Committee on Finance. - Vote 67—Health (Resumed).

In the course of the discussion on this Estimate reference has been made——

Would the Deputy please allow me? Deputy Rooney moved to report progress last night.

I would like to bring to the Minister's attention the very serious lack of accommodation in our mental hospitals, particularly in Grangegorman Mental Hospital which is world famous from the point of view of its medical services and which is, I think, the biggest in the country. Yet, the accommodation there is inadequate. I would like the Minister to consider the possibility of improving conditions there and improving the amount of accommodation both in Dublin and elsewhere.

I want to refer now to the hospital programme. As far as I remember, the figure in connection with that programme was £7,500,000. A certain number of hospitals were included in that general plan. Other hospitals, even though they were in need of a certain amount of financial assistance, were excluded. I want to refer in particular to the hospital at Baldoyle which is more or less an adjunct of Cappagh. We all know the wonderful work that is done in Cappagh for children. When children have received the necessary treatment at Cappagh they have then to be brought back by easy stages to normal life. They cannot just be pushed up into possibly overcrowded homes where the work done in Cappagh will be undone due to environment. They must be given a chance to rehabilitate themselves after treatment.

Cappagh Hospital cannot afford to keep the children after they have completed the course of treatment, since that institution must have accommodation available to take others needing treatment at the earliest possible moment. Those requiring rehabilitation are transferred to Baldoyle. A child who has received treatment for a deformed leg cannot just get up and walk as soon as the treatment is completed. The child must be brought back to normality in easy stages. That part of the work is done at Baldoyle Hospital, but the accommodation at Baldoyle is absolutely inadequate.

If we regard this hospital as one working in conjunction with Cappagh —that is the way we should regard it because Cappagh has not the accommodation which will enable it to carry out the type of rehabilitation done at Baldoyle—we find the children in Baldoyle not having any kind of adequate accommodation. Finances should be made available so that some proper housing accommodation could be provided for these children. At the present time the children are accommodated in some kind of old wooden structure, very nicely kept inside by the staff but absolutely inadequate for the purpose. I hope that the Minister for Health will carry out some alterations in the general hospital programme so that certain hospitals which were not included in the general plan can now be included and the necessary financial assistance made available to them. I feel that if this is done, it will be a very great service to the many young children going into Cappagh. It will put the finishing touches to the worldfamous treatment made available at Cappagh Hospital.

I mentioned last night that I thought we should begin by improving our dispensaries because the dispensary is really the health centre for the majority of our people. Recourse can be had to the hospitals when a case becomes more serious, but the dispensary in the first instance is the health centre. I hope, now that the city boundaries are being extended, the Minister for Health will ensure that a clinic will be provided in or near Finglas within the shortest possible time. There has been an agitation for a long time to have such a clinic provided at Finglas. Those behind the project were the Jubilee Nurses' Association. We are all aware of the great work done by that voluntary organisation in various localities and they are very anxious that a clinic should be provided at Finglas, having regard to the growing population of that area.

Similarly, I know that there is a convalescent home for nurses at Howth. Some kind of grant was made available by the Department of Health which enabled that building to be renovated. There are certain extensions still needed and it is only right that we should have a proper convalescent home for nurses who fall ill while rendering service to the sick in various hospitals. I believe myself that this Howth convalescent home should be brought to a stage which would enable us to provide suitable treatment for nurses who fall ill in the discharge of their duties.

I understand from the Minister that it is proposed to implement the Health Act, 1947, about which there was so much controversy. I should like the Minister to tell us whether he intends to clean up that Bill. There are certain clauses in it which were considered objectionable. They were believed to be a violation of the Constitution and it was considered that certain provisions of the Bill offended the propriety of the individual. These matters were pointed out to the present Minister when he was Minister for Health in 1947 but no action was taken. I think the medical profession in particular pointed out these clauses. At a later stage, a letter was directed by the Irish Hierarchy to the Fianna Fáil Taoiseach of that time. Apart from a formal acknowledgement, that letter was not replied to. I feel that ordinary courtesy demands that some action should be taken and certainly consideration should be given to the representations made.

I want to know from the Minister whether it is intended to amend the 1947 Health Act in any way. The argument was put forward by the former Minister for Health, Deputy Dr. Browne, that if it were proposed to implement another mother and child welfare scheme, apart from the one which he was anxious to implement himself, it would be necessary to amend the 1947 Act. I want to know from the Minister whether it will be necessary to amend the 1947 Act if it is not intended to put through the scheme which Deputy Dr. Browne had in mind or whether it is his intention to put through the type of scheme which Deputy Dr. Browne was anxious to implement some months ago. I think it is only right that we should hear from the Minister about the 1947 Health Act in regard to which there was so much controversy and, possibly, misunderstanding. He should clear the air for the House and the country.

In the course of the debate on this Estimate, various aspects of the entire health services have been adverted to. Some Deputies have, of course, concentrated on particular aspects, but anybody who surveys our health services to-day must realise that these services fall far short of the standard necessary to provide adequate treatment for our people and to improve the standard of the nation's health. It is quite true, of course, that during the past 30 years considerable improvements have been effected in our health services. It is quite true that the standard is better to-day than it was 30 years ago but, having said that, one cannot feel satisfied that our services have yet reached a standard with which we can be content or that they are as good as they are in many other countries with resources not very much greater than we have here. Let it be said, because I think it is too often ignored, that for a good deal of the improvements which have been secured in our hospitals and sanatoria we have to thank the Hospital Sweepstakes Fund. Were it not for the very substantial sums made available from the sweepstakes for the past 20 years, one wonders what our hospitals and sanatoria services would be like to-day. If you subtract from what has been injected into the provision of hospitals and sanatoria the amount of money received from the Hospital Sweepstakes Fund, you will find that the State itself was a relatively small contributor to the funds provided for this purpose.

It is clear to anybody who has given the matter any thought that what the country needs to-day is not just a mother and child scheme but a comprehensive health service covering not merely the mother and child but also citizens who are not mothers or children. Concentration on one aspect of our health service can only lead to neglect of other aspects of that service which are no less urgent and the provision of which will make no less contribution to the nation's welfare than the provision of a particular health scheme. To-day we have no comprehensive health service. Our present health services are disjointed; they are unco-ordinated and deficient and there is still, unfortunately, painful evidence that it is the depth of the purse and not the need of the citizen which determines the standard of medical service provided for some of our citizens. We have got to abandon that mentality entirely. The test of medical treatment ought not to be the depth, width or length of the purse. We ought to organise, not one aspect of our health services, but all aspects of our health services on the basis of giving to each and every citizen the best possible medical service and the best skilled attention that can be made available for the provision of curative treatment for our citizens.

We can see before our eyes to-day the deficiencies which loom up before us in the matter of our health services. Take the position, for instance, of the mentally defective child. Will anybody who has taken the trouble to study the problem of the mentally defective child attempt to say that our present facilities for dealing with that problem are anything like adequate?

If any Deputy tries to get a mentally defective child into an institution he will realise how woefully inadequate is the institutional treatment provided. There is no other form of treatment available for the child; it is impossible to treat mentally defective children at all. Mothers beset with the problem of looking after other children cannot possibly concentrate on the one mentally deficient child, particularly if that child has got habits which are known clinically as the habits of smashing. The only treatment available for that type of child is in an institution, but there are literally thousands of children waiting to get into those institutions. These children are not cured when they go into these institutions; they are merely housed there. There are no discharges from the institutions and no vacancies except those created by death or the extension of the buildings. The result is that there is a complete clutter up in these institutions. They want to do more work, to accommodate more children and to discharge the high mission which the religious orders conducting these institutions undertake, but they are frustrated in doing so by insufficient funds, insufficient accommodation, with the result that the unfortunate mother has to deal with the mentally deficient child at home and is unable to get for that child the proper institutional treatment which we ought to provide if we have any pretence to be a civilised community.

One has only got to visit the St. John of God's institution at Blackrock, the other institution at Drumcar, or the Stewart institution at Palmerstown to see the magnificent work which is being done for the mentally deficient child. One has only got to ask the medical superintendents in these institutions if they are in a position to offer accommodation to all those seeking admission in order to be speedily awakened to the fact that they have applications from all over the country and are compelled to refuse them. Not only that, but these institutions find themselves in such a financially embarrassed position that they are unable to undertake the provision of extended accommodation to provide the means of housing mentally deficient children.

It is true that some money has been given to these institutions, but it is a mere drop in the ocean compared with what is needed to provide adequate institutions for the accommodation of these mentally afflicted children. Until we face up to that problem, do it speedily, do it in a big and comprehensive way, we cannot claim to have tackled wholeheartedly, or with a view to arriving at a satisfactory solution of the problem, our medical services.

Take the treatment of the blind. There are three or four institutions which cater for blind persons. One is the St. Mary's institution run by the Sisters of Charity at Merrion which does excellent work there under the most difficult conditions. It is a pleasure to anybody to visit that institution, to see the loving care bestowed by the nuns of that community on the blind entrusted to their care and their zeal and enthusiasm to do the best they can to equip the blind child for the battle of life. Nobody who has seen that institution can have anything but the highest admiration for the magnificent work which goes on there in order to give the handicapped blind child an opportunity of fighting the battle of life and taking his or her place in the community of which he or she in better circumstances might be a normal member.

Then when one goes to St. Joseph's institution at Drumcondra one finds about eight Carmelite Brothers, the only members of the Order in Ireland, with no recruitment into the Order I think for the past 15 years, struggling against a constantly mounting bank overdraft to try to provide accommodation for the blind persons in that institution. They have no money to buy the barest necessities of the institution, no money to repaint it, no money to provide proper bedding and clothing.

I paid a visit to that institution three years ago and I felt it needed money so urgently for painting, renovation, decoration, structural alterations, improved toilet accommodation and the provision of better beds and better bed clothes that I resolved to try to get them some money. After about three years' hard work we managed finally to get them a sum of over £20,000 for the purpose of carrying out certain reconstruction and renovation work which was absolutely necessary. That money was got from the Hospitals Trust Fund and then I believe only on a rather strained interpretation of the relevant Act which threw some doubt on whether money, in fact, could be made available for an institution of that kind which was not a hospital or a sanatorium. That institution has to be run on what it can collect from door to door and with the relatively small assistance which it has received from the State and the local authorities in respect of patients who reside within the institutions. As I say, when one sees the accommodation provided for blind persons and goes and sees similar accommodation provided in Belgium, Holland, Norway, Sweden, Denmark and Switzerland, one realises how far behind, at times, is the accommodation and the amenities which we provide here in comparison with those provided in other countries where the same problem has to be faced and where it has only been successfully faced on the basis of State intervention, that is the State making the funds available to do this necessary work.

The question of dispensaries has been raised here. While many things have changed in this country over the past 30 years, while the face of the world has changed and the face of the frontiers of Europe has changed, the one thing that has not changed in Ireland has been the dispensary. It has withstood the downfall of empires; it has withstood changes of frontier; it has seen gigantic armies march across the frontiers of Europe, gigantic nations tumble and a world cataclysm. Still it has survived all that. There it still is—an immovable relic of the detestable poor law system of other days. I do not blame any particular Government for this. I think it is a reflection on and a shame for every Government, and contrary to our whole concepts of human and spiritual values.

I recall that in my own constituency in 1938 and in 1939 we tried to get four dispensaries built at a cost of about £2,000 each. However, the wiseacres in the Department of Local Government said: "That is far too dear." Nothing was done during the emergency, and afterwards the county council advertised for the building of the four same dispensaries and got tenders in at nearly £8,000 apiece. Again, the wiseacres in the Department of Local Government said: "That is far too dear." This state of affairs will go on for another two years, and by then the cost will have further increased. If somebody had taken time by the forelock and had showed some little imagination, the dispensaries would have been built in 1938 at a cost of £8,000 for the four, but they would now cost £30,000 or £32,000. One cannot get a properly organised dispensary service by this crab-like approach to the whole problem.

In the main, our dispensaries, as to 90 per cent. of them, are bleak buildings, unrelieved in drabness, cold, usually dirty, and rarely painted. Anybody who goes into a dispensary for the purpose of having a disease treated comes out again with the disease coupled with a good cold or a good does of influenza. Children who have got to be brought there for treatment, must stay outside in a queue in their prams until their turn comes. I am not blaming the doctor for this, because he cannot build a new dispensary and, if a nurse is in attendance, I am not blaming her. All this is the function of the local authority, and the work should be spurred on by the Department of Health. A new crusade to provide decent dispensaries should be launched — comfortable places where people will find conditions tolerable when they have occasion to visit them, where they will be encouraged to come and get the best medical advice that is available—so that the dispensaries themselves will not have the forbidding appearance and the grim outlook that they have to-day.

I hope the Minister will give attention to the problem of dispensaries. I do not blame any particular Minister or any particular Government in a matter of this kind. It is a festering sore that we have never got down to eliminate. We ought to do something in the way of providing decent dispensaries for our people. There is no reason why we cannot do so. The money is there, the material is there, the labour force to build the dispensaries is there and both the materials and the labour force are likely to become available in increasing quantities in the future as the housing problem moves on speedily towards a solution.

All schemes of health services throw up at once the question as to the method of financing those schemes. That arose particularly in the case of the mother and child scheme. A considerable amount of time and attention was given to the question of providing a mother and child scheme as part of a scheme of general medical services. As I said at the outset, what we need is a comprehensive medical services scheme covering the entire country and open and available to every member of the community.

Dr. Browne has referred to what he described as his mother and child scheme. It is not necessary now either to go into the details of that scheme or to refer to the circumstances in which it was abandoned, except to say this: since Deputy Dr. Browne has pontificated on that matter so much and so often, and so frequently indulged in serious misrepresentations of the facts and of the views of others, if that scheme had been handled by any Minister with ordinary care, with ordinary prudence and by a Minister who did not believe in bull-in-the-china-shop tactics, that scheme might well have been brought to maturity by this stage. But Deputy Dr. Browne, as he now is, was heedless of advice from his own colleagues, was heedless of the efforts of the Hierarchy to help him—and they tried to help him and not to thwart him; I know that from my own personal experience as one who tried to help him. If Deputy Dr. Browne had heeded the advice of his own colleagues, had taken from the Hierarchy the assistance which they were willing graciously and generously, to give, he need never have found himself in the difficulties which subsequently arose in connection with that scheme. In short, if Deputy Dr. Browne had behaved in this matter as Deputy Dr. Browne and not tried to emulate Dr. Goebbels in the ukases which he was issuing in the matter, we might have had a satisfactory mother and child scheme in operation to-day, in operation with the goodwill of all Parties, a scheme which would, in no sense, offend against Catholic teaching from any particular angle.

Deputy Dr. Browne, in the matter of his handling of that scheme, has now thrown up for solution very serious problems which must be solved by any Minister dealing with the question of health services in this country. I believe there is no question among our people in this House, with, perhaps, a few exceptions, that we want to respect the Catholic teaching of the Hierarchy of this country.

I see no future for a nation, especially a nation religiously constituted as we are, which does not, nor, if I were to deal with the matter on a materialistic basis, do I see anything better offering for the poor and the weak by the adoption of practices and methods which run counter to Catholic social teaching. Here we have the opportunity of building a health service in accordance with Catholic teaching and Catholic dogma. No serious difficulties can arise in providing a scheme which will conform to the requirements of the Catholic Church in this matter and that scheme could easily have been provided in respect of mothers and children if it had not been for the incompetent and stubborn way in which the whole problem was handled by a Minister who regarded prudence as his enemy and care as something which he was not prepared to regard as equipment in the armoury necessary if he were to guide a scheme of that kind to maturity.

I think we can get a scheme which does no violence whatever to Catholic teaching and which will be found to be in accord with such teaching. We can adopt various methods to finance any comprehensive health scheme. We can impose taxation and at the beginning of the financial year set aside a certain amount of that taxation to finance a defined comprehensive health scheme; we can impose taxation on certain specific commodities and hypothecate that the produce of that taxation will go to finance our comprehensive health scheme; finally we can go over to the insurance basis whereby a health service will be put on a contributory insurance basis, the citizen paying a certain contribution, the employer paying a certain contribution, and the State which must concern itself with the health and the well-being of the nation paying a very substantial contribution. In that way and by the adoption of that scheme——

Why should employers contribute to that type of scheme?

Time does not permit me. I am trying to bring my remarks to a close, but the answer to the Deputy's question is that the decent employer, the Christian employer and certainly the Catholic employer should accept moral responsibility for the welfare of his workers. That is the least he should do and that should be done all the more readily when you remember that many workers do not work under ideal conditions or in ideal buildings. Many workers, to the Deputy's knowledge, have gone home after work in the evening having been exposed to draughts from the broken or faulty windows, defective doors or bad walls and ceilings of many factories. It is the employer's job to take some interest in his workers. After all, if his horse got sick he would pay a vet.

He has to buy his horse.

If his motor car got punctured he would go to the dealer to have it mended. If the factory in which he employs his men needed it he would have it painted. If his office needed a new carpet he would buy a new carpet. If he needed a spread or a champagne party in order to get more business he would have that as well. If he can do these things, why should he not pay a contribution to keep his workers in good health or improve their standard of health? I hope that that is sufficient answer. I am sorry that I must rebuke the Deputy for this decline from the high line of social teaching which has been his guiding star up to recently.

I was only looking for information.

I hope that he has got it.

I have not got the information I wanted.

It has shaken you, anyway.

It has not.

Then you are incorrigible.

I would not like to see any worker dependent on his employer in that way.

There is no question of dependence. It would be done in the same way as national health insurance, employment insurance or widows' and orphans' pensions. Quite frankly, I think that a scheme on an insurance basis is the best in the long run. It puts every citizen on the same basis and every citizen has the feeling that he is paying for what he gets. It forms a satisfactory pool of money from which to provide a decent scheme. As well, the State pays the bulk of contribution because it must all the time concern itself with the promotion of the public health and the public good and with contributions from workers which are easily within their competence to pay I see no difficulty in financing a scheme of that kind.

In practically every country where the best health services in the world are to be found, the schemes are financed on that basis and if the Minister were to look to the New Zealand and Australian schemes he would find examples well worthy of emulation. If it be pleaded that people who are unemployed could not pay, there would be no difficulty in the world because every one of these cases can automatically be covered by the State undertaking to pay their contributions when men are not able to work through unemployment or through physical incapacity.

These are the pure mechanics of the scheme. The principle should be the provision of the best possible health service we can give, making need and not wealth the passport to the best medical skill we can provide. If the scheme is put on a contributory basis, it will, I think, at once overcome any possible objection from the point of view of Catholic teaching and give a health service substantially better than anything we know now. I believe, having given the matter some attention, that it is only through methods such as these that we are ever within a measurable period of time likely to give the nation the standard of health and medical services which our citizens urgently need.

Deputy McGrath rose.

The Deputy will remember that this group of Estimates must come to a close at 5.25 p.m. and that the Minister must have some time to reply.

I would like to support Deputy Norton in his plea on behalf of mentally deficient children. I had experience of trying to get a child into one of the institutions which look after them and it is practically an impossibility, especially for girls. I know of one case which the South Cork Board of Assistance was trying to get into an institution for three years. I would appeal to the Minister to do something about it. I believe that there are about 8,000 cases in the country and accommodation for only about 1,500, and the Minister can visualise what it is to have such a child, as Deputy Norton pointed out, in a small house with other children while the mother tries to look after it.

When the present Minister left office in 1947 he had brought in an Act which greatly benefited the local authorities and helped them to improve their health services. By that Act they were recouped everything above what they spent in the standard year 1947-48 to the extent of 100 per cent. until the amount spent in 1947-48 was doubled. That was of great advantage to the local authority and kept extra expenditure off the rates which was borne by the Central Fund. One group of bodies, however, was neglected—the voluntary hospitals. When the present Minister was in office before, they were guaranteed and their deficits were paid every year, so that they need not depend on the interest from their investments in order to carry on their work. During the last régime that was changed; three years were picked out, 1947-8-9, and the average deficit over those years was taken as the amount that would be recouped.

You can imagine, with the rising cost of everything now, what a hindrance and impediment that is to those voluntary hospitals to carry on. I appeal to the Minister to go back to what he was doing before he left office and to pay the deficits of those voluntary hospitals which are doing such great work for the sick of this country. These hospitals are carried on by voluntary bodies. They are there for accidents and for anything else that may arise. They have a strong claim to have their deficits guaranteed, as formerly. We all know well that they are run as economically as possible. It was entirely unfair to make the change which was made during the last régime.

I would ask the Minister to investigate the position as regards the new hospital which is being built in Gurranebraher, Cork. That hospital was to have been a fever hospital but, at the request of the previous Minister, the corporation agreed to hand it over as an orthopædic hospital and plans were drawn up for such a hospital. Tenders were invited and the building contract was handed to the general building contractor who started work in December, 1949. In that contract there was an agreement that for every week the contractor would be behind time there would be a fine of £150 and that for every week the contractor would be delayed the corporation would have to pay £150 to him. Because of a delay in appointing sub-contractors for the electrical and mechanical installations in that institution, the contractor was held up and where he had 90 men employed the number was reduced to nine or ten men. Some months ago the architect agreed that he was delayed to the extent of nine months. The contractor contended that he was delayed a good deal longer. However, about £6,000 of public money was wasted as a result of the delay in appointing sub-contractors. In addition, there was an increase of about 10 per cent. in wages in the building industry. All that added considerably to the cost of the building. Then there was also a very large increase in the costs of the materials for the building. Quite recently I was inquiring about this matter and I was informed that it was almost impossible to get the equipment originally intended for the mechanical installations of this institution. The plans for that institution have been changed several times. Within the past four or five months a big chimney shaft which was erected in one portion of the building had to be taken down. All the steel specifications were changed although the steel for the institution was on the grounds there and ready to be used.

My experience of the Department of Health is that they are continually changing everything. A question was asked in the House to-day about the erection of a regional hospital at Wilton, Cork. I saw Deputy Hickey laughing and I laughed myself. I should like to know what the changing of plans, since that site was first purchased 18 years ago, has meant in architect's fees. After 18 years, a suggestion was made a couple of months ago that there was a cottage in the way of the avenue and that it ought to be shifted. The Minister should come to a decision and when plans are decided on for these institutions there should be no changing and twisting and giving of money to architects, as has been the case the whole time from my experience under the Department of Health. I think that the case of the Gurranebraher Hospital is a disgrace, where so much public money was wasted.

The regional hospital to-day is still as bad.

That hospital was not even started.

It was planned to cost £700,000 and now it is going to cost £1,000,000.

The tuberculosis benefits which the Minister introduced, and which were of such great benefit, contain some few defects. There is a housekeeper's allowance for looking after the dependents of the patient, but there is no allowance for a sister or anybody else who has to stay at home and look after the patient when he comes out of a sanatorium. I know of cases in Cork where sisters had to give up their work and come home and look after the patient because the father and mother were dead. These girls, who had to give up their jobs, got no allowance whatsoever. I think that that is wrong and I hope that now that I have brought it to the attention of the Minister the matter will be remedied. It is a pity that time is so restricted because there are many other matters with which I should like to deal.

We have orthopædic surgeons who should be encouraged and we have a thoracic surgeon who is anxious to do more work—and all the time we have patients waiting in the district hospital for beds in Mallow. There are about five non-tuberculosis beds in Mallow. The thoracic surgeon states that he is quite able and willing to carry out these operations in the district hospital. He says he has the same facilities there as he had in St. Kevin's Hospital in Dublin. No obstacle should be put in the way of that surgeon's performing these operations in the district hospital in Cork rather than waiting to have them done in Mallow. I think that that would make more beds available.

It would be wrong for any Cork Deputy not to pay tribute to the energy which Deputy Dr. Browne put into his work for tuberculosis patients in Cork. We disagreed with him on many matters. I came in when he was criticising his predecessors for not building the hospitals which I have mentioned quicker but I would say that that was for want of experience. The relatives of tuberculosis patients appreciate the great work he has done and the relatives of children who had defective limbs, and so forth, appreciate the fact that he brought orthopædic surgeons to Cork to look after them.

I do not intend to dwell on the mother and child scheme. I believe that the people who were responsible for that bungling should answer for themselves, but the people who did not know what was going on should have cleared out long before they did.

I am afraid it would be impossible to reply to all the points which were raised in this debate. I have taken a note of all of them and I know that many of the points raised by Deputies will be remedied to their satisfaction. I wish to deal with a few general points. I must say that I resented the implication of the ex-Taoiseach, which amounted really to accusing me of not making an act of faith when I was introducing my Estimate that I was going to live up to Christian principles. I do not think it is necessary for anybody here to make that act of faith, whether he be a Minister or a Deputy, or to state that he will base his proposals on Christian and Catholic principles. I think it would be more Christian if we were not accused of doing otherwise, and I am quite sure that if I should depart from that there will be numbers of Deputies prepare I to cast the first stone.

Deputy Costello also asked me whether the dissolution of this committee composed of members of the medical association and members of the medical staff of my Department indicated that I was following a line hostile to the medical association. It indicates no such thing. I think it was wrong of my predecessor to set up this committee. He put the principal medical officers of the Department on this committee with the members of the medical association and, whatever scheme they might draw up, I would still be depending in the ordinary way on these principal medical officers to advise me on such a scheme.

It is quite obvious they could not give an objective criticism or objective advice since they would be part of the scheme themselves. I therefore withdrew the principal medical officers of my Department from the committee. At the same time I asked the members of the medical association if they would continue and let me have a scheme formulated by them. I hope they will do that. As far as I am concerned I am only too willing to co-operate with the members of the medical profession, the nursing profession, the dental profession and so on. Their help would be invaluable to any Minister.

In reply to some of the questions put by Deputy Costello, I personally am not in favour of a complete scheme of State medicine. Deputy Dr. Browne says that will come inevitably. He may be right; perhaps it will. But in present circumstances, at any rate, I am not in favour of it. I do not want any Deputy to infer from that that I am not in favour of a very full extension of local authority medical services. Some people may regard that as a step in the direction of State medicine. Whether they are right or wrong, I do not know. I believe that local authority institutions need improvement structurally in their dispensaries and hospitals. They also want more highly trained personnel. To that extent I may perhaps be open to the accusation of favouring State medicine. I am not in favour of going further than is necessary to provide the specialised services necessary to give our people the best possible service both in protection and treatment.

With regard to the treatment of mental deficients, when I was in office on a previous occasion I was very interested in that. I visited the existing institutions. I made some progress during the brief period in which I was in office on that occasion towards enabling some of these institutions to extend their accommodation and also some progress towards introducing new people into the field. At the present moment there are plans in progress under which about £1,000,000 will be spent on mental deficients. That will not solve the problem but it is as much as can be done in present circumstances. It is not a matter of finance. It is connected with the problem of building contractors, nursing staffs and so on. These are not available in sufficient numbers. As soon as the present plans are complete I have no doubt but that we can proceed with a further programme. There are between 6,000 and 8,000 mental deficients and they have to be divided into special categories according to sex, age to some extent, the degree of deficiency and so on. It would take a tremendous variety of institutions to deal with the problems properly. It will be some years before we can reach anything approaching the ideal situation.

Deputy Norton referred to a comprehensive scheme catering not only for mothers and children but for other sections as well. I do not think that the need for that was ever lost sight of. The mother and child scheme came in for a good deal of publicity as Deputies are aware, but work was being done all the time for the benefit of other members of society in the building of general hospitals, regional hospitals, the recruiting of specialised staff and for public authority institutions in general. I do not think that the idea of a comprehensive scheme was altogether ignored.

Deputy Dr. Browne referred to our county homes. I am very interested in them and I have read the report drawn up by the inter-departmental committee to which Deputy Dr. Browne referred. The various Departments of State interested in the matter were represented on that committee. A report was submitted. It was a very good report. I have made a particular addition to it and the report will be submitted to the Government and the Minister for Finance for approval. I am sure that approval will be forthcoming. Local authorities will then be notified as to what is expected of them and they will be encouraged to modernise and bring these homes up to a certain standard of ordinary comfort for the older and poorer people who have to take refuge in them.

Vote put and agreed to:—
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.