more thorough and frequent examination of school children from the point of view of health, but nothing, so far as I know, has been done.

You took 16 years to bring it in.

I do not want any more of your impudence. Wait and see if you can make a speech for yourself. I do not want interruptions from the Deputy.

I shall give the Deputy full protection.

I know it is hard to keep men like him quiet. There is no justification for the long delay in taking the first step in connection with that—the issuing of model regulations to enable local authorities to draw up their own regulations with these model regulations as a guide. I do not think there would be any difficulty in getting local authorities to act under the Bill, as it was provided by a sub-section of a Bill introduced in January, 1948, that the central authority would pay all the increased expenses. There was no disputing the fact that the Bill was necessary. When I brought it before the Dáil, no member of the Opposition or the Government Party at the time argued that it was unnecessary. Any speeches that were made were to the effect that the scheme should be put into operation as soon as possible. It was pointed out at that time that the school medical inspection was entirely inadequate. As we all know, with the very small personnel looking after public health in the counties under the local authorities, the medical officer or his assistant would not have time to visit the schools and examine the children more than once, in the average county, in every two or three years. In fact, in some cases, it is longer than that. It was pointed out also that in some of these inspections—in all of them, I suppose—there would be some children absent, so that some children would miss being examined for six or seven years. Irreparable damage might be done in the meantime. If a child develops an infection of the eyes or bad teeth, or tonsils or adenoids, damage may be done that it would be impossible to repair as time goes on. There may also be slight deformity which would develop and become established if the child was not seen in time.

There were other things discussed very fully at that time, such as immunisation against diphtheria. I do not know what progress has been made in regard to that, but I think the figures had shown up to 1947 that immunisation had remarkably good results and if it could have been extended to the whole country so that every child would be immunised, we would probably reach the time when diphtheria would be practically unknown here. These are facts known not only to medical men but to laymen, and the only reason I raise them is to say that I see very little justification for the delay in putting the mother and child welfare scheme into operation. It is an important question, as if the health of mothers and of children is looked after, our young people would be facing the world in a healthy condition and it would be easier to maintain the general level of health through the country from that on.

I have always believed that we have a very good organisation to work on. I do not think that, in any country, there is such a good scheme as we have here in the dispensary doctor. In the rural areas and small towns, the dispensary doctor knows his area very well, he knows practically everybody in the area and they know him. As a general rule, they respect him and would be inclined to do anything he would ask them to do in regard to the preservation of health. I do not know what the Minister intends to do, but if he does intend to follow roughly on the lines that I had believed in when I was there, of making the dispensary doctor responsible for both prevention and treatment of disease, it should not take a great deal of organisation to get it going. It would undoubtedly require revision of areas, where a doctor has a big area which it takes him all his time to cover at present in his ordinary dispensary duties. When the prevention of disease is thrown on to him as well, including the care of expectant mothers, looking after infants, school inspection, immunisation, and so on, he would not be able to do as big an area. It may be necessary to have the areas reconstructed so as to give the doctor an area he could look after, or it may be better in some cases to give him an assistant where he has a very big area, but even that would not take an awful lot of time.

As a matter of fact, in 1947, when I was in the Department of Health, a survey was taking place of some of the counties to see what changes would be necessary in the dispensary areas, in order to apply this system we had in mind of making the dispensary doctor responsible for prevention as well as treatment, renaming him the district medical officer. I do not know whether that survey of the various counties has been completed, but it probably has been before now, so it would not take so very long to put the scheme into operation. We have all over a very good foundation to build upon. There may be some dispensary doctors, as you find in every other class, who are not as good as we would like to have them, but the great majority would be capable of carrying on the new duties as well as the old, provided they got the necessary assistance.

One thing that has been mentioned here by a number of speakers is dispensaries. Everyone is inclined to call them clinics, but what we call them does not matter a lot. We should try to improve these buildings and have a comfortable room, which could be heated in the winter time, where patients can be examined and also some sheltered place for people to wait, which they have not got at the moment in many cases. The local authorities should be helped at that stage in the provision of clinics. They find it difficult to carry on, with the very heavy burden of rates, especially as they have been increased in the last year or two, and they will not be inclined to undertake any more expenditure if they can avoid it. They should be encouraged with some financial help to provide these improved clinics.

It also goes without saying that the doctor must get proper medical equipment and drugs, and equipment for minor surgical operations. It was contemplated also in 1947—I do not know what the present Minister's view may be—that each district medical officer would have a nurse and a maternity nurse to help him in his duties. Because of the increased duties, especially looking after the mothers and infants, a maternity nurse would be necessary; and for the school inspection, immunisation and so on, a general nurse would be necessary.

When I met the doctors in 1947 we had a talk about these various schemes we had in mind and I hoped at that time that these new schemes would be coming into operation, say, early in 1948. We discussed the position and it was agreed that the county managers of county boroughs would be authorised to give the doctors as increase in remuneration—which, I think, worked out at about 40 per cent. It was regarded by these men themselves, and also by me, as a temporary settlement until we would meet again to discuss the larger duties that they might have to take on. It was understood, of course, that when these larger duties would be given to them their remuneration would have to be reconsidered with a view to increasing it.

A Deputy

Who was to bear the cost?

The central authority. The local authorities were not to pay any more for all these things. I do not know whether the medical officers at the time would have been perfectly content to carry on were it not that they expected that conversations would take place again, within 12 months at any rate, for a further review of their remuneration. Time has gone on and I think it is up to the Minister to meet them and to discuss whatever new scheme he has in mind and also their remuneration.

In addition to pay, which is usually the first point raised by men in the public service, they spoke of their conditions of employment. They are on duty for 24 hours—not only theoretically but really on duty because, if they are not there when a call comes, they get into trouble. It is true, of course, that they may be many a night at home sitting at the fire and going to bed and sleeping like anybody else without being disturbed but they are always liable to be disturbed and, if they are, they must go and attend the call. Some of these men said it was unfair that they could not feel that they would get at least, let us say, an evening a week to go some place where they felt they were free to go and were not subject to any censure or penalty if it was found that they had been away from their home. I must say that I agreed that there was a good deal in that point and I did promise at that stage that we should investigate the possibility at least of getting men to relieve one another for, let us say, two evenings a week and perhaps every second Sunday so that one was free to leave the area and go off to the nearest town or seaside or wherever he liked to go, from, say, 3 in the evening until 9 the next morning or whatever hour might be decided upon. That is a thing that certainly should be done and the question should be discussed again with these men whenever it is possible to take it up with them.

It will be quite easy, of course, in the towns, even small towns, when the new scheme comes in because I take it that even in small towns there will be either two men with two separate districts or there will be one man with an assistant, so that time off or a few half-days off or every second Sunday off will be easy to arrange. The more difficult problem will arise in the case of the medical officer of a rural district, but even there, if two men living side by side can arrange between them for one to take the responsibility for the other man's area for a couple of evenings a week, it should be possible to work out some scheme of that kind.

Another point I want to mention is that, apart from the Bill, there was a White Paper issued by the Fianna Fáil Government in 1947 and some of the matters which were dealt with in the Bill were discussed in the White Paper. The White Paper gave an outline of the policy which the Fianna Fáil Government intended to pursue. One thing that was in that White Paper, to which I attach a great deal of importance, was the laying down of the limits of means inside which a person is entitled to free treatment. I do not claim that everybody in this House would agree with the limits that were laid down. There may be very serious difference of opinion about that but, unless we adopt State medicine altogether, where everybody gets free treatment—a thing, I must say, I do not approve of at all and, as far as I know, the Minister does not approve of it either—then we have to make some sort of regulation with regard to the people who are entitled to free treatment. The present system is not good. As far as I know, the definition at the moment under which a person can claim free treatment is that, if he says that he cannot keep himself and his wife and his family in comfort and at the same time pay for a doctor, then he is entitled to free treatment. Any of us might claim that. It is a very poor definition, in my opinion, and as a matter of fact, people who are not very well off are sometimes too proud to claim that.

Therefore, it would be much better, in my opinion, to lay down a definite limit of means and then the person is not asked to rely on his own conscience as to whether he is able to pay the doctor or not. We did lay down the limit there in that White Paper that a person who was earning less than £5 a week or, in a rural area, a person with less than £25 valuation, was entitled to free treatment in every way— free treatment at the district clinic, free medicine, free institutional treatment and everything else and then there was a class between £5 a week and £10 a week in earnings and between £25 and £50 valuation who would be entitled to free institutional treatment.

Within the last four or five years I knew of two distinct cases of comparatively small farmers, whose valuations were about £30, who found it impossible to get free treatment for an operation that was necessary, not an immediate operation, of course, but an operation that would have made a great difference to the health of the person concerned. They knew that they were unable to pay the fee that was necessary and they just felt that they had to carry on under the circumstances. I quite admit, of course, that if these two men had gone to the county manager or the county medical officer of health or somebody like that, the thing could have been fixed up but they thought under existing conditions that they could not get free hospital and surgical treatment and they just went on without the operation.

People should be put in a position to know exactly how they stand and if they know that, if they have certain means, they are entitled to free treatment they can go and get it. That particular question should be decided. The Minister should come to some decision upon it and make it known as soon as possible.

I spoke here last year about the hospital policy. I do not want to go into it fully again but I would like to ask the Minister whether he has come to any decision or made up his mind what policy should be pursued. I said that personally I was in favour of district hospitals. My predecessor was not very much in favour of district hospitals. He was more in favour of the bigger unit where I suppose his view was you could have more expert opinion and more expert surgeons, and so on, to look after the patient. That is a very good view in itself but, on the other hand, people will get on all right in a district hospital in certain cases and they would much rather be in a district hospital. In other words, they would rather be nearer home. My experience is—I do not know whether other Deputies agree or not—that more and more women are going to institutions for confinement. They find it difficult, I presume, to get help at home during that particular time and they are worried about the children in the house and so on and they have come to the conclusion and their people have come to the conclusion that they would be better in an institution and let the house look after itself somehow or other. There were a good many new hospitals built, although one would imagine from listening to Deputies like Deputy Hickey that there were no hospitals built in this country for the last 20 years, and in these new hospitals that were built the experience has been that the maternity wing has been too small every time.

In some of the county hospitals I visited as Minister for Health they were proposing certain changes which would give them more beds for maternity. They could be treated practically as well, I would say, in district hospitals, and the ladies themselves would rather be in the district hospital which would not be so far from their homes. I think, therefore, that the district hospital is useful first for maternity and, secondly, for minor accidents. A young person, for instance, breaks his leg. He may not have anybody that is capable of looking after him in his own home. It may be a small home where it is not easy to give him sufficient space, a good bed, and so forth, to himself. Such cases would be all right in a district hospital. It is the type of hospital that could be looked after by a well-qualified medical practitioner. I think we should go in more for the district hospitals. That would relieve, to a great extent, the pressure on the county hospitals and the bigger hospitals, as we go up the scale. In particular it would relieve the congestion taking place now in respect of maternity cases. I should like to know if the Minister has made up his mind on this policy with regard to hospitalisation or not and, if he has, whether he is going to encourage or, if not encourage at least sanction as far as practicable, the building of district hospitals in various parts of the country where they are not to be found at the moment.

I do not want to speak on the subject of the county hospital because every county has one of some kind or another. I think that, on the whole, they are very successful and that they are doing very good work. It entails the employment of a general surgeon, a physician, and perhaps, in some of the bigger ones, someone to look after gynaecology as well. But I think that the idea of giving a county hospital to every county has been put into effect. The only thing that remains is to build proper county hospitals in some counties. A number of counties have got very nice ones and a number of counties have not, yet.

I do not know what progress has been made with regard to regional hospitals. When I toured the country in 1947 there was, for instance, a site in Limerick which had been purchased by the local authority for the construction of a regional hospital. I think that they were anxious to push on with the work there as quickly as they could. We had also some consultations with the authorities in Galway with regard to the building of practically a whole new hospital and the and the reconstruction of some of the Central Hospital. I do not know whether any progress has been made or whether any start was made on that scheme. However, I take it that these regional hospitals will be provided. Beyond that, of course, there are the specialities—thoracic surgery, orthopaedic surgery, genito-urinary, cancer, and so forth.

When we were visiting the various centres with regard to these hospitals —I think I mentioned this matter last year—I saw more than the foundations of a fever hospital laid in Cork. The county manager was with us then and I said that I did not see why he could not go ahead with the work then. That was started, I believe, early during the war. All the development work was done underground; all the passages underground were ready to put in the sewerage, water, light and heating installations, and so forth. The foundation walls were built —some of them running up to a height of three or four feet. When the war came it appears that the work stopped. In 1947 I said to the county manager that I could not see why he could not proceed at that stage. I do not know whether any progress has been made since then. I must say, of course, that the incidence of fever is much less now than it was in 1938 or 1939. There has been an improvement in the preventive measures that can be taken against fever and great improvements have been made in the treatment of fever so that it does not spread, and we have not, therefore, got so many cases for the fever hospitals. But surely, if the building was not necessary as a fever hospital, it could have been proceeded with and used as a very suitable hospital for some of the other purposes for which they are crying out for facilities in Cork.

What about Santry Court?

I may be able to say something about that, too.

I should like the Deputy to do so.

It does not arise in this year's Vote, or last year's Vote, or that of the year before that.

I shall reply to the Deputy all right.

And the Cork Fever Hospital was not this year's, or last year's, or that of the year before either.

It could be.

So could Santry Court.

The Deputy does not like me to refer to Cork Fever Hospital. I do not know why.

You need not worry about Cork at all.

I do, when I look at you.

We will look after Cork.

I will look after it, too, for a few minutes. There is no reason why the Cork Fever Hospital could not, I think, probably be converted into a hospital which would be useful, perhaps, as a maternity hospital—I do not know. The matter would require to be examined by experts to see if it could be done. Perhaps it could be used even as a sanatorium. However, it appears to be a great pity to leave so much work, which cost a great deal of money, at that stage without going ahead and doing something with it.

There was no water supply.

And no sewerage.

It is extraordinary that they should have gone so far without a water supply. I do not think the sewerage was put in, but provision was made for it, and for the water supply too.

That is right.

It appears to me that the Cork Deputies do not want to hear about this. I do not know the reason.

Do not say that.

I think it would be useful. Talking of Cork, we also, in my time, purchased an estate—I forget the name —for a regional sanatorium. I remember that the Minister, when he came into power, criticised me—as he did in many things, I must say—very severely because we had let it for grazing. The Minister will learn sense; I hope he will though I do not know whether he will or not. He has since then, I believe, authorised the letting of the lands for grazing twice, once about six months ago and again a few days ago, so he should be a bit more careful about criticising his predecessor in matters of that kind because, when he comes in himself, he forgets his criticism and authorises the letting of the land for grazing himself.

I presume that these regional hospitals are going to go ahead in Galway, Limerick and Cork. There were suggestions about them last year, but I do not think there was anything further than suggestions. The site was got in Limerick. I think there was no doubt that a regional hospital, that is, a general hospital, should be provided in Cork and also in Galway. I just want to know what progress had been made. Generally speaking, I think these hospitals, either regional, county or district, must be provided and I do not think we should stop for want of money or finance. It is sometimes pointed out, for instance, that there is only so much in the Hospitals' Sweep Fund and that, therefore, we cannot go any further at the moment. I think if there never had been a Hospitals' Sweep these hospitals would have to be provided. The attitude we should adopt is that we are thankful to have money handed over to the State by the Hospitals' Sweep, but if the money does not come from that source, then it must come from the Exchequer—by way of loan, I take it. As a matter of fact, it would not in that case be a loan. The greater part would have to be by way of grant, because the local authorities could never finance a loan of anything like £500,000 or £1,000,000 for a county or regional hospital. In any case, it should come; it could be borrowed money as far as the Government is concerned. We should not, therefore, adopt the attitude that we must wait for the Hospitals' Sweep Fund to increase before we can proceed with the sanctioning of further buildings.

I mentioned other buildings here last year. Unfortunately, I had not the advantage the Minister has of having documents from which to speak, and I could only speak largely from memory, but to a great extent from statements I had made from time to time when I was Minister myself. Looking back over these statements, I was able to check up say, on the number of beds provided in certain sanatoria and so on.

I spoke here last year about Newcastle. At that time there was a rumour —but not more than a rumour—that they had taken a nurses' home. During the time I was Minister for Health I got a report on more than one occasion that the sanatorium committee in Newcastle required more room for expansion to build a nurses' home and to enlarge the hospital. There was a certain field. I do not know where the field is but I know it adjoins the hospital grounds and it was a large field of, as far as my recollection goes, perhaps ten or 11 acres and maybe more. The committee thought that the farmer who owned this field was trying to mulct them by asking too high a price. He was asking £1,600 I think and therefore they did not take it and nothing was done about it. It was at least very convenient to the hospital and it would have been convenient to take it and have a nurses' home beside the hospital. Last year there was a rumour that the hospital committee had taken a farm something like a mile and a half away and that turned out to be true. The Minister had, of course, to sanction the grant for the purpose of that farm from the Hospitals' Trust Fund and I do not know that he was justified in sanctioning the purchase of this particular farm because it is entirely inconvenient, a mile and a half away and, as far as one can find out, it cost as much per acre, practically, as the field adjoining. We do know, of course, that this farm was owned by a defeated Clann na Poblachta candidate and whether that had some influence on the Minister or not we can only judge for ourselves. I was told —I do not know whether it is true or not—that the nursing council had objected to this as a centre for nursing as it was too far away and they would not be inclined to regard it as a suitable place for the training of nurses. I do not know whether that is true or not.

On a point of order, would the Deputy state if he is making an allegation against the present Minister that by virtue of this man being an ex-Clann na Poblachta candidate——

I want the point of order.

I am raising this as a point of order.

I have not heard the point of order yet.

I have listened to such defamations carried on in this House for the past hour.

Has the Deputy a point of order?

I want to hear it.

I think it is wrong of Deputy Dr. Ryan to make any allegations——

That is not a point of order.

Are you the Chairman or am I?

We obey the Chair. You do not obey the Chair. I emphasise that the people on that side of the House do not and never did.

In case the Deputy has any objection to things like this being said, I merely stated the fact that a farm was taken that was entirely unsuitable. Everybody knows that it was unsuitable and the only explanation is that it was owned by a Clann na Poblachta candidate.

Would you let me explain?

There is no explanation in a point of order.

Would you let me reply?

Not at all. You can reply later, in an extensive speech.

When he is replying he should mention another Clann na Poblachta publicity agent.

The Deputy has never heard of Stephen Hayes. An dtuigeann tú Gaeilge?

What about him?

He was from Wexford.

He never heard of him.

Deputy Rooney will chip in on that. Whenever there is any dirt to be thrown Deputy Rooney is not behind the door.

More "Dáil reporter" stuff.

Is the Minister getting rattled now?

I am not a bit rattled.

The Deputy from Cork can give an explanation of those two instances. He says he is going to reply. Has he noted them before I go on to something else?

We go on to county homes. County homes were commented upon very adversely by the Minister during one of his tours around the country shortly after he took over. He spoke of very antiquated methods. In fact, he said no change had been made in these county homes since they were first built and, as far as I know, no change has been made since. The difficulty in dealing with these various people in county homes was the number of classes that there were. I think they could be divided roughly into three classes: that is the mental defectives or imbeciles, unmarried mothers, and old people.

I think anybody who is going to tackle this question of improving the system of county homes will have to deal with each of these three classes separately. There is very little provision in this country for the mental defectives. I think so far as I remember it is estimated that there would be about 6,000 of these imbeciles in this country, and, except in a few special homes with accommodation for about 500 and certainly less than 1,000, there is no accommodation for them. That leaves us with a very big problem.

If we are to deal with these imbeciles properly, apart from the mere epileptics, they must be divided into at least three groups. You have those who are not very bad and who, with education, might be trained to make a living for themselves. Then there is the middle class—those who are worse than the first class but who when trained could look after and care for themselves even though perhaps they might not be able to earn a living for themselves. The third class of mental defectives who are particularly hopeless would have to be cared for. With all these difficulties you would have the further question of the various ages and of course the different sexes. Anybody can therefore see you would require a very large number of units to look after these mental defectives because they must be segregated firstly according to sex and again as to age and to the degree of their trouble and mental capacity. It does not mean, however, that you must have separate institutions for all these classes but you must have separate units for the various sections.

We were, for a short time while I was in the Department of Health, discussing and had made some progress at least in enlarging one of the small institutions for these mental defectives and we were discussing the possibility of having some special institutions set up to take on the case of these people. Whether that will take some considerable time to effect I am not sure, but I take it that whatever Minister for Health is in office he will aim at that and get it done as soon as it can be done.

The second class we have to consider are the unmarried mothers. There are some institutions in the country, at least three or four, where these girls are taken in by religious orders and looked after and where they remain for perhaps 12 months or so after the birth of their babies. They then go out to work and the baby is kept in the house and trained or is boarded out, sometimes when the mother leaves. In this case it would again require more accommodation, though it is not as big a question as that of the mental defectives. You would, however, require more homes of that kind for housing the unmarried mothers, who at the present time have to go into the local county homes or the local authority homes.

Is it reasonable to keep them for 12 months?

That is a matter of opinion. I was talking to some of the Sisters who are concerned in these matters and have experience of them in this and other countries. Some of them are of the opinion that these unmarried mothers should be kept for 12 months, but others think that three months are sufficient. They all have their own views on these things and it is hard to dispute the point with them. Whether it is three or 12 months, more accommodation would be necessary if these people were to be properly looked after.

The old people would be dealt with in a variety of ways. When I was in the Department of Health for a short time many people suggested to me various ways of dealing with them. I think myself the best suggestion is that they should be taken back by their own people and their own people should be encouraged to take them back by giving them more than the allowance which they can get at the moment. At the present time, if an old person is in a house and the people claim home assistance they only get a matter of 5/- or 6/- a week. In these circumstances they cannot afford to give their time to look after the old people who then drift into the county homes. If that amount was enlarged so that a person could afford to keep the old people the latter would then be probably very much happier and the local authority would not have to pay so much in the maintenance of these old people, the cost of which is very heavy on an institution to-day. That should, I believe, be the first approach to this question of what is best to do with the old people now in our county homes.

There was a further suggestion that these people should be housed in a colony of cottages built in an area, similar to the labourers' cottages but of the bungalow type and that two, three or four of them should live together and that there should be a common hall or room where all the inhabitants of the colony would have their principal meal and could congregate for reading. I do not know whether that would be an acceptable scheme or not but it would provide these old people with a much more congenial atmosphere than they enjoy at the moment in the county homes. The other alternative is to try and split them up and put them in smaller numbers into large houses or cottages and make the whole thing a little bit more homely than the conditions in the county homes at present where you have large numbers together with very little interests.

We had also some discussion last year on the beds provided for tubercular patients. I then gave some figures which, as I have mentioned already, were to some extent from memory and to some extent taken from answers to questions and mentioned in speeches in the Dáil.

On that basis, I was able to ask about the proposals with regard to certain of the institutions which were expected to provide extra beds for tubercular patients. From some of these sources I found that in 1947 the local authority sanatoria had 1,529 beds, the local authority and voluntary hospitals, 500 beds, and the private committee sanatoria, 1,115 beds. There had been a fair increase in the number of beds for seven or eight years, up to 1947, and, in fact, in the case of the local authority sanatoria, there was a 45 per cent. increase. I have not got the information with regard to the others. There was, at any rate, a substantial increase and, at that stage, we had discussions with various of the sanatoria authorities, local authorities and so on as to the possibility of providing more beds. I mentioned already that there were three large houses or buildings in which I was interested— the High School in Sligo, Ardkeen House, Waterford, and Kilereene House, Kilkenny. I asked last year on this Estimate whether any progress had been made with regard to the conversion of these buildings into sanatoria and what progress had been made since the Minister took office in February, 1948, and I should like now to hear from the Minister what the position is with regard to them.

I think it was in 1946 that the then Minister for Local Government provided a grant of £100 for an extra room for a person suffering from tuberculosis, where it was advisable that that person should be isolated, so as to give him a clean and airy room to himself. This grant was provided to build the extra room or a chalet for the purpose. I do not know how that scheme has progressed in the past 18 months. It was estimated at the time the scheme was inaugurated that about £280,000 would be spent under this heading and in the following year the Department earmarked £55,000 for the purpose.

I do not know how many were provided or how many people availed of that scheme and whether they have availed of it in the past year or so to any extent. I asked last year also whether any progress had been made in the provision of X-ray facilities to enable people to be X-rayed easily and cheaply or free, because it would be possible in that way to detect the early incidence of tuberculosis. In Dublin, a mass radiography centre was provided by the corporation some few years ago and it has done very good work indeed, but I should like to know if it has been extended to centres outside Dublin, and, if not, if it is intended in the very near future to extend the system to the other big centres.

One thing I am personally fairly sure of is that contacts are not being dealt with as effectively as they should be. I have seen cases of people being taken to the sanatorium and there did not appear to be anything particular done with regard to other people in the house. That is very wrong because we know that tuberculosis is very infectious and it is wrong not to take every possible precaution, where there is a tubercular case in a house, to see that all contacts, especially those living and sleeping in the same house, are examined at intervals by radiography to see if they are developing tuberculosis in the early stages. If we can get them in the early stages, the chances are that they can be cured. I do not think this matter of contacts is being tackled as vigorously as it should be, even in the City of Dublin.

I find also from looking up some of the records that, in 1947 when I was Minister, I authorised an increased grant to the Medical Research Council for special research into the chemotherapy of tuberculosis. That grant was brought up to £6,000 and I have no doubt the Medical Research Council spent that money to the very best advantage. I should like to know whether there is any report with regard to any research carried out and what the result is. There was also a scheme for B.C.G. vaccination against tuberculosis organised by the Dublin Corporation and a grant was given for the purpose. I think I saw a reference in the papers recently to some progress being made in St. Ultan's in connection with it and I should like to know something more—it is perhaps too soon to expect a result—about whether the work is proceeding satisfactorily and when we may expect a result.

When I was in the Department we had inaugurated a scheme of sending some of the medical officers of health or their assistants—those dealing with tuberculosis—to foreign countries to study tuberculosis. Some were sent to Scandinavia, and it had been arranged at the time that some would go to the United States and to Canada. I should like to know what progress has been made under that scheme of sending our men to those foreign countries to see how things are being done there. When they come back they will have the opportunity of discussing their experiences with those who have been in other countries and in that way we could eventually evolve here the best scheme on the basis of what is being done in these various countries. There was also a committee on occupational therapy for tuberculosis, which I have not heard of for some time.

A Bill was passed late in 1947, and regulations were issued under it, dealing with the costs, and so on, of all these various public health schemes. The big provision in that Bill was that which put all the additional expenditure on the central authority. It provided that the local authorities would not be required to spend more on health than they were spending at the moment until the central authority was contributing an equal amount. It was estimated at the time that about seven years would elapse before that point was reached. As soon as the central authority was contributing as much as the local authority was spending, then it would be possible to let them march pari passu or, if you like, to reconsider the whole matter. That was the big idea of that Bill.

There is another thing in it which is usually referred to as the maintenance allowance for those suffering from infectious diseases. That is a scheme that had been advocated for some time. We were very anxious to bring it into operation as soon as we could. It is a type of scheme which it would be necessary to examine from time to time—to revise and to review its operation—because, I believe, it has been found from experience that it is not working satisfactorily in some individual instances, though generally speaking, I think it is working very satisfactorily. It is a great thing to have it for those who are suffering from tuberculosis. There are individual cases where it is not working as well as one would expect and, as I say, it would be necessary to review and to revise it in cases of that kind.

Now, I spoke about the hospitals. I want, if possible, to get more up-to-date information with regard to the beds that were being provided in these various sanatoria, and in these local authority and general hospitals. I think I mentioned last year that, when I was responsible for the Department, we had discussions with the authorities of St. Laurence's Hospital on more than one occasion. My recollection is that our final agreement with that hospital was that they would give us 60 beds for tuberculosis, and also a thoracic unit. I do not think it would have taken them very long to provide the beds, though it might have taken them longer to provide the thoracic unit. I would like very much to know how these two proposals have proceeded, whether the beds are now available and whether the thoracic unit is now available, or when they may be expected.

With regard to Peamount and Newcastle, I mentioned last year that Peamount was to provide three of these 40 bed units, and that Newcastle was to provide two 40 bed units. I pass Newcastle very often on my way down to the County Wexford, and, as far as I can see, they are not yet ready, so that they are a good while in process of construction. But they have not been completed. Now I am sure that if I had said to the Minister in February 1948 that I intended to provide two of these 40 bed units in Newcastle and did not, and had to admit that I would not have them ready for 18 months, he would have been appalled at the delay and probably would make the charge, that he made before, that we were criminally neglectful of these people and were responsible for their deaths by not making quicker provision for them.

If you had substituted the 1,200 beds that I have in the last 18 months, besides the 80 that were not provided in Newcastle, I would not have objected to your delay at Newcastle.

I wonder if the Minister is counting in the 1,200 beds some of those that were in process of completion before he took over?

Santry Court, for instance?

At Our Lady of Lourdes Hospital, 43 or 45, I think, had already been finished, as a matter of fact, before the Minister took over——

They were not.

——and something like 100 in Rialto were also finished.

According to the plan of 1934.

With regard to Killybegs, as well as I remember, the draft plans had been sent to the local authority there, but there was some delay by the architect. I do not know what progress has since been made with regard to the provision of beds in Killybegs. With regard to Castlerea, the Minister is probably including Castlerea in the 1,200 beds that he speaks of. I said last year that I had some conversations and negotiations—perhaps I may have used the word "negotiations"—with regard to Castlerea before I left.

Will you say that before you left office you were considering that Castlerea would be taken over?

When the Minister was winding up the debate last year—I was not here—he said that I had drawn on my imagination. Now, that is not true. If the Minister had taken the trouble——

You have no imagination.

If I had I might be like the Deputy. As I say, if the Minister had troubled to ask the secretary to the Department I am sure he would have told him that he had talked to me about the possibility of getting Castlerea. He then came to me and said that there was some difficulty about the mental hospital attendants in Castlerea. The question arose as to what could be done with them if it was taken over. Deputies, of course, will understand that Castlerea is a branch of Ballinasloe Mental Hospital. I suggested to the secretary, if that difficulty arose, why not take over a wing of Ballinasloe, in which case there could be no difficulty with regard to the mental hospital attendants in either place. He came back to me a few days later and said that the difficulty was over and that we could take Castlerea.

I am sorry, that is untrue.

It is absolutely true. The Minister can ask the secretary to the Department whether it is true or not. I had that conversation with the secretary.

It is quite untrue.

It is absolutely true.

Would the same truth be attached to the latest news quite recently?

My officers had to go down to the Roscommon County Council and ask them if they would allow us to take over Castlerea.

That may have occurred subsequently.

The main answer, however, is that the beds are there now for the patients. They were not there during your 16 years. That happens to be the fact, an unpalatable one for you to swallow.

Keep your hair on now. I am sure that if you are there for 16 years that we still will have people in this country suffering from tuberculosis. There always will be something to be done. Let the Minister not think that, if he is there for 16 years, he is going to finish everything.

I am not claiming to finish everything. I started something, and that is what is worrying you.

If the Minister had asked the secretary to the Department whether I had discussed with him the possibility of taking over Castlerea he could say that, in fact, we discussed it more than once. I should say three times.

Of course, you discussed all sorts of things, but you did not do that.

Keep your hair on. Ask the secretary. He knows that we had those conversations about Castlerea.

The net point is that you did not get it.

Then do not try to be pretending that you did.

The Minister told the House last year, when concluding the debate, that I did nothing whatever about it, and that I did not know anything about Castlerea.

I did not say that.

I am just saying that if only the Minister had the decency to consult the secretary of the Department he would have known that the possibility of getting Castlerea was discussed, and that at our last conversation I was able to say to the secretary: "Well, if that is the case we can go ahead and get it".

Would you say there was a possibility that it was taken off the files?

I did not suggest that.

That statement was made lately, but I am holding no brief for it.

There is not a cliché in the political world the Deputy does not know about. Going back to the subject I was dealing with, it is quite possible the Minister had to send down his officials to talk to the local authorities about the terms on which he would take it over.

To ask them to give it over—that is quite a different thing from arranging to take it over.

The Minister, in the course of his speeches—with all the various things he is doing—finds it convenient to say that certain things were done, let us say, 12 months ago. It amuses him to say things like that. However, we will let him have his little amusement in claiming these things, if he likes it that way. One matter that has arisen in the Minister's time relates to mixed nursing. What I mean by that is whether it is advisable to have religious orders and lay nurses in the same hospital. There are various objections to it and they have been stated over and over again. The lay nurses complain that they have not the same opportunity for promotion and they claim that they are made do more than their share of night nursing.

I do not think the thing was altogether satisfactory when I was in the Department of Health. I did authorise an official of the Department, when we were discussing the building of the regional sanatorium in Cork, to ask a religious order if they would take over the nursing of the sanatorium. It was a very big job and it would mean the employment of 400 nurses. They felt they could not undertake it. I thought it would be better to have all religious or all lay. I knew they did not mix very well and you did not get satisfaction. I believe that the sisters are very good nurses, in fact, some of the religious orders here are tip-top nurses and I would not stand for any of my friends—I do not know whether the person I refer to is a friend of the Minister or not—criticising the sisters at a local authority meeting that they had not carried out their duties as efficiently as they should have.

Do you mean to say that the lay nurses are inefficient?

They are both quite efficient, but sometimes they do not get on well together. It was stated at a local authority meeting that the religious orders had not done their duties as they should. I do not agree with that. I think they make very good nurses. In the case where this controversy arose the Minister was good enough to say that I also favoured that system of either religious or lay and that he was not averse to taking company with me in a case where there might be a little bit of difficulty or unpopularity. It is quite easy to make your attitude clear in finding fault with the religious orders as good nurses, but it leads to dissatisfaction in many cases when you have both in the same institution. That does not mean that the lay or the religious nurses are inefficient; they may both be very good, but together they do not work as they should.

A bad blend?

I agree. My criticism of the Minister is that he is not doing the solid work of preventing disease and building up a healthy population as he should do it. I think he should have gone to greater pains and given more time to pushing forward the mother and child welfare scheme. For the short time that I was in the Department of Health I felt that whatever else we might do we should as quickly as possible build on a solid foundation in our efforts to secure a healthy population. I do not think it would prevent the ordinary work of the Department going ahead if we were to attend also to that aspect. The regulations necessary to deal with the mother and child welfare scheme could have been prepared and submitted to the local authorities, who could then amend and adopt them and proceed with the necessary clinics and medical staff and nurses.

Last year the Minister made the plea that he wanted to deal urgently with tuberculosis and other matters. There is no reason why he should not do so, while at the same time getting the mother and child welfare scheme going. He could also deal with immunisation and free treatment for certain classes. In that way we would be building on a foundation that would give good results over many years. I admit it is the kind of work that perhaps has not the same publicity value as the Minister might get out of opening tuberculosis wards.

Even if a great deal of work is put into the building up of this mother and child welfare scheme the ordinary person knows practically nothing about what is being done. Nevertheless, it is something which should be done. When the Bill was introduced in 1947 that was really the pivotal point of the Bill. The idea was to build on a solid foundation.

There were other points in that particular Act—they may not be so important—upon which I would like to know what the Minister's intentions are. One part of that particular Act dealt with infectious diseases. There was a good deal of controversy about the removal of a person suffering from an infectious disease, even when such removal might entail a certain amount of force. There was also a certain amount of controversy with regard to the medical examination of school children. Some of the present Ministers, who were in opposition at that time, took very grave exception to those particular provisions in that Act. One threatened, as a matter of fact, that if he ever became a member of a Government he would immediately have those provisions repealed. In the meantime, he threatened to bring an action in the Supreme Court to contest their constitutionality. I would like to know what the Minister's intentions are with regard to these particular clauses. Does he intend to remove them from the Act and, if so, when does he intend to deal with them?

Whatever enthusiasm I had for speaking in this Estimate has been considerably damped, not because there was not a great deal of information in what Deputy Dr. Ryan has said, but because in this hot weather even a speech lasting an hour and a half becomes somewhat boring. I agree with what Deputy Dr. Ryan said, to some extent, with regard to the fundamental concept of the provisions in this Health Estimate. While all of us must pay tribute to the Minister for the energetic way in which he has dealt with the provision of beds for tuberculosis sufferers, I think more comes within the scope of the Department of Health than just tuberculosis. For a considerable period now the tendency has been to devote attention almost entirely or mainly to tuberculosis.

There is a very important problem which affects every person of moderate means. I refer to the provision of medical facilities. I would like to see an effort made to provide free medical facilities for persons who are unable to pay for treatment. A man of moderate means with a wife and family is unable to meet very high medical charges that a serious illness to himself or to a member of his family may entail. In the coming year I would like to see the Minister devote his attention, now that he has made such substantial progress in regard to the provision of beds for tuberculosis patients, to dealing with that particular matter.

In addition to tuberculosis there is a very serious problem with regard to cancer. That, as we all know, is a very dangerous disease. I understand that it is every bit as serious as tuberculosis in its effects. A committee was set up by the Minister to investigate the problem of cancer. I am sure that committee has been working but I do not know what it has actually done. I do not know whether it has submitted any report. Perhaps when the Minister is concluding he would inform us on the points I have raised.

On the Estimate for the Department of Social Welfare I tried to raise the case of people who are suffering from some form of paralysis which prevents them from earning a livelihood. I was in some doubt at the time as to whether it was a matter for the Minister for Social Welfare or for the Minister for Health. I am not altogether sure which Department should deal with it. Since the sufferers of this disease are incurable, probably it is a matter for the Minister for Social Welfare; but I would appeal to the Minister for Health to discuss with his colleague in Social Welfare the problem with which these unfortunate people are faced. Some of them are in their 40's and 50's; some of them are in their 30's and some of them are in their early 20's. All of them are unable to earn a livelihood and they are dependent upon their parents or upon relatives. I would like to see something practical done for the people affected by this disease.

I was very glad this afternoon to hear the plea made by Deputy Mrs. Rice in regard to nurses. Everyone must agree that the conditions under which our nurses are working at the moment and have been compelled to work for a long number of years are brutal. In this enlightened age such conditions ought not to obtain. I think the Minister has a sympathetic interest in the problem. I know he is aware that it exists and I know that he is anxious to deal with it. If we are to have nurses the conditions of apprenticeship and the conditions under which they work when qualified must be radically changed. It is regrettable to see some of our finest young girls leaving the country to be trained in British hospitals, because they think they get a better training there and because they know they will serve under better conditions there when they ultimately qualify.

With regard to food hygiene, I would urge upon the Minister that he should examine the problem of meat killed outside the city and brought into the city for consumption. I understand this matter is dealt with by the Department of Agriculture in the public abattoirs in the city. I know that outside the city there is no regular inspection and there is a danger for those who consume meat killed under unsatisfactory conditions outside the city.

Progress reported; Committee to sit again later.
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