Committee on Finance. - Vote 67—Health. – Dáil Éireann (14th Dáil) – Tuesday, 10 Jul 1951

Committee on Finance. - Vote 67—Health.

Minister for Health (Dr. Ryan)

I move:—

That a sum not exceeding £1,917,600 be granted to complete the sum necessary to defray the Charge which will come in course of payment during the year ending 31st day of March, 1952, for the Salaries and Expenses of the Office of the Minister for Health, and certain Services administered by that Office, including Grants to Local Authorities, miscellaneous Grants and a Grant-in-Aid.

The House will appreciate that having so recently resumed the responsibilities of Minister for Health, it is necessary for me to confine, as far as possible, my remarks on the present Estimate to a few statements. The many major matters of policy which require decision cannot all be dealt with in the course of a few weeks, but the House will have an adequate opportunity later of considering the decisions which are taken. I wish to repeat, however, that the Government intends to extend health services, including a mother and child service in accordance with the general intentions of the Health Act, 1947, and with the provisions of the Constitution and its social directives.

I think it appropriate that I should give a résumé of the vital statistics for 1950, in view of their great significance both on health and social grounds. The figures, I may say, are at this stage provisional.

The birth-rate per 1,000 of the population for the year 1950 was 21.0 as compared with 21.5 for 1949. While this is above the average for the decade preceding the recent war, it is the lowest rate recorded since 1941. The birth-rate for England and Wales for 1950 was 15.80 and the rate for Scotland was 17.9.

The marriage-rate for 1950 was 5.4 per 1,000 of the population, the same as that for 1949. The 1950 rate for England and Wales was 8.1 and for Scotland 7.8.

The death-rate for 1950—12.6 per 1,000 of the population—was a little below the rate for the previous year but above the very low figure of 12.1 for the year 1948, which, incidentally, was the lowest rate ever recorded for this country. While international comparisons of death-rates may not be quite valid, it is of interest to note that the death-rate for 1950 for England and Wales was 11.6; for Scotland, 12.4.

The infant mortality rates, at 45 per 1,000 births, although still too high, is the lowest ever recorded. It compares with a rate of 53 for 1949 and an average rate of 68 for the ten years to 1949. The fall in the rate is attributable to some extent to the reduced mortality from diarrhoea and enteritis. The number of deaths from this disease in 1950 among children under two years of age was 256, the lowest ever recorded for this country.

These figures indicate that the special measures taken in recent years with the encouragement of the Department of Health to deal with the problem of infant mortality have been effective, but the position is not yet satisfactory. The 1950 infant mortality rate for England and Wales was 30 and for Scotland 39.

Deaths from most infectious diseases were also below the figures for the previous year. The provisional figure for deaths from all forms of tuberculosis during 1950 was 2,353, representing a death rate of 78 per 100,000 of the population, as compared with 91 and 104 per 100,000 for the years 1949 and 1948 respectively. The rate recorded in 1950 is, I am glad to say, the lowest in our history but, like the infant mortality rate, it is still too high and the national effort to reduce it must be maintained. That there is ample room for improvement will be realised from the fact that the 1949 rate in Denmark was only 19 per 100,000 of the population, less than one quarter of our rate.

The number of deaths from diphtheria was five as compared with ten during the previous year; from measles 31, i.e. 25 less than the number during 1949, and from whooping cough 60, which is less than half the number during the previous year. Deaths from poliomyelitis, however, increased slightly from 21 in 1949 to 23 in 1950. Deaths from influenza also increased although the recent epidemic did not reach this country until early in January, 1951. Deaths from this disease in 1950 numbered 307 as compared with 280 during 1949.

The death-rate from cancer was 130 per 100,000 of the population in 1950, as compared with 139 for the previous year. This figure is very high and emphasises the need for the improvement of our cancer services to the maximum possible extent.

I do not intend to go into any of the general questions because, as there is a limited time allowed, I feel Deputies should have an opportunity of using that time to the maximum extent. I will be very happy to deal with any points that may be raised at a later stage.

Mr. MacBride

Does the Minister draw any inferences from the statistics he has quoted?

Dr. Ryan

I did draw inferences as I went along, I think.

Mr. J.A. Costello

I, of course, appreciate the difficulty in which the Minister finds himself recommending these Estimates, which are really the Estimates of the last Government, to this House and his difficulty in framing new policies and in deciding on major policies in the very short space of time he has had since he came into office. At the same time, realising all his difficulties and also appreciating his desire not to occupy the time allotted for the discussion of this Estimate by an opening statement of any great length, nevertheless, I regret that there are one or two omissions from his statement of rather prime importance.

In the course of his remarks about matters of major policy, the Minister indicated that it was the intention of himself and his Department to extend the health services, including a mother and child service in accordance with the general intentions of the 1947 Health Act and with the provisions of the Constitution and its social directives. I would have wished that the Minister would have interpreted those words for the House and for me in particular. Since the Party which now forms the Government promulgated its programme of 17 points, which included as its fourteenth the matter of health services to which the Minister has referred to-night, no indication has been forthcoming or given in any way as to the principles which will guide the Minister and his Department in formulating schemes for the extension of the public health services and in particular for mother and child services.

I do not understand what is the purport of the phrase which the Minister repeated again to-night from the fourteenth point of the new Government's programme, that these schemes are to be formulated in accordance with the intentions of the 1947 Health Act, the provisions of the Constitution and its social directives. I have no desire, nor have I any intention, to reopen the very painful controversy which arose about a previous so-called scheme for mother and child health services, but I do think that we are entitled to know, and the people are entitled to know, on what principle the Minister intends to formulate his new proposals for the extension of health services and particularly for the services relating to mothers and children. What is the significance of the use of the phrase from the Constitution "the directive principles of social policy"? We know, the House knows and the country knows, that in reference to the scheme for mother and child an authoritative opinion was sought from the Catholic Irish Hierarchy. They did not give it from their own mere motion.

They were asked by a then Minister of State for an express specific ad hoc authoritative decision on the principles which should guide a Government in formulating a scheme for a mother and child service under the then existing provisions of the Health Act, 1947. That authoritative decision is now available. Why the shyness of the Minister and his Party in keeping away from that authoritative opinion or in referring to it in any way either in their programme or in the announcement of policy given by the Minister in his statement to-night? We have in the Constitution these directive principles of social policy but we have in reference to this particular scheme which has caused so much controversy an ad hoc specific directive given authoritatively in answer to a request made by a then Minister of State.

I would like to ask the Minister if it is the intention of the Government, when formulating this scheme which he has stated it is his intention to formulate, presumably at some early date, to formulate it in accordance with the directions given in the authoritative decision of the Irish Hierarchy? I want to know why the shyness? Why is this phrase taken from the Constitution? Is it taken as a subterfuge to avoid referring to the decision of the Irish Hierarchy? A very grave national disservice was done to this country by certain members of this House who denied the right, or challenged the duty, of the Irish Hierarchy to pronounce upon matters of faith and morals in answer to a specific query put to them on a particular topic. I would like to have an assurance from the Minister that this is not what it appears to be, a mere subterfuge, something which will continue the damage which was done by those people who denied that right, and challenged the duty of the Irish Hierarchy.

One of the principal reasons why I feel impelled to-night to intervene in this debate is because of an omission from the Minister's statement. I realise and appreciate, as I have said, his desire to give as much time as possible to private Deputies to discuss this Estimate, but I do think that he ought to have given this House some indication of the reasons which impelled him to dissolve the joint medical committee which I set up, when acting as Minister for Health, for the purpose of formulating the best possible medical service for this country. It appears from the newspapers, and from the proceedings of the Irish Medical Council in Galway last week, that that joint committee has been dissolved. I think that we were entitled, and that the House was entitled, when a major decision of that kind was reached by the Minister, apparently very shortly after taking up office, to have been fully informed as to the reasons which actuated that very serious action on his part.

I felt, in the conditions which subsisted at the time that I set up that joint committee, consisting of representatives of the medical staff of the Department of Health and representatives of every branch of the medical profession in this country, general practitioners and specialists of every kind, that that was the way to deal with the problem as it existed at the time. My experience, during the course of my short time as Minister for Health, of the deliberations of that joint committee convinced me that the course which I took was the correct course, that it was the one that was best calculated to achieve beneficial results for the health of the people of this country, and of all sections of the people. I have seen no reason since to change that view. In the absence of any explanation from the Minister, I feel a very great deal of apprehension as to this very grave decision that he has taken, and of the effects which it will have upon any scheme which he may endeavour to formulate and put into effect in the future.

I must assume, in the absence of any such explanation, that the dissolution of this joint committee which was working harmoniously, and working well in the interests of the people, was another part of the price which the Government had to pay for certain political support from certain benches in this House. I do hope that it does not indicate anything more than that on the part of the Minister or of his ministerial policy. I do hope sincerely that the present Minister, belonging as he does to the medical profession, will not adopt that attitude of aloofness, that attitude of disdain, that attitude of turmoil, of strife and struggle which was the characteristic of his predecessor, of the Minister in charge of the Department, before I took up that office. I feel that the present Minister will not adopt that same attitude of strife towards the medical profession and his colleagues, and that he will realise that the only possible hope for any extension of health services in this country, and for the beneficial working of those health services in the interests of the people and in the interests of all sections of the community, is by securing the willing co-operation of the medical profession, of all and every section of it. That that willing co-operation is available and is cheerfully forthcoming, is beyond all question.

The principle of improving the health services has been accepted by all responsible moral and social institutions in this country. Church and State, the members of every political Party in the State, and the medical profession are agreed upon that principle. But what the aim must be, and what must be achieved, is the working out of details which will not conflict either with moral principles or with the just requirements of the community.

How is that to be achieved? I thought when I had responsibility—I think so still—that the best way of achieving the ideals and the ideas which we all believe in, was to secure co-operation which, as I have said, is freely available and is willingly forthcoming, from the medical profession, from those who will have to work the scheme, and from those who are in a position, by reason of their specialised knowledge and lengthy experience, to give advice to the Minister, to his Department and to his officials. I believed in the principle of co-operation in all Departments of Government while I had responsibility as Head of the Government. I believed in consulting the interests of those people who would be affected either by proposed legislation or by the administration of any Department. I believed in consulting the persons who would be willing, able and qualified to give advice and assistance. I believed also in the principle of consulting those whose interests, private or public, would be affected by any act of Government or any act of administration.

It was because I believed in that, and believed in it firmly, that one of my very first acts as Minister for Health was to set up this committee consisting, as I have said, of the representatives, highly qualified representatives, of the Department of Health and representatives of various sections of the medical profession. They met and sat and worked in harmony. During the weeks when they worked under my administration I left them alone, but I do know this, from a report I got just shortly before I left office, that a very considerable amount of beneficial work had been done by that body.

The atmosphere of suspicion which had surrounded all discussions, the friction which had been engendered in the previous months had all passed away. The result was that the representatives of the Department of Health and the representatives of the medical staff of the Department of Health had pooled their knowledge with that of the specialists, the general practitioners and the other qualified persons who gave freely their experience and their knowledge and their zeal to this committee and its working. A vast amount of work was done, and I believe firmly that, as a result of the discussions that went on for those weeks, a considerable number of the difficulties have been dissipated, and problems dissected. It was reported to me that they were well on the way to producing a practical scheme for the principal cities of this country— Dublin, Cork and Galway, and that they proposed taking over other centres of population in a short time and dealing with very difficult problems relating to health and, particularly, relating to mother and child schemes for rural areas.

Now, apparently, all that work is to be cast aside. That is the price that has to be paid for the support of two, three, or perhaps more of the Independent Deputies who are keeping the Government in office. I have no objection to that. If the Government are prepared to pay such a price for that particular support it is their affair. What I do object to is this, that politics have been placed before the public interest and the interests of the community. I do certainly hope that, whatever motives may have impelled the Minister to dissolve that committee, he will avail himself of the goodwill which is forthcoming in abundance from the medical profession, notwithstanding the gross slanders, libels and lies that were disseminated about them during the past six or 12 months.

That committee sat for some weeks. Their terms of reference were short and comprehensive. So far as I directed them at all in their work, and I met them but once, I told them that they knew more about the problems that had to be solved than I did. They knew the directives that had been given by the Irish Hierarchy. Subject to those directives, I told them to bring forward the best possible health scheme they could for all sections of the community. These were the only terms of reference they had, to give their advice, to place at my disposal or that of my successor, or the then Government or any subsequent Government, the benefit of their knowledge gratuitously, voluntarily and freely and to give their advice in order that the best possible health scheme, the best possible over-all health scheme would be devised and put into operation for all sections of the community.

I was told in the course of the general election campaign that it had been disseminated abroad in certain of the Dublin constituencies that I had given as one of the directions to this committee that they were to have a means test for any scheme that they would put into operation. I was denounced from platform after platform on that basis. I acquit the Minister and his colleagues of any such defamatory campaign. Those who took part in such a campaign know to whom I am referring. One of them told me that he campaigned against me on that very basis. I asked him where he had got the information. No such directions were given by me.

This committee, as I said, and I repeat and emphasise, worked and acted in harmony. No deliberative assembly, whether it be great or small, is worthy of its setting up or worthy of its continuance unless there is brought to bear upon the deliberations, the tasks and duties of a legislative assembly, a variety of opinions and different viewpoints. The members of such an assembly should bring forward different arguments which should be cogently put and hotly debated if you like.

It is thereby that any proper decision can be arrived at, by consideration of all the difficulties and all the various points of view. That is what this committee was doing. They were meeting voluntarily, giving their services voluntarily, and the thanks they got from certain Deputies in this House was to be told that they were looking only for their own class interests and for their own pecuniary advantage.

It was stated that I had handed over the fate of the mothers and children of this country to the medical profession. It was stated that I had done so because of my family connections with the profession. I regard with nothing but contempt all of those who uttered those slanders about either me or the followers of the honourable vocation of medicine. What I do object to, and where there is a great disservice to the public is the fact that efforts were made to disillusion the ignorant people of certain parts of this city and to pour poison into their minds for the purpose of getting a few votes here and there. Even individual members of the medical profession were lampooned and slandered from public platforms. Specialists were held up to ridicule and scorn.

I may be accused, as I have been accused, of being the advocate of the medical profession. If that accusation is made, as it probably will be, I here and now, in advance, plead guilty, freely and fully, to that charge, if it be a charge. The medical profession is an honourable vocation. Many of its members, individuals, have been dragged in the mire by members of this House for the purpose of catching votes. I have been slandered, and members of the medical profession, as a whole, have been slandered. The endeavour has been made to disillusion the people and to resurrect or to implant in the minds of certain sections of the people of the City of Dublin something very much akin to class hatred.

It matters not what damage is done to me or any individual members of the medical profession. We are strong enough to bear those slanders, and people know the value of them. The real damage is the damage to the public interest, and that damage was done, and done to a very great extent. I hope the present Minister will undo it. I hope that he will see the value of co-operation.

I hope that he will realise that there is available to him a vast reservoir of goodwill. People of all kinds, with specialist knowledge in the medical profession, are ready to give their services to him and to his Department. I do hope that this decision, to which he has not so far adverted, is merely the price that he has to pay for two or three votes in this House and does not indicate a policy of aloofness, struggle and strife, which was the dominant characteristic of the administration of one of his immediate predecessors. Schemes for the health of the people should not be made the sport of politics nor should any effort be made, by lampooning individuals or the medical profession as a whole, to gain a few votes for passing political kudos or power.

I hope that the Minister will not cast aside the services which are freely available to him. Let it not be said, if it be the excuse for the dissolution of the Joint Medical Committee, that it is the function of his officials to advise him and that, therefore, it is better that they should not be attached to a joint committee of this kind. I have no doubt that these very eminent officials, medical officials of his Department, officials to whom I should like, in passing, to pay a tribute for their efficiency and loyalty and service to the country, have obtained great value, much knowledge and great experience from their deliberations in this committee, that the cut and thrust of argument and discussion and the dissection of difficulties and problems has enabled them to see the difficulties in proper perspective and has enabled them to see how these problems can be grappled with and a real solution found for the various problems facing us in connection with the health service of the country.

There is an ideal to be sought after, the ideal of getting the best possible health services for all sections of the community. That is not an ideal that can be attained in a day, two days, a year, two years or even ten years, and we have to have a long-term policy and a short-term policy. It is not by dragging around catch-cries at elections or putting them on posters to be carried around by women at election meetings that we are going to secure the best possible scheme. It is by getting the best possible advice from those who know, from those who have worked amongst the people, who are familiar with the problems and who know the kind of solutions that can only be effective and made to work that you can get any sort of health service that will be of any use to the community as a whole.

This joint committee had done useful work. It pointed the way through the difficulties and showed how it could be done in Dublin, Cork and Galway. There was no scheme in existence here during the course of the general election for mother and child or anything else. There was nothing but a political catch-cry, nothing but broad, general outlines with no details worked out. In the City of Dublin, there was no co-operation secured from the three maternity hospitals, but the catch-cry of the "free for all and no means test" was waved before the people and the medical profession was slandered and defamed for the purpose of securing votes. I believe the Minister will not carry out that policy. If he does not and if he goes in the way which we believe is the right way, he will secure our support and active co-operation.

There are many ways in which extension of health services can be secured. The mother and child principle has been mentioned by the Minister and the directive principles of social justice have also been mentioned by him. May I direct the Minister's attention and the attention of some of the Deputies to one of the phrases in one of the directives on social policy in the Constitution? One of these directives is that the State shall strive to promote the welfare of the whole people by securing and protecting as effectively as it may a social order in which justice and charity shall inform all the institutions of the national life. To those who spent their time defaming me, the members of the medical profession and the medical profession as a whole, I commend that phrase in the Constitution. They are members or would-be members of what is probably the paramount institution in this State, the Parliament of the people, and if justice and charity are, in accordance with these directive principles of social policy, to inform the institutions of this House and Parliament, they ought to inform the actions and words of each member of this House.

I brought away from my short period with the Department of Health one paramount impression, apart from the fact that that Department had loyal, faithful and efficient servants at the disposal of the people, and anything I may say now is not in any way to be taken as in the remotest degree reflecting upon them, their efficiency, their loyalty or the great public service they have given and are prepared to give to the people and to any Government which represents for the time being the people of the country.

I did notice that there was, in the course of the day-to-day administration of this Department, being done, by administrative action, something which was, slowly, no doubt, but steadily and surely, leading to socialised medicine. I have nailed my colours to the mast long ago on the question of socialised or State medicine. I will have nothing to do with it, in or out of Government, and I will do everything in my power to see that no Government or anybody with whom I am associated does anything which will bring about, or in any way help, the cause of socialised or State medicine.

I have no doubt that the Department, in the course of its administration, whatever head it may have had, with the possible exception of one, had no notion that it was heading in its administration policy towards socialised State medicine, but look at the number of salaried medical officials scattered throughout the State at present—surgeons, medical doctors, obstetricians, pediatricians, all the various specialised services and all being subjected to the system of salaries, the system of control by nonprofessional people who have not the knowledge, experience or training to fit them to deal with matters which these specialists and general practitioners have to deal with in the course of their work. They are rapidly becoming form-fillers, civil servants, to the detriment of the professional work they ought to be doing for the people. The Minister ought to watch that tendency very closely to see that the actions of these professional men, whether in the public service throughout the country, under local authorities or otherwise, are not either confined or limited by the crippling action of bureaucracy, or by the necessity for complying with the manifold regulations of the Department, in their professional work and the work for the benefit of the sick, the poor and the insane whom they have under their care.

There is one other, somewhat of a personal, matter which I wish to mention on this Estimate. Very shortly before the general election campaign was about to start, I received a deputation from the nurses' organisation representing nurses and midwives. They put before me their case for increased remuneration and betterment of conditions. I can say now, as I did not say then, that I am, and was, entirely sympathetic towards the point of view they put forward. I declined to take any action because of the pendency of the general election and a possible change of Government, because it might be said, if I expressed my sympathy or did what I could well have done, directed an increased remuneration and a betterment of their conditions of service, that I was doing it solely for political purposes. I think I can rely on the present Minister to deal sympathetically with the claims of these nurses for increased remuneration and betterment of conditions and to give kind consideration to the claims for increased remuneration and betterment of conditions of midwives.

The last thing I wish to put forward as a point for the Minister's consideration is that he should take into sympathetic consideration the position of the jubilee nurses. They have rendered very good service to the poor people throughout the country, and particularly in the poorest sections along the western seaboards. They do not quite know how they stand at the present time. I believe it was never the intention of my predecessor as Minister for Health in any way to put an end to those services or do anything that would act to their detriment. I would be glad if the Minister would give an assurance that they will be looked after and that their services will be availed of in the future as they have been in the past.

Captain Cowan

I am sure the House has listened to the speech Deputy Costello has made with its usual respect for his powers of oratory, but let that speech be examined and what do we find? We find that under the 1947 Act provision was made for the establishment of a mother and child scheme and steps were taken to implement that provision. We know that the medical profession opposed the mother and child scheme, and were violent in their opposition to it. We also know that they were in conflict with Deputy Dr. Browne, the Minister for Health, on whom the responsibility in implementing that particular scheme rested. I do not want to go into recent history in all its details. We do know that Deputy Dr. Browne was removed from office; we do know there was a general election and we do know that the Government that removed Deputy Dr. Browne from office was itself removed from office. Those are the simple facts of the case. Some Deputies who are styled Independent Deputies in the House here, voted for and brought about the change of Government, simply because of the attitude of the last Government in regard to the mother and child scheme.

I welcome the decision of Deputy Dr. Ryan, the present Minister for Health, in dissolving this joint medical committee that was set up by the previous Government after Deputy Noel Browne's services were lost as a Minister—for the time being, at any rate—to the State. I agree with Deputy Costello that this State wants the best possible over-all health scheme, to include the mother and child scheme and many other schemes that can follow from the Health Act of 1947; but I do not agree that the best people to formulate that scheme are the doctors. When Deputy Dr. Browne ceased to be Minister, there was rejoicing in the Irish Medical Association and when those people who had obstructed him in every way were invited to go down to the Custom House and to formulate a new scheme, they went there feeling victorious in their fight against their colleague, Deputy Dr. Browne. Can anyone imagine that they were the best people to formulate a mother and child scheme that would benefit the ordinary people? Were they to formulate a scheme that would benefit the people as a whole or would benefit their own profession? I would like to know what reports they made. What are those marvellous reports that they submitted to the last Minister for Health, the last Taoiseach, Deputy Costello? I should like Deputy Dr. Ryan, the present Minister for Health, to make those reports available. Let us see what the results of those conferences in the Custom House were and what real steps they took towards the establishment of an acceptable mother and child scheme.

Health—public health — is the problem that is before us at the moment. Many problems have been faced by society, not only here but elsewhere, in the past. When it was a matter of dealing with the landlords, with the iniquities of landlordism, of trying to improve the position of tenants, was it a committee of landlords that was set up to do that? When child labour was to be ended in the mines and in the industries, was it the capitalist employers of the children who were to be set up as the committee to deal with that evil? In this, we find a committee of members of the Irish Medical Association sent down to the Custom House, vested with all the powers they require to make a scheme that would be beneficial to the ordinary people of this country. It would take more than Deputy Costello's oratorical powers to put that over on the people.

I am glad that the Minister took steps to dissolve that committee and I hope that, in accordance with the principles of the 1947 Act, he will establish a scheme that will provide a mother and child scheme for this country without a means test. After all, where the people did get an opportunity of speaking on that in the recent general election they spoke on it in no uncertain manner and those of us who did stand for a mother and child scheme without a means test were elected.

Mr. O. Flanagan

Some of you very poorly.

Captain Cowan

It does not matter. Some of the people who opposed it were just as poorly elected. Some of them who supported this mother and child scheme and supported Deputy Dr. Noel Browne were elected by a big number of votes, like Deputy Oliver Flanagan, who stood up in this House to support Deputy Dr. Browne before the dissolution and who said what he thought about Deputy MacBride in no uncertain manner before the dissolution. I am sure that some of the big vote that Deputy Oliver Flanagan received in Laois-Offaly can be attributed to his support of Deputy Dr. Browne.

Mr. O. Flanagan

The trouble is that I did not know yourself or Deputy Dr. Browne at that time. If I had known you my speech might have been different.

Captain Cowan

If it had your poll might have been different.

Mr. Rooney

It might have been 15,000 again.

Captain Cowan

I am not going in this debate, limited as it is in time, to go over the whole position regarding the mother and child scheme, but I am glad that Deputy Dr. Ryan, in his position as Minister, has routed that committee out of the Custom House, and I sincerely hope that he will implement the provisions of the 1947 Act and that he will adhere to the things he said himself on so many occasions when that Bill was going through the Dáil: that it would be too difficult to impose a means test, that it would be impossible, that it would be too difficult to say why something should be given at £500 and not at £501. He made it perfectly clear that because of the administrative and other difficulties there was only one way it could be and that was without a means test.

Mr. O. Flanagan

And without the approval of the bishops. Is that the idea?

An Ceann Comhairle

Deputy Flanagan should allow Deputy Cowan to make his speech without interruption.

Mr. O. Flanagan

I would like to hear Deputy Cowan making the same statement here and now which he made to Deputy Costello in my hearing: to protest against the bishops was why he voted Fianna Fáil.

It does help one, a Chinn Chomhairle, to keep reasonably within the bounds of order with your assistance.

As I was saying when Deputy Flanagan interrupted, I was delighted that the Minister did what he did, and I hope that he will follow the line of his own argument in this House when the 1947 Health Act was going through: that there would be a mother and child scheme and that it would be put into operation without a means test. Why should any father of a family, any husband whose wife requires essential medical treatment, have to go before a local authority or Government official and disclose to him all his private means and circumstances, his mortgages and his debts, in order to get the medical treatment that is essential for his wife? Why similarly should a father whose child requires expert medical attention have similarly to expose his whole private condition to the person who comes along and asks what he earns and owns, and what he has to support?

I look on that means test as an iniquitous thing. I have always condemned that means test, whether it be in social welfare with regard to old age pensions or otherwise, and I am glad to know that in condemning that means test I have the support of the organised trade unionists of this country behind me. Deputy Flanagan might consider that apart entirely from a document which was sent privately to the Head of the Government, there has been no teaching by any bishop in this country on the mother and child scheme without a means test, no teaching that would bind any Catholic in this country, and Deputy Flanagan is welcome to find an answer to that anywhere he likes. I cannot be bound and nobody else can be bound by documents sent secretly that are not part of the teaching as teaching should be done.

When I said recently, dealing with this matter at a public meeting, that now that the election was over I was prepared to deal with it with anybody who wanted to raise it with me there was an immediate disappearance into the trenches, there were no further attacks, no further onslaughts. That is all I have to say on the matter.

This mother and child scheme without a means test is a very big issue. It resulted in one Minister leaving the Government; it resulted in the defeat of a Government. The country is adamant, if I understand it aright, that it wants a mother and child scheme without a means test.

Mr. O. Flanagan

You will not be a Deputy when that is passed. I can guarantee that.

Dr. Esmonde

I welcome the statement from the Minister that there is no health scheme in being at the moment, but I also share Deputy Costello's apprehensions on the dissolution of the Health Council. I naturally feel that the possibility of the return of the Browne scheme, on account of the political developments that have taken place in the last month, is possible. I had the privilege as a doctor of being present at the biggest collection of Irish medical men that ever took part at a meeting in Dublin. At that meeting we had general practitioners, dispensary doctors, private practitioners and specialists in all shades and walks of their profession and unanimously we were agreed that the Browne health scheme was absolutely a flop from every angle. It was unworkable. It was unworkable for the reason that we had not the hospital facilities in this country to cover it. It was unworkable for the reason that we had not the staff to cover it, and it was also unworkable for the same reason that the health scheme is failing in Britain to-day, that we have not the money to run that scheme. It might have been a civil servant's dream. It might have been all right on paper but as far as the doctors were concerned and as far as the nurses were concerned and I can assure you that as far as the patients were concerned it was no dream for them. It was the most unworkable and unsatisfactory scheme that could ever have been conceived. I would even go further and say that it was not a scheme at all.

Deputy Cowan took the opportunity, when he was speaking a few moments ago, to offer a gratuitous insult to the profession to which I have the honour to belong. He suggested that the relations that existed between the landlords and the tenants are the same relations that exist between the doctors and the patients. If there is any medical man listening to me in this House to-night, be he a specialist or a general practitioner, or whatever walk he comes from in the profession, he will know, and the people in this country who have been attended by doctors will know, that the relations between the doctor and the patients are relations of friendship. He will also know—and if he does not know I am going to tell him here to-night— that the Dublin specialists work for four and five hours every day in our public hospitals and institutions, for which they do not get one shilling in return. I am stating that because Deputy Dr. Browne, in his public utterances with regard to my profession, let it go out to the general public that there was no free treatment for people in Dublin, in rural Ireland, or, in fact, in any part of the country whatsoever.

I should like to make a few suggestions, as one who has practised in rural Ireland for a great many years, with regard to our health scheme. As a doctor, I feel that it is necessary for us in Ireland to have the best medical services we can get for the unborn children who are going to form our race in the future. We want an ante-natal service—but a workable ante-natal service—run as a practical scheme. Already in our bigger towns —in Waterford, Cork, Dublin and Limerick—we have ante-natal clinics. I suggest to the Minister that in every town with a population of over 3,000 we should have an ante-natal clinic. If the Minister wants a good example of such a clinic I suggest that the next time he travels in his constituency he should stop at Arklow and go into the clinic there—a clinic, I might add en passant, that exists by the generosity of the Countess of Wicklow, who had it built and equipped at a cost of £3,500.

This clinic is serviced by the jubilee nurses to whom Deputy Costello has referred and who are doing good work up and down the country. In this particular case, the jubilee nurse, instead of having to go round from morning till night on ante-natal work, has the facilities, thanks to the generosity of the Countess of Wicklow, which enable her to deal with the people who come to the clinic. As a result, the death-rate and the ante-natal and post-natal troubles of the women and children in that area have diminished considerably. I suggest that the Minister should adopt the idea of having an ante-natal clinic in all towns with a population of over 3,000 if it is going to cost only £3,500 to build a clinic such as the clinic at Arklow and a house for the jubilee nurse, who services it, to live in. The county council supply the clinic at Arklow with free calcium, free Virol and free cod liver oil—the essential ingredients for ante-natal and post-natal work. The county council pay the local dispensary doctor for his attendance there once a week. Record sheets are kept and the necessary tests, essential to a woman when she is in that condition, are gone through. That is one of the things we could have in this country. We do not need any means test for that.

Deputy Cowan is worried about a means test. We do not need any means test for clinics such as the clinic at Arklow. Anybody who wishes is free to go to see it—I have checked it up carefully—anybody who goes to the clinic at Arklow is, in the majority of instances, a necessitous person requiring free treatment. Nobody is forbidden to go there. Anybody is free to go who pleases.

I suggest to the Minister that he begin at the bottom of the ladder. Our dispensary system in Ireland may be a bit obsolete but it is not as obsolete as that. It has served a function here for a great number of years. The Minister's first aim and object should be to put these dispensaries into decent working order. I am not a dispensary doctor but from time to time I have serviced a dispensary. In one dispensary in particular which I call to mind, I was obliged to mix bottles of medicine for patients with what was tantamount to bog water. There was no water laid on in that dispensary: there was no decent lighting or heating and there was no waiting-room. In another dispensary in a town with a population of 5,000, the patients were standing on the roads in the winter months. I mention that in order to point out some of the things which I believe are essential in Ireland to-day. The best place to start is at the bottom of the ladder. Instead of talking about free medical services for all, let us talk in a rational and sensible way. Let us get a health service together—an ante-natal clinic and a decent dispensary service.

I come now to nurses. With the exception of the jubilee nurses, the Lady Dudley nurses who function in the West, we have not in Ireland to-day these nurses at our disposal. Deputy Dr. Browne's scheme envisaged enormous health centres and clinics everywhere. Where was he going to get the nurses? I know he could not get them. They do not exist. The scheme I suggest is feasible to work with the nurses that exist already. If nurses have to go down and work in remote parts of the country—they are only human people, the same as anybody else—they will want a decent salary and a decent standard of living. You cannot expect highly and well-trained girls to accept service in the Irish medical service and live in a remote part of Ireland if they have not sufficient financial remuneration to enable them to get about occasionally and get a bit of entertainment.

I want to say a few words now with regard to the Irish Bishops. Why did the Irish Bishops intervene in Deputy Dr. Browne's scheme? They intervened in Deputy Dr. Browne's scheme —and the Deputies opposite, no doubt, will agree with what I say as well as the Deputies who are sitting behind me on these benches—because it was their lawful duty to do so. They intervened because they wanted to preserve the sanctity of the home. They wanted to preserve the Heaven-sent right of the mother and father to safeguard the health of their children. They did not want the State to adopt the position of usurping the function of the parents. It was their duty to do so and I am proud, as an Irish Catholic, to say they did right. Why in Soviet-controlled countries and in Communist China are the bishops, the priests and the clerics paying the extreme penalty? Because they are espousing the principles which the Bishops of Ireland espoused, the principles of freedom.

This question is grossly misunderstood. Decent people, not of our religion, believe this was some form of Catholic interference. It was not. The Hierarchy were simply standing up for the rights of free people everywhere, no matter what their religion, be it Catholic, Protestant, or Jewish. It is no great thing to have to say about the free world, and to know that some portion of the Press in this country. I regret to say, and in other countries thought fit to throw mud at them and accuse them of trying to use the situation for their own interests. If this country is misfortunate enough ever to become conquered or overcome in a time of aggression, who will you have to stand as the voice of freedom? You will have the Irish Bishops. As they stood on this question they will also stand on other matters appertaining to freedom.

I have nothing further to say except to assure the Minister, as a medical man and as a member of the Irish Medical Association, that he will have from this side of the House and from me as a doctor all the co-operation we can give him to further and improve the welfare and the health of the mothers and children of Ireland.

Mr. Kyne

I should like to put before the Minister a few points which occur to me as an ordinary member of a public assistance committee. I do not speak with the legal training of Deputy Costello, nor with the authority on Church matters that Deputy Cowan professes to have, but I feel that I can indicate the view of the ordinary local representative of a committee whose function it is to look after the health of the inhabitants of our area.

One thing that struck me was that in dealing with those who suffered from tuberculosis we were inclined to overlook many of the illnesses that beset us in the country. The Minister, in his opening statement to-day, drew attention to the serious fact that deaths from cancer have seriously increased. He has indicated that it is his intention to give more time and, I presume, more money to combating this dreadful scourge. I would plead with him to keep his promise in that regard because whatever the number of deaths from tuberculosis there is no relation to the dreadful pains and sufferings of those who have the misfortune to die from cancer.

There is another problem which we on the local authority find is pressing very seriously on us and that is the problem of children who are mentally deficient. These, because of the scarcity of homes or places in homes where they can be taught and educated, and sometimes possibly taught a trade, are placed in an unenviable position. We have quite a large number of children on the waiting list and each year their chances of receiving the greatest benefits from these hospitals are dwindling. I understand that there is very little hope that any of those on the waiting list in my constituency will find a place for the next four or five years. In one case so acute was the problem that I know of an infant of only 12 months who had to be placed in the care of the mental hospital. I think it is an indictment of our Health Department that we have not a place suitable for these children or that we are not likely to have a place for them in the near future. I would ask the Minister, when he is replying, to indicate—I am aware it will be of special interest to many other local authorities — what plans there are or what plans he intends to make for the care of these mentally deficient children.

Another matter is that in a number of small sanatoria set up under county councils the patients are left to lie there for quite long periods, awaiting transfer to regional hospitals. Very little medical attention can be given to them that is of any great use and because of the want of something to occupy their time, such as instruction in some handicraft like basket-making, leather work, making gloves or handbags, time lies heavily on their hands. Because of the weariness of the long day and very often of the long night they reach a stage that their rest rather than being of assistance to them is actually a handicap. We had an unfortunate experience in my constituency. The Irish Countrywomen's Association volunteered a free teacher who would attend a number of evenings per week and instruct those patients so that they could occupy their time. The offer was turned down because of some red tape rule or regulation. I feel that anyone who is willing to help those people who lie in hospitals should not be strangled by any regulation or by any sub-regulation of the Department or by any rule of a county medical officer.

Since this debate began, I was hoping to hear advocated the cause of one section who served the interests of health in this country.

Up to now I am afraid it has not been stated. I refer to the midwives who work for the local authorities. These are so ill-paid and so ill-treated in relation to holidays and allowances that in many cases vacancies cannot be filled because there are no applicants for the posts. Surely it is not unreasonable to suggest that a midwife in charge of a district extending over 15 miles should be given a mileage rate sufficient to enable her to run a car. A mileage is at present paid to subsanitary officers and to sub-health officers, together with a six weeks' university course, to equip them to inspect houses with a view to tenancy lettings. Surely the work of bringing a worker's child into the world and of saving the life of the worker's wife is more important than the letting of a county council cottage. The health inspector who may visit such a cottage on three or four occasions will probably get 6d. per mile allowance for his motor car. The midwife will have to travel on a bicycle, in a donkey and cart or in whatever mode of conveyance the husband can provide for her. Should she hire a car that car will have to be paid for out of the pocket of the worker whose wife and child she is attending. I think that position ought to be remedied. Its solution is not an impossible task.

In 1950 Deputy Dr. Browne, then Minister for Health, outlined a sevenyear building programme for hospitals. What progress has been made with that programme? In my constituency in Waterford we have been promised a district hospital since 1934. The building of that hospital has been put back for ten or 15 years. We were told to carry out reconstruction work to tide us over. If the Minister will check the files of his Department he will discover that our architects, our quantity surveyors and our local representatives are unanimous in informing the Minister and his officials that money spent on the reconstruction of the hospital in Waterford will be money thrown down the drain. Our county surveyor offered, if it would convince the Minister, to resign his position so that money would not be thrown away.

Will the Minister reconsider the decision in connection with Waterford hospital? Linked with that is the question of maternity hospitals at Lismore and Dungarvan. Is the policy of the last Minister to continue, the policy that only certain named hospitals will be built over the next seven years? If that policy is to continue we have very little hope of satisfying an urgent need in providing maternity facilities for the working people around Lismore and Dungarvan. I hope the Minister will see his way to reconsidering the present position and allowing even a limited number of maternity hospitals to be built, not only in my constituency but in other constituencies also where the need is equally great.

Because most Deputies will seek an opportunity of saying a few words in this debate and because our time is limited, I will follow the good example set by the Minister and come to a speedy conclusion. In connection with the mother and child scheme, I believe there is need for such a scheme. I believe that scheme should be as wide and as free as possible and should embrace all the people who may need it. I appeal to the present Minister, as I would have appealed to the last Minister had I had an opportunity to do so, to let us have that scheme with the goodwill and the blessing of the Church.

Dr. Browne

I would like briefly to refer to a couple of points to discover the Minister's views in regard to them. My first point concerns the county homes. Shortly after taking office as Minister for Health, which, strangely enough, embraced responsibility for looking after the county homes, I took an opportunity of visiting many of them. Following on that visit I gave vent to a violent condemnation of what I considered then to be the scandalous conditions under which our old people spent the closing years of their lives. I spoke in perfect honesty at the time. Possibly I spoke too much from my heart and too little from my head.

There are particular instances where Christian local authorities have taken steps to improve the situation but, generally speaking, I gathered the impression that we lagged far behind the conditions and standards which could be rightly demanded by a community so complacent in its professions of Christianity and its adherence to the Christian way of life. In order to find out whether I was exaggerating the conditions which prevailed generally, I established, with the consent of the Government—and this is a matter upon which I doubt if there will be any difference of opinion—a committee of civil servants to investigate conditions in our county homes. Civil servants are not prone to emotion or to sentimentality. They are concerned merely with hard work and fact-finding in spite of what many people believe. They set about their task diligently and conscientiously, and in due course they presented me with a report from which I got little satisfaction when I discovered that it largely corroborated many of the general impressions that I myself had received in my visits to these institutions.

I am not concerned at this stage with criticism of those conditions. I merely want to inquire from the Minister whether he has yet had an opportunity—it is possible that he has not— of reading this document and studying it, and whether he has considered the recommendations contained therein, and whether he will obtain the sanction of the Government for the implementation of those recommendations, recommendations involving the expenditure of a good deal of money, in order to bring our county homes somewhere near that level which any community professing Christianity should expect to find within the confines of their State.

I shall not dwell further on this particular point because I do not believe that it would help just at the moment but I can assure the Minister and the House that I propose to return again, and yet again, to this problem on every possible opportunity that presents itself and where the opportunity does not arise, I shall do my best to make it arise because I am satisfied that we should be thoroughly ashamed of the conditions under which many of our people are living.

I would suggest that we should take it upon ourselves to encourage the Government, and if necessary to drive the Government, to tackle this problem as a matter of urgency, to see that these institutions are properly equipped, heated and properly ventilated, that lifts are provided where necessary, and that proper kitchens with proper kitchen equipment and proper staffs are provided. To a limited extent I attempted to eliminate, as far as I could, the appalling prevailing sense of pauperism which exists in these institutions, relics of 100 or 200 years ago, when the Governments of those times deliberately set about to bring this atmosphere of pauperism into the lives of those of our people who were not blessed with worldly wealth. It is a tradition which I certainly shall work towards eliminating from out our life. As I say, it is a tallish order. To a certain extent, I must accept blame for not having got more done in that regard.

I sincerely hope that the Minister will accept it that there is a very serious problem there. It is an extensive one and I am quite certain that our Government will face it as such and feel that any money would be well spent, and rightly spent, in improving the lot of these people. They are a section of the community who have little voice in our affairs. I do not think they matter very much from the voting point of view, or from a purely sordid political point of view, but they are one of our responsibilities and we have tended to neglect them up to the present. Admittedly past Governments have had serious and very big problems to deal with, but I do not think that that should exculpate future Governments or the present one, from tackling the problem in an energetic and conscientious way or from doing something to right the very serious wrongs which exist at present.

I have not had the opportunity or the experience of Deputy Dr. Esmonde of attending the meeting of the mutual admiration society in Galway, or wherever it was held, of the medical profession. I happen to be a doctor and it is probably useful that I should say that we should not allow ourselves to be carried away by the perfervid oratory of a doctor who thinks that all doctors are fine fellows. I think we should approach the problem of our health services in a reasonable and rational way. So far as I am concerned, I share the views of Deputy Costello, the views of all of us here in this House, that we must have the best possible services for our people. Where we differ—and many of us differ pretty violently on occasion—is as to the methods whereby we can achieve this objective of the best possible service for our people irrespective of wealth.

I believe that the medical profession contains just the same proportion of saints and angels, good, hard-working members, lazy, slothful, dishonest, corrupt, conscientious and sincere human beings as there are in any other branch of society—whether they be carpenters, butchers, bakers or any other section of the community. It is about time that we got out of our heads the idea that just because a man's people had enough wealth to put him through a university and to make him a doctor, he suddenly had a halo put around his head and acquired certain standards and certain principles of behaviour which render him a man apart from all human beings. I think that is an idea that should be exploded. We are no better in that regard than anybody else in this House. We work because we are paid to work. We employ the ability we acquired in the pursuit of our profession and we see that we get fairly well paid in the process.

I was naturally very glad to know that the Minister had the courage to act as a Minister should in this matter. As a doctor, he may not share the same views as I have. It is one of the principles of democracy that we can all differ if we wish, but I am glad to see that he had the courage to decide to remove these people from the Custom House where they were enthroned by the previous Minister for Health, the previous Taoiseach, Deputy Costello. They had, of course, no right whatsoever to usurp the powers of the man appointed by this House to act as Minister for Health.

The Medical Association is a trade union. It has all the rights of any trade union, to fight for improved working conditions, higher pay, better wages and better salaries for its members. It has the right to go to Ministers, to make representations to Governments, to recommend increased salaries, improved working conditions and all these other things, but it has no right to trample on this House. It can make recommendations to the Minister and he has a perfect right, if he wishes to do so, to reject these recommendations. The previous Minister for Health had no right whatever to hand over his authority to these people as he would have had no right to hand over to Deputy Seán Dunne of the Labour Party, liberty to go to the Department of Agriculture and run that Department, or to Deputy Larkin to go to the Department of Industry and Commerce to run the industry of the country. What right had these people for special consideration over farm labourers, industrial workers, technicians or carpenters? Until he has been given such powers by this House, no Minister can delegate his power to these officials. So long as I am here I shall fight for the supremacy of the Oireachtas against the medical profession or any vested interest which tries to usurp the powers of this House.

As I say, we shall probably have an opportunity of discussing the mother and child scheme at a later date. If it is intended to bring a means test into the scheme, I am advised that it will need legislation, and we shall have an opportunity of discussing that legislation. For the information of the Minister, I may tell him that I propose to vote against any legislation that will introduce a means test. Forewarned is forearmed possibly. I think the people generally know me well enough to know that I would not accept and will not accept this ridiculous 18th century incubus being imposed on the people; that they are to have these inquisitions and inquiries as to whether they have this money or that money. I do not mind whether it is done by the doctor or not. It is all the same. It is inquiring into the private life of people. I want a service available to men, women and children just because they are sick— the same standard of service, not one for the rich and one for the poor. I assert that there is such a service at present. I object to the means test for many reasons, and I will give them later on if there is a debate on the subject. Firstly, I think that administratively it is stupid, it is idiotic and will not work in time. Secondly, I believe that it is medically a bad principle. I believe that medically it is not a question of what I believe or think or what airy fairy notions I have. The fact is that you have a dispensary red ticket system, which is a bad system, and, on the other hand, you have the nursing homes, the private beds, the private wards and consulting rooms. If you want to see the difference, go to Deputy Esmonde's dispensary, and then go to a Merrion Square consulting room and see if there is any difference.

Mr. O. Flanagan

Or to Deputy Dr. ffrench-O'Carroll's.

Dr. Browne

I will leave Deputy Flanagan to make his own speech. It is all very well to blind your eyes to this. It would be nice for me to get up and say nice things about my own profession. It is no fun to have to say these things, but I am facing realities and facts. As far as I am concerned, I have been sick a long time, and I have never received anything but the greatest kindness, courtesy and care from my medical colleagues. But that is not the point. It is not a question of how you are treated or I am treated. It is a question of how the underprivileged, the poor man, the man who has nobody behind him, who has no wealth behind him, no power behind him is treated. These are the considerations which must be faced.

The Medical Association naturally did not like my scheme. How could they like it? They probably would not get paid as much under my scheme as they are getting paid at present. Deputy Dr. Esmonde said that I had made a certain statement about doctors. I did not. I made it quite clear that they are no worse than any other section. I think that generally speaking our general practitioners do a fairly good job, but if we are to have a first-class health service we must eliminate the differences between the two types of service.

Ultimately I believe we will have a full-time salaried service. I know that is unpopular with my medical colleagues. But I am certain that it will come, and it will depend on the social development of our State whether it will come quickly or slowly. We are living in the same T. model stage of social development as any young State. We are taking on the same levels, the same divisions as existed in England and other nations which are already growing out of these things and casting them aside as providing an indifferent service and reducing the quality of existing services. I think that for the time being the full-time salaried medical officer would not give us the best service. I think Deputy Costello was hardly kind or fair to the full-time officers throughout the country who are doing a pretty good job in difficult circumstances at present. When I say that, I do not think the full-time salaried officer is likely to be desirable at present though it may be the ultimate ideal. We must remember that everybody in this House is a salaried man. The man who works for his salary is not a new institution; it is not a new idea. Why should not a doctor work just the same as a teacher or a T.D. or a civil servant or a shopkeeper?

There is a lot of nonsense talked about the doctor-patient relationship. That relationship is an important thing. But there is no reason in the world why it should be interfered with or why it should be altered just because under a State service you do not happen to have to hand over £5 or £2 2s. to a doctor; that it is done by the local authority or by the State. Why should that interfere with the doctor-patient relationship? The fact that you hand over the money or that the State hands over the money, why should that interfere with a doctor's treatment of you or your respect for him? I do not think that it would interfere.

As I said, I believe that ultimately we will have a full-time salaried medical service even if we do not want it. The fact that there has been such a development across the water will inevitably mean that most of our young doctors who are being taught to take part in a full-time service will accept it as perfectly normal and natural. They will come back here and these ideas will be accepted. As I say, it is a thing which will come by evolution and will take time, but it is inevitable and cannot be avoided by the Medical Association or by any inept, incapable or indecisive Government.

It is likely that we will be discussing this matter again, but it is worthy of note, first of all, in relation to the mother and child scheme that Deputy Costello stated that there was no such scheme, that it did not exist at all, and various other things. The fatuity of such a suggestion from a man who was head of a Government which voted the best part of £1,000,000 for the scheme hardly bears examination or listening to. As the same man negotiated as an advocate for such a service with the Medical Association on his own admission, that takes a little bit of believing or accepting from one for whom we have the right to have a certain amount of respect. Deputy Dr. Esmonde suggested that the equipment was not there, that the hospitals were not there and the staff was not there. It would be interesting to know, if there is a limitation in staff, a limitation in equipment, a limitation in hospital services, who is getting the services at the moment. Would it not be correct to suggest that in many cases the people who are getting the services at present are the people who can pay for them, the people who have money? Even if there was a limitation of hospitals, nobody has suggested that there is any limitation in the number of doctors throughout the country who would be available for this service.

It is important to bear in mind that the Oireachtas in 1947 laid it down that there shall be no means test in the mother and child scheme. It is also important to remember that nowhere throughout their condemnation of my scheme did the Hierarchy object to this scheme because there was no means test. There was no specific mention throughout their condemnation of a means test as such. The only people who objected and passed resolutions against this scheme because it had no means test were the Medical Association. It is the Medical Association that we are fighting here on behalf of the people. It is they who attempted unsuccessfully to usurp and to repudiate the will of this House, and it was in defence of the will of this House and the supreme authority of this House that I took the steps I did take at that time.

There is one other point which I would like to refer to the Minister. It is in connection with the salaried officers whom the Medical Association are very anxious to remove from their posts. One of the most satisfactory things which we had the pleasure and privilege of doing in the Department of Health was the establishment of full-time salaried officers of a very high level, specialist level. We intended to carry out extension of this service. We started off with a thoracic surgery service. It was the intention to develop an orthopædic service, then as Deputy Costello suggested, gradually to develop pediatric, gynæcological, obstetrical and radiological services, and to have such schemes on a regional basis. That is an excellent idea, and one that will materialise in time, I am certain, but it looks as if the Medical Association are anxious to destroy that proposition at this early stage.

The House does not have to accept my word or my suggestion or my view on this. The realities are these, that we started two and a half to three years ago to do something in relation to thoracic surgery in this country. The position was—I myself knew it only too well—that it was not possible for a man who did not have money, outside two sanatoria in the country, to obtain essential major thoracic surgical operations which might save his life, and at that time we set about establishing a regional thoracic surgical service which is now in being. Most Deputies are probably aware that in that service, probably one of the few things in which we are, we in Ireland are right up in the European class. Our people can feel quite satisfied that as far as this particular State service or public service, whatever you like to call it, is concerned, we have as good as there is in Europe and I think as good as there is in the world. In that service there are full-time officers doing a great job and saving plenty of lives. The extension of that service to orthopædics has begun and the Medical Association are anxious to destroy it. The idea is that they want to save some jobs for their friends who used in the old days travel from Dublin, Cork, Galway or Limerick, wherever the family cliques and rings were, and take these county jobs whenever they had the time to collect the five guineas or whatever it was. That is the blank truth. It is not very pleasant. I fought it successfully in the thoracic business and was in the process of doing so in the orthopædic business. I wanted to do it in the case of every branch and if God gave me the opportunity to get back again as Minister for Health I would pursue that policy to its logical conclusion, so that we would have what we profess to want, the best medical service for all our people, irrespective of whether they have money or not.

Attempts have been made in recent months to stay the progress of this Department towards the ideal which it should be the intention and the object of every member of this House to achieve, that is, that in that part of our life where the health of our people is concerned we should not start to readopt the old ideas, the old social forms of the people who left 30 years ago, when the community was divided into the people with money and the people without money, the haves and the have-nots. Where did we get this idea that we, a people who 30 years ago all belonged to the same level, the same social class, the same economic class, should now start to divide up our community again in respect of our health services? Personally, as far as that is concerned, I consider it to be a major political issue, which I hope we will have an opportunity of discussing more fully at a later date, because to me it involves a division: on one side the people who showed themselves so clearly in the election to be the adherents of the old régime, the old ways, the ways of privilege, the ways of wealth, the ways of the rich against the poor, the ways of the strong against the weak. As long as I am in this House, unashamedly, no matter what it may cost in votes, popularity or prestige, I will fight those people as long as there is breath in my body.

Mr. D. Costello

The regrettable controversy which has raged in the country over the last few months over the mother and child scheme, served at any rate one useful purpose. It has focussed the attention of the public for the first time in any large degree on the question of the health services. While, since the foundation of this State, much progress has been made in alleviating the social ills which obtained in this country, the health services of the State have been one of the social problems which, up to recent years, have been comparatively neglected. To my mind, it augurs well that so much interest, so much controversy, even though it was so heated and so bitter at times, has now been focussed on the health services of our State, because I am convinced that the health of our people is now the major social problem which faces any Irish Government that may be in office.

In tackling the public health services, the Minister, as Deputy Dr. Esmonde has pointed out, should start from the bottom of the ladder. Whether or not there may be a case for abolishing the dispensary system which is known as the red ticket system and for introducing some sort of national contributory insurance scheme, there is still, none the less, in the short-term, a great and vital need for improvement in the dispensary system as we have it to-day. Whether that system will be abolished or not remains a question for the future. In the short-term, the task of the Minister at present is to see that the existing dispensary services are improved.

It must be quite obvious to the Minister, to any doctor, to every Deputy, to any patient who has had any dealings with the dispensary system that it is full of anomalies and most inadequate to meet its requirements. First of all, particularly in the Dublin area, there are not enough dispensaries; there are not enough doctors. It must indeed appear strange to Deputies that there is to-day the same number of dispensaries in Dublin as there was when the system was first established over 40 years ago. I know that a recent survey has been carried out of the dispensaries in the Dublin area. I think certain recommendations have been made. I hope the Minister will act on those recommendations and that the number of dispensaries in the City of Dublin will be increased and that the number of doctors will be increased. Similarly, one of the matters that requires attention in the dispensary system is that there is no secretarial staff attached to the dispensaries. The result is that doctors have the task, sometimes the onerous task, of registering births and deaths, and so spending portion of their time which should be given in attendance to the patients doing secretarial work which could be done by clerical officers if appointed to the dispensaries.

The third matter which requires attention relates to the buildings in which the dispensary services are operated. Deputy Dr. Esmonde, speaking from experience, has told the House of the sort of buildings these are. I think that his experience must be fairly common amongst dispensary doctors throughout the country. It is an experience which is regrettable. This is a matter which calls for immediate attention and remedy on the part of the Minister.

I should like the Minister to refer to page 65 in the First Report of the Department of Health. Deputies will see from that report that it is proposed to earmark £400,000 for the improvement of the dispensaries throughout the country. I should like to know from the Minister when he proposes to spend that money. I hope it is his intention to expedite its expenditure in order to ensure that a service which is of daily and vital interest to our people will be improved at the earliest possible moment.

The Minister will have the task of introducing the regulations to be made under the 1947 Health Act in relation to the mother and child. Deputies will understand that these regulations will be of the greatest importance to the health of our people, and so the Minister, in drawing them up, will need to have regard to the existing facilities for mother and child welfare. What, in my opinion, is more important than the drafting of the regulations, is the provision of adequate services to service the scheme when it is put into operation. As regards the Dublin area, it is well known that the number of beds in the maternity hospitals is so totally inadequate that mothers have to leave them from five to eight days after the birth of their children.

It is not merely the desire of the alleged social reformers that increased facilities should be provided in this respect, but it is the recommendation of that much maligned body, the Irish Medical Association, that additional bed facilities in the Dublin area be provided. I understand that the figure for the Rotunda hospital is 100 beds; Holles Street, 100 beds, and the new Coombe hospital, 250 beds.

The Minister, in drawing up his scheme for the mother and child, must bear in mind that the facilities to work it must be there beforehand, and that these facilities must include ample bed accommodation for those in need of it. In the drafting of such a scheme, and in bringing his proposals before the House, I would ask the Minister to keep in mind a system of child welfare which has been started on a very small scale in this country, and which, I understand, is in operation in Holland and on a small scale in Denmark. I refer to the system of health visitors. I think that if the Minister could introduce such a scheme here it would bring immediate benefit to our people. If regulated in a proper way it could provide for a full and an efficient system of health visitors, who would visit the homes of the mothers after birth, advise them on such matters as hygiene and diet, the manner of feeding the child, on how the house should be kept, and, in recommending improvements. This system has worked admirably in Holland, and it could be worked here. One of the reasons for the high mortality rate amongst young children in this country is that sufficient steps are not taken on preventative lines. We have not done enough in the direction of advising mothers on matters such as hygiene and diet in order to prevent the diseases which children are subject to.

I would also ask the Minister to consider a scheme of voluntary contributory insurance which again is being worked in many other countries. In America they have what is known as the Blue Cross system. In Denmark, too, they have a system of voluntary health insurance. In England, between 1932 and 1939 there was a large-scale system of voluntary health insurance. I would ask the Minister to consider the adoption of such a scheme here, so that our lower middle classes, who are really more adversely hit by economic conditions than any other class, would have an opportunity of contributing to it. In that way, they could insure themselves against the expenses which so frequently arise during periods of ill-health. Such a scheme, as I have said, has been operated successfully in other countries. It could be operated here by a voluntary body, not under the control of the Minister. It could be operated by a national medical council, such as that advocated by the Irish Medical Council and in the report of the Commission on Vocational Organisation. Such a body, while not under the control of the Minister, would, at the same time, require State assistance to ensure that its finances would be maintained on sound lines. I think that such a scheme is worth considering.

I would ask the Minister to examine the Blue Cross scheme in operation in America, and the voluntary schemes which have worked successfully in other countries in order to see if we could introduce here, along with our present scheme of free, assistance for mother and child, a scheme by which those people, who do not come under the present free scheme, would be able to contribute to it voluntarily, and thus insure themselves against the costs which arise from medical attendance at birth and medical attendance for children.

The Minister will, of course, be aware of the large-scale planning for hospitalisation contained in the report of the Department. I think the House would like to know his views on this proposed hospitalisation, and whether he approves of the regionalisation of hospitals which the scheme proposes. I think that the regionalisation of the hospitals of this country is an admirable scheme. There has been too much centralisation in Dublin. Such specialised subjects as pathology and radiography are largely centred in Dublin. A scheme of large regional hospitals would tend to obviate that tendency. I understand it was the intention of the last Government to do that. It would help, to a large extent, to obviate the present tendency of centralisation of many of our specialist services here in Dublin. It would also help to give a better service in those centres where the present specialist services are totally inadequate or nonexistent in some cases.

Finally, in reference to this large-scale building programme which has been envisaged by the Department, I would like to say that I consider the provisions of the Public Hospitals Act which gave the Minister for Public Health such extraordinary and almost despotic power over the funds of the Hospital Trust, should be amended. I think the power which is given to the Minister for Public Health under the Public Hospitals Act of 1933 should be cut down. As it stands at present, I understand the law is that the Minister, without reference to the Hospitals Commission, without reference to the Government, without reference to the Department of Finance, can institute, how he pleases, such buildings for public hospitals, such improvements in existing hospitals and in the dispensary services as to him at the time may seem fit. I do not think that that power has been abused in the past, but the power is open to grave abuse.

There is not only the obvious abuse of political pressure being put on a Minister for Health to sanction payment out of the Hospitals' Trust Funds towards hospital building in one particular area. There is one other abuse which could creep in of cutting down funds to voluntary hospitals in order to strangle them in pursuance of some doctrinaire policy which the Minister for the time being may hold. These are real dangers, and at the present time we should take steps to see that they are avoided. I would be in favour of seeing some sort of control over the spending of the Hospitals' Trust Funds either by means of the Hospitals' Commission as it exists at present, or by means of Government decision on any moneys that are spent by the Minister for Health in pursuance of the Public Hospitals Act, 1933.

I would also like to see some system instituted by which the House would have the opportunity of discussing any proposed large-scale plans for hospitalisation or the improvement of the existing hospitals in the country. I advocate this because I feel that the danger I envisage is a real one. The power put into the hands of the Minister for Health at the present time is an extraordinary one and, in present circumstances, a dangerous one. My view, and, I think, the view of every Deputy, is a desire to have an improvement in the health services of this country. I am completely in favour of spending the Hospitals' Trust Funds in a manner most advantageous to the country, but I do not think that these funds should be spent at the caprice of one individual Minister. The Government should have a say in the spending of the money, and the House should have an opportunity of discussing such expenditure.

As I say, I am in favour of the large-scale regional hospitals which are proposed. I am in favour of spending the trust funds money at present existing on improving our dispensary services and improving the existing maternity and voluntary hospitals in the City of Dublin, and I urge the Minister to proceed, with all due expedition, with the work of spending that money.

Mr. Corry

I would like, on this Vote, to pay tribute to the former Minister for Health, Deputy Dr. Browne. I pay tribute to him as one who saw his work and the effects of his work, not only in my own constituency but throughout County Cork. When he took over office he lined up the sanatoria at Mallow, Macroom, Skibbereen and Millstreet—four extra hospitals in three years. There is many a patient at home in Cork, happy and healthy to-day, who would have gone to his grave but for the manner in which beds were provided by Deputy Dr. Browne. I am one who was politically opposed to him during that period but, nevertheless, one who recognises his worth at all times.

I do not know what Deputy D. Costello was aiming at when he pointed out that he was anxious to remove certain powers in regard to the Hospitals' Trust Funds from the Minister. I am wondering if he is going to suggest that these powers should be handed over to the Medical Association. As one who approached Deputy Dr. Browne when he was Minister for Health in connection with the regional hospital and the maternity hospital in Cork, I must say that the manner in which he treated us was a generous one. I do not think that he should have had any political leaning towards Cork because, as far as his Party was concerned, it had got no seat in Cork County. Still, he came to Cork and did his part.

Our local Board of Public Assistance, who are getting roughly £3,000,000 from the Hospitals' Trust Funds, are going ahead with plans and specifications for the Cork regional and materity hospitals and are procuring specialised treatment for both. I think that Dr. Browne's worth as Minister for Health was generally recognised and that the general run of the people of this country deprecated the manner in which he was removed from office. I do not wish, a Chinn Chomhairle, to delay the House, as I understand that time is limited on these matters. However, I feel that I would not be doing my duty to my constituents and as chairman of the South Cork Board of Public Assistance if I did not pay tribute to one who, whilst politically opposed to me, still did his work well and did credit to the office which he held.

I have heard a lot of talk here about dispensary doctors. I believe in having a dispensary doctor a whole-time official, paid as such and prevented from engaging in any private practice whatever. My experience has been, and it is a pretty wide one, that a poor person coming to a dispensary doctor with a red ticket will be seen but once. When he comes a second time he will be given a ticket for the hospital. Such has been my experience, in fact my general experience. As one who has been a member of a board of public assistance for the past 26 years, I must say that, whatever good there was in the old people, there is much less in the present generation. Indeed, the younger they are the less work they are inclined to do for the remuneration they receive. I would be totally in favour of a system under which a dispensary doctor would be a whole-time official, definitely prevented from engaging in private practice. I did not hear much in this House about the £400,000 that is allocated for the improvement of dispensaries.

If it is going, I can promise the Minister that I will be calling on him next week for a pretty good whack out of it, because there is no doubt that our dispensaries in the South Cork area need improvement and there is no Deputy here who is a member of the South Cork Board who will not agree with me in that. I do not see why we, as ratepayers, should be asked to foot the bill, while Dublin, from what we can see, is to collar all the money. If there is money going, we want at least our share and I can guarantee that, while I am here and while I have a good team representing the South Cork Board with me, we will get our whack.

Mr. Rooney

It was very amusing to hear Deputy Corry praising Deputy Browne, when we remember the first few months the inter-Party Government were in office and when Deputy Browne was carrying out an inspection in Deputy Corry's constituency of the conditions in relation to the need for hospitalisation. It would be laughable if we could now quote the criticism directed towards Deputy Browne by the Fianna Fáil Party at that time because he was carrying out a personal survey of conditions in hospitals throughout the country.

Mr. Corry

It was I who, as a member of the Cork County Council, announced publicly that Deputy Browne's statement as to what he required the Mallow Hospital for had converted me to his viewpoint and who moved that he get Mallow Hospital. I give credit to a good man any time —sometimes even to Deputy Rooney.

Mr. Rooney

I am not in a position to contradict Deputy Corry's statement. The present Minister has taken over a Department which was brought to life by the inter-Party Government. Deputy Browne, as Minister, pursued the tuberculosis campaign vigorously and enthusiastically and his administration in that respect was eminently successful. We have only to compare the programme now before the Department with the programme before the inter-Party Government when it took office to see the different approach to matters relating to the health of the nation. It would be absolutely unfair to disregard the work carried out by Deputy Browne during his first years of office. He certainly did his job well and he has the appreciation and gratitude of the nation, particularly in relation to tuberculosis, but apparently what happened towards the end of his period of office is somewhat similar to what happened to the cow that filled the bucket full of milk and then kicked it over.

With regard to this problem of hospitals, we find, in general hospitals where there is a need for more accommodation, portions of these hospitals set aside for children and I advocate that we should have a proper children's hospital. The medical profession in general are in favour of a hospital in which all children would be accommodated, instead of having a room full of children in one hospital and another room full in another. One finds that position in many of the general hospitals in the city.

The dispensaries which have been referred to are in many cases primitive. It was suggested that we should start at the bottom rung, and, if we improved conditions in the dispensaries, it would be a first step towards improving the health of the nation, because the dispensary can be regarded as the health centre in each locality. A survey of County Dublin was carried out some time ago by the county medical officer. He was accompanied on his tour of inspection by several councillors, and the primitive conditions existing in some of these dispensaries, with their lack of light and any kind of proper amenities, made us realise that the first problem to be tackled is the provision of proper dispensaries for the people in the different areas.

I should like to urge also that the pay and conditions of nurses should be improved. The hours of duty are in many cases too long. Conditions were improved, I know, both in the matter of pay and hours of duty, with the formation of the inter-Party Government, but there are still complaints by the nursing associations that the pay is inadequate and the hours of duty of nurses too long. I hope that some new regulation will be brought into force to improve these conditions. The profession of nursing is a vocation, and a very unselfish vocation. It is more of a vocation than a profession because the conditions existing in it cannot be regarded as attractive and it must be an unselfish vocation which induces girls to take up nursing.

The Minister should also have a survey of the hospitals carried out in order to ascertain the amount of improvement and maintenance which existing hospitals require. Only yesterday, as a visiting governor to the Meath Hospital, I visited the hospital and saw the very great need that exists there for proper painting and cleaning up—something which has not been done for a very long time. Possibly that work might have been done but for the war, but there are probably other general hospitals which need similar cleaning up and incidental repairs.

I heard Deputy Browne say that the service available to the poor is not the same as that available to the rich. I do not think that is a fair statement and anybody knowing the service and the accommodation available to the very poorest of our people in Dublin Union will be ready to contradict that statement. The service and conditions there are comparable with the best in Dublin City. People become alarmed when it is suggested that they ought to go to the union, but, when they go, they are amazed by the wonderful service available to them. The service is only the best and that is at it should be. I hope that the conditions existing in Dublin Union will be provided in all other institutions in which the poor are being treated.

Progress reported; Committee to sit again to-morrow.

The Dáil adjourned at 10.30 p.m., until 3 p.m. on Wednesday, 11th July, 1951.

Dáil Éireann debate - Tuesday, 10 Jul 1951

Committee on Finance. - Vote 67—Health.

Dáil Éireann debate -
Tuesday, 10 Jul 1951