Dáil Éireann debate -
Thursday, 26 Mar 1953

Vol. 137 No. 8

Committee on Finance. - Vote 63—Health (Resumed).

Captain Giles

The bigger the Estimate we are passing, the calmer the atmosphere. There is a vast amount of money involved in this Estimate, but I am satisfied it is properly spent and is doing an immense amount of good. This is a Department which comes close to the lives of the people and these millions of pounds are being spent all over the country. There is a vast number of big buildings at present and it is time we reviewed the position. I think we are spending too much on buildings and not enough on labour in them. Anyone who looks at the country and the big buildingswould think Ireland was a leper colony, that we were an untouchable nation. Instead of more buildings, I would rather see the money spent on equipping the buildings we have.

Health is one of the greatest assets a human being can have, and he who loses his health is an unfortunate man. Looking back over a long number of years, I believe there has been a vast amount of abuse of health—through overfeeding and overdrinking—and as a result our hospitals are crowded. In other cases there is ill-health through underfeeding. These things need to be rectified.

Mr. O'Donnell

Deputy MacEntee has rectified the overdrinking.

Captain Giles

We should concentrate on putting the homes of the people on a better standard. A vast amount of education of a certain type is needed. We are a fairly well-educated people; even the poorest man can read and write and think for himself, but there is something lacking. All those homes would be more happy and more healthy if we could give them the finishing touch and get the people to realise how to spend their own money in the best way. A vast amount of money going into the homes of many of the poorer and middle-class people does not go where it should go, to the needs of the family. A vast amount of it is squandered, with the result that there is undernourishment and ill-health and our hospitals and homes are crowded with underfed, underclad and sickly children. Money is often spent on drink, overfeeding and gambling which, if it were spent on the family and the home, would mean a saving of millions of pounds. I would ask the Department to concentrate first and foremost on that, before they build any more gigantic buildings. An attempt should be made to train the people in the way to spend their money to the best advantage. If the proper things were done in the homes we would not need half the hospitals.

I see the dispensaries crowded week after week by people with red tickets getting bottles. In many cases these medicines are very expensive and itcosts a vast amount of money to keep the dispensaries equipped and stocked and up to date. Many of these "bottles", or whatever they go for, are not needed at all. If the people looked after their own homes, had proper food and sanitary accommodation and minded their business, they would not need to be calling on the taxpayer to provide bottles for them. Even a cough is used as an excuse to keep the children from school—the poor darlings are in bed, sneezing and coughing and cannot go to school. This costs tens of thousands of pounds to the taxpayers. If the children were well fed in the mornings and were well clad and sent to school, they would not need to worry about the cough and colds and sneezes. These are the things on which the taxpayers' money is being spent and that is why we have to spend millions on health services.

We should have physical culture exercises in our schools for the benefit of the children. At present the physical development of our children from the earlier stages is completely neglected with the exception of a few places here and there. In every national school there should be physical culture exercises to develop our children. If that were done we would have a healthier race of people. At present all over the country you see dwarfed young people who should be manly and vigorous. They are puny looking and when you look at the homes they come out of and the parents they have you think they should be vigorous and healthy. We should concentrate more on the homes and the schools and give our people the things that they need. Physical culture exercises would bring about an immense improvement in our people. They would develop the chests of our children and then we need not worry about having them tested for T.B. or any other disease. In the country the children have the pure air, but they never breathe deeply enough to fill their lungs.

We should also develop the organisation of boy and girl scouts and give our young people a healthy outlook. We should change the present rotten system. Our young people think of nothing but the dance halls, lounge bars, dog tracks and racecourses. Atleast 50 per cent. of the people in hospital at present are there as a result of these things. In that way we could save millions of money.

As far as my county is concerned, we have got a raw deal from the Department. We got practically none of the hospitals' sweepstakes money in my county, although we were entitled to a good share of it, because we contributed a lot to it. We have a county hospital in Navan which was formerly a county home. We have spent thousands of pounds on that hospital, but it has the old county home look still. I am glad to say that we have a very good staff of nurses and doctors there who are giving splendid service. We have spent a lot of money on that hospital to make it as good as it could be. At a future date, when money is available, I hope we shall have a regional hospital for two or three counties and be able to close down these old hospitals.

We have had to attach a T.B. wing to the county hospital because there is no alternative, as the sanatoria are overcrowded. It is disgraceful to have a T.B. wing side by side with the county hospital and not ten yards away a county fever hospital. As I say, my county needs attention in that respect. For 25 or 30 years, no matter what efforts we made, nothing was done for us. We did not get any share of what was going, and therefore I think we are entitled to consideration now. We have a maternity home in Trim which is well equipped, but there are only eight or ten beds in it, with the result that half the people who want to go in there cannot get into it. That should be made into a proper maternity home to serve the needs of the county.

So far as the medical services in the country are concerned, our doctors are a conscientious, noble body of men who are giving splendid services. In most cases their services are given without any charge being made. If they charge what they should charge they would be rich men, but they never do that. There are very few doctors who are out to make big money. They treat their patients very reasonably at considerable expense to themselves, andthey certainly deserve the greatest praise. I hope that the Minister will make every effort to bring about co-operation between the doctors and himself so that we can start off on the right foot.

Our nurses also are amongst the best in the world. Young girls who go into the nursing profession spend three or four years in training and when they qualify they dedicate their lives to the sick and the poor. They attend them night and day and they are certainly a credit to the country. Across the water they are very anxious to get Irish nurses because they are conscientious and stick to their job. Any doctor in an hospital over there will say, "Give me Irish nurses and I know my patients will be safe under their care".

For a long number of years in this country we have had Jubilee nurses who give noble and valuable services. The time has come to review the position of these nurses, who, I must say, gave valuable services in my county. The Jubilee nurses and the other nurses should be amalgamated. The State should take over these Jubilee nurses and none of them should be dispensed with. They are doing trojan work, but the finances are running out and in a few years that service will be closed down. I should like to see these nurses taken into the general nursing profession and fitted into a national scheme, as they are all qualified nurses. In any case, it is time that anything which was handed over to us by another country should be left on one side. Britain should be let look after its own interests and this country should have all Irish nurses.

As far as dispensaries are concerned, a great deal requires to be done. I am glad to say that in my county during the last few years three or four very good dispensaries have been erected and have been attached to the doctors' residences. I was speaking to one eminent doctor who spent 25 years in England and he told me that he never saw a better dispensary in Great Britain than the one he had here. I believe these dispensaries which we are building are more or less of a standardpattern and I hope such dispensaries will be built all over Ireland. If money is available, I hope we will go ahead and see that every dispensary is worthy of the Irish people. The money expended on these dispensaries is being well spent and is providing facilities for our doctors which are badly needed.

There was not sufficient accommodation in the old dispensaries, and in many cases the patients had to stand outside in the cold and wet during the winter months. Perhaps the doctor was irked and in bad humour because of the overcrowding. Perhaps things did not run smoothly. In the new dispensaries, on the other hand, things run very smoothly. There are properly upholstered seats for those waiting. There are fires and all the amenities essential to such a building are provided. The doctor has every facility to treat his patients as they should be treated. From that point of view, we are making some advance.

I would like to see some tightening up in connection with the red ticket. I do not say that anybody should be kept from getting all the treatment that medical science can give him, should that be necessary. I am satisfied, however, that there is a good deal of abuse in connection with the red ticket. I know doctors prepare bottles and give them to patients. Those bottles are brought home, the first spoonful is taken, and if it does not taste as pleasantly as the patient thinks it ought to taste the bottle is put up on a shelf until Monday morning, and when Monday morning comes the bottle is washed out and back the patient goes to the dispensary for another bottle. There is too much waste in that way, and if one could calculate the waste over the entire country it would run into tens of thousands of pounds. Some tightening up is necessary there.

I am satisfied that generally we are making slow but steady progress. We are moving in the right direction. Instead, however, of building sanatoria and hospitals we should start in the people's homes, educate them in proper ideas with regard to their health, teach them how to preserve their health, show them how to be thrifty,show them how to eat properly and give their children physical training in the schools. If we do that, we will have no need for big sanatoria and county hospitals, and I hope the Government will make an effort to start now in the homes and in the schools.

Mr. O'Donnell

I would like to join with Deputy Giles in congratulating our Irish nurses and our Irish doctors, particularly our dispensary doctors, on the very fine work they are doing. I represent one of the poorest constituencies in Ireland, West Donegal.

Mr. Kennedy

Says you!

Mr. O'Donnell

West Donegal is one of the poorest constituencies in Ireland, yet it is one of the constituencies which takes least advantage of the red ticket system. A patient living in the heart of the mountains has never yet had to depend on a red ticket for the attendance of his medical adviser. That is a proud boast and it is something of which we in Donegal are justifiably proud.

I know a dispensary doctor who practised in the Rosses, one of the most rugged and wildest parts of West Donegal. During his 30 years there he saw only three red tickets. That is not to say that every patient during those 30 years paid that doctor for his services, but the quantum demanded by the doctor depended entirely on the circumstances of the patient. That doctor knew the financial circumstances of the patient. That doctor knew the financial circumstances of all his patients so well that he demanded from them a fee in proportion to those circumstances irrespective of treatment. I think that system where one has the fullest co-operation between the doctor and his patient is the best system. It is certainly a better system than the system at present in operation in England whereby the doctor is compelled to attend every patient even though he may only suffer from an imaginary stomach ache. That may be the result here of the new Bill circulated by the Minister. That Bill cannot be discussed at the moment but the fact remains that we are providing in this Estimate some of the moneysnecessary for the implementation of that measure.

As Deputy Dillon said, why should we make it compulsory for the doctor to prescribe for us until such time as we are actually ailing? Why should it be made possible by an enactment of this House to create that kind of atmosphere between a patient and doctor? The proposed Bill reminds me somewhat of the farmer who went to buy a horse before he had built a stable: we are trying to provide hospital treatment for patients before we have built the hospitals. That is our main trouble. We require hospitals and hospital beds.

Twenty years ago in County Donegal we were waiting for a district hospital in the town of Dungloe. Twenty-two years ago we were promised a county hospital in the town of Letterkenny. When Deputy Dr. Browne was Minister for Health in the inter-Party Government I remember the anxiety he displayed—I know it was a genuine anxiety—to have that district hospital erected in Dungloe. I remember coming with my fellow Deputies from County Donegal to interview Deputy Dr. Browne. I remember his endeavour to expedite matters and to cut out all the red tape which was holding up the building of that hospital. I remember reaching a stage in those interviews when we thought we had smoothed out all the difficulties and, as the Minister told us at the time, building could proceed.

We are as far away to-day from that project as we were ten years ago. Our nearest residential hospital is 22 miles away. We are still waiting for that hospital, a hospital in which we were promised a maternity bed for every woman who needed it. We cannot get beds at the moment for really urgent cases. Deputy Dillon told us this evening about the case in Manchester where a patient was waiting for three and a half years for a bed and at the end of that period received a top priority telegram informing her that a bed was available. She was then able to say that she did not want a bed and they could keep it. I do not know what her ailment was.

Would it surprise the Minister to learn that in the townland of Meenmore in the Rosses I made representations three and a half years ago for the admission of an infant to a children's hospital here and we have not yet succeeded in getting a bed for that child? For three years we have been waiting for admission for that unfortunate child to a Dublin hospital. I have made representations to the ministry and to the Donegal County Council and I have received the usual formal acknowledgement "Tá brón orm a rá nach bhfuil aon leaba le fáil go fóill." Is it not a shocking state of affairs to think that, in the heart of the Gaeltacht—this Gaeltacht that we are all so anxious to preserve—children suffering from these diseases must remain on a waiting list for three and a half years? That is quite true.

Now I come to our dispensaries. They are in a deplorable condition. In the village of Anagry a new dispensary was required urgently. What was the solution? An ex-British Army hut was suggested, a discarded British Army hut without heat and without any proper sanitary accommodation was suggested for a new dispensary. Fortunately, however, the local county councillors and the people got up in arms and refused to accept the British Army hut with the result that we are now in process of receiving and having erected a proper dispensary in the town of Anagry. How many other existing dispensaries are in an equally bad condition? I should like to see the local authority own the residence of every dispensary doctor in the country.

I should like to see the local authorities erect dispensary residences for every dispensary doctor in the country and, attaching to such residence, I should like to see a proper dispensary with at least one bed therein for an urgent emergency case. In that way, we should bring some relief to the unfortunates who are living a considerable distance from hospital and who are dependent upon not too reliable transport to get them there in case of emergency. These dispensaries would pay for themselves by the saving in rental—aye, and by the savingin medicines, medical appliances and equipment, which are actually rotting in some of these dispensaries. I know dispensaries where the doctor, on a wet dispensary day, has to place a bucket underneath a leakage in the roof. I know dispensaries were the doctors have had to discard and throw out powdered milk which had become useless in these antiquated buildings.

Some months ago I asked the present Minister if representations could not be made to his counterpart in the Six Counties whereby patients from Donegal County generally could receive medical treatment in the various hospitals in Derry City. I was very glad to hear my colleague, Deputy Cunningham, back me up in that matter. There is something wrong with a system under which we see a patient from, say, Malin Head, Gweedore, Bloody Foreland or some of these outlying spots, brought by ambulance through the Six Counties all the way down to Dublin for treatment and back again by ambulance—and passing through Derry City in which some of the most up-to-date medical services are available. I should like to see some liasion between the authorities whereby such a person could receive medical treatment in the Six Counties, thus obviating the necessity to travel from Donegal all the way down to Dublin and, at the same time, saving the taxpayer a considerable amount of expense.

As many Deputies know, it often happens that, having travelled all the way down from Donegal, patients have difficulty in obtaining a bed in a hospital in this city. That fact will readily be appreciated by Deputies who are continually pestering hospital authorities for beds for patients from the Western seaboard. I should like to see the Minister make some serious approach to his counterpart in the Six Counties in regard to this matter. I should also like to see some serious effort made to cut down the waiting list at these hospitals and, particularly, I want to see the speeding-up of the building of hospitals. I want to see red tape cut—that red tape which has tied up in knots the erection of the hospital in Dungloe and the county hospital in Letterkenny.

Another very important and pressing matter is the rehabilitation of tubercular patients. As we know, the public authorities are responsible for these patients while they are in hospitals. Once they are discharged I think it should be the duty of the public authorities to try and rehabilitate them in some form of employment akin to that which they carried out prior to contracting this awful disease. I know several cases where tubercular patients who require the usual biannual check-up applied to local authorities for employment—be it as ambulance drivers or attendants in various institutions or as officials. It would be beneficial to have these ex-tubercular patients in these places because they would be under the eye, practically speaking, of the medical officers who attended them during their illness. Unfortunately, their pull —be it political or otherwise—has debarred them from obtaining these appointments with the result that they are receiving no opportunity of rehabilitating themselves and they find that they have to emigrate. When they emigrate they may have to live in the bothy, the hut or the communal camp in Scotland and in a short time their second condition is worse than their first. Some serious effort should be made to find suitable employment for such ex-patients.

Again, I should like to see some co-operation between the various medical inspectors and inspections in rural Ireland. I remember that, in one week in a certain dispensary, on the Tuesday we had the local dispensary doctor, on the Wednesday we had the county medical officer of health examining the schoolchildren, on the Thursday we had an optician who had travelled something in the neighbourhood of 70 miles to examine the same schoolchildren, and on the Friday we had a doctor who came down from Dublin to examine—by way of being a referee— National Health Insurance applicants. Surely some liasion could be arranged between these various medical officers whereby one doctor could do all this work. It is ridiculous to say that five medical men should travel considerable distances to the one dispensary— distances in respect of which the travelling expenses in some cases farexceeded the amount being paid by way of public assistance to these people. There should be some liasion in these matters between these various concerns and that would bring about a considerable saving to the taxpayer. It is a matter which should be seriously considered by the Minister.

We have heard a lot of talk about county homes. We have one in County Donegal. I am not certain of the number of patients in the county home, but I am certain that there were 25 official employees in it, between chief clerks, clerks, typists and various others. It is a very fine building, particularly the portion which housed these 25 employees of the Donegal County Council. I think a lot of these employees could be dispersed. We have the home assistance officer, the superintendent home assistance officer; then there are the various typists and paymasters. There is a considerable amount of superfluous expenditure in the running of these county homes. I think Deputy Dillon is right when he says that something on the lines of the parish home should be established, a small home for two or three parishes, run by, supervised by, and in which patients would be cared for by some of these religious orders.

We have in the City of Derry the Nazareth House. I have discussed with some of the patients there the treatment they receive and the circumstances in which they live. Certainly there is no comparison between the standards of the county home and the standard of living in the Nazareth House in Derry. The Minister should seriously consider the establishment of small parish homes to which the destitute old people of the parish could go. It would leave the large building free for renovation to be used, possibly in an emergency, as modern hospitals or used as tuberculosis homes. It has been done for the old fever hospitals and there is no reason why it could not be done with the present county homes if the scheme suggested by Deputy Dillon were proceeded with.

In conclusion I would appeal to the Minister to expedite the appointment of dispensary doctors where vacancies occur. In the island of Arranmoreduring the past 20 years we have had 29 medical officers of health. It is ridiculous. The reason is, of course, that no doctor appointed wants to spend any time on the island. I know of a number of doctors who are most anxious to procure that appointment and who are willing to give a guarantee that they will spend ten years on the island if they are appointed medical officer of health for the island. Unfortunately these applicants to whom I refer have been unable to secure the permanent appointment on the island but the gentlemen who do receive this permanent appointment only use it as a stepping-stone to better dispensaries in the county and elsewhere. I would suggest to the Minister that when a vacancy occurs there in future some condition, such as that the successful applicant be required to reside for a period of three, four, five, six or seven years on the island before applying for a transfer or resigning, should be laid down. If that were done the people of the island would feel satisfied and secure in the knowledge that they are going to have a permanent dispensary doctor for at least some years.

I would say further that he is not going to attract the right class of applicant for the island until something is done about the erection of a doctor's residence on the island and the establishment of a proper dispensary. There is no reason why a proper residence with a dispensary attached could not be erected for, say, £2,500 and I know for a fact that many times £2,500 have been spent on paying the fee due to locum tenens who are being sent there when the permanent man was allegedly ill. I would make that final appeal to the Minister to do something for these unfortunate islanders by guaranteeing them continuity of service from a dispensary doctor and by guaranteeing to the doctor a proper residence and a proper dispensary on the island.

Dr. Ryan

Perhaps I will commence by giving a little bit of consolation to Deputy O'Donnell. I can assure him that in regard to the hospitals for Letterkenny and Dungloe, plans and preparations have reached the stagethat it will be possible to start building this year.

Mr. O'Donnell

I heard that before. I am listening to that for a long time.

Dr. Ryan

You have never heard it from me.

Mr. O'Donnell

I am afraid I did. However, I am prepared to take the Minister's word and I am very glad of it.

Dr. Ryan

A number of Deputies have drawn attention to the fact that in Great Britain, where they have a different system of medical service from what we have here, people are waiting for three years to get into hospitals. I do not know what the object of that quotation was. The only thing I can conclude from it is that a new scheme was necessary in England if people were in such a very bad way that they had to wait three years for hospital treatment. That is not to say that I am in favour of nationalisation. I am not. As a matter of fact, a British Government over 100 years ago in the Victorian times, brought in free treatment in this country for certain classes. I am asking the Dáil in a Bill that will come before it soon, to extend that free treatment somewhat but you may as well accuse those who introduced the British improvements in the Victorian times of being in favour of nationalisation as to accuse me.

Again, we are accused of putting the cart before the horse; in other words that we have not got enough hospitals and, therefore, we should not proceed with our scheme. As Deputy Dr. ffrench-O'Carroll very properly pointed out when he was speaking in this debate, the T.B. scheme was brought along before sanatoria were built and we got quite good results. We achieved a substantial reduction in the death rate, and if the same can be done in regard to other diseases besides T.B., there is no reason why we should not bring in our scheme for general health services.

I do not want to quote Deputy Dr. Browne more than anyone else because he only said what many other Deputies said, but he pointed to the fact that if we give facilities to too many people to go into hospital we will not havethe beds for them. That reasoning means this: It is better to leave things as they are; if anybody is going to be excluded from the hospitals let those who cannot pay be excluded and let them put up with the consequences. That is a very callous way to look on the question. Surely we should give an opportunity to everybody to get hospital treatment as far as we can. At any rate, do not let us make it a case of keeping out the people who cannot pay. Let us put them all on an equal basis and then it will be up to the hospitals to give priority to the most deserving cases from the medical, not from the financial, point of view.

If Deputies will think over the question they will come to the conclusion that the scheme we are proposing is a fair one because it puts everybody on the same level. If we have not enough hospitals the medical authorities in the hospitals will have to do the best they can to admit those that are urgent cases and to try to postpone those that are not too urgent.

Deputy Dillon made a statement there which Deputy O'Donnell quoted. I was not surprised at Deputy Dillon making the statement because Deputy Dillon allows his tongue to run away with him and he has not much regard for facts and truth but to see a sensible Deputy like Deputy O'Donnell coming along and quoting the statement made by Deputy Dillon is rather disturbing. Has any Deputy in this House the idea that under any scheme we may bring in a doctor will have the right to come to any person and say: "You want treatment and I am going to give it to you?" That is so far-fetched that I do not think anybody could assert it, but Deputy Dillon did so. To think that it would be quoted by any sensible Deputy makes one hopeless about getting Deputies here to understand the effects of various schemes. However I suppose we may take it that Deputies generally will not be deceived by Deputy Dillon's rhetoric.

Deputy Desmond asked a question with which I should like to deal now. It was in regard to the position of a non-paying patient in a public assistance hospital who brings a charge of neglect, of malpractice or any othercharge, against the hospital authorities. The law was, I believe, that that person had no case to bring before a court but I just want to say what the law is now. Section 108 of the Health Act of 1947 gives that person the right to sue the health authority for damage to his property or to his person caused by the negligence of the health authority or their officers or servants in the health institution.

I thought when I was bringing in the 1947 Act that I made that matter right and that a poor person would have the same right of action against hospital authorities as the person who is paying, but we found, after the Act was passed, that we had covered only health authority institutions and that we had not covered public assistance institutions. Section 7 of the Health Bill, which is before the Dáil at present, provides that every district institution shall become a health institution so that non-paying patients will in future be entitled to sue for damage like paying patients. The matter will, therefore, be put right as from the date on which the Health Bill that has now been before the Dáil becomes law.

Deputy Corish referred to a complaint that people are kept standing outside dispensaries waiting for hours for doctors to turn up. I must say that I could understand that it might happen occasionally, but very, very seldom, that a doctor might be out on a serious case at the time the dispensary was due to open and that he might therefore be late. If, as Deputy Corish alleges, that is occurring constantly, these people should complain, and either the county manager or the Minister for Health will have the matter investigated. Personally, I do not think it occurs very often or in the case of very many dispensary doctors.

Deputy Corish also complained that sometimes when the patient comes to a dispensary doctor he is given a prescription that is costly, and for the dispensing of which he is not able to pay. We all know that a dispensary patient should not have to pay for the compounding of any prescription, that the medicine should be supplied to him free.

A number of Deputies spoke on thematter of the infectious diseases allowances, which are commonly referred to as the T.B. allowances, and which are payable in the case of a man who has dependents, or, in fact, in the case of a single man, who gets tuberculosis. He gets a certain allowance to maintain himself if he is single, and to keep his family, if he is married. First of all, it was complained that these allowances were too low, but I should point out that the figures which were read out by Deputy Dr. Esmonde are now out of date. The allowances are now much more generous than they were at the time the figures which Deputy Dr. Esmonde quoted were in operation. However, that was not the point raised by Deputy Corish.

The point raised by Deputy Corish was that when a person reaches the stage where the treatment is finished the allowance is stopped although he is not fit for work. This is a rather difficult problem. When these allowances were introduced in 1947, we naturally had to make some regulation with regard to the time during which the allowance would be payable. I think the obvious thing was to prescribe that the allowances should be payable as long as the person was receiving treatment. Treatment in that case also means treatment to the satisfaction of the medical officer of health. It would be difficult to suggest any other rule. I do not know how we could justify any other rule so far as these allowances are concerned.

The best solution, I am quite sure, is to introduce a system of rehabilitation such as that of which Deputy O'Donnell spoke and to have that system extended all over the country so that local authorities, when they reach the stage where they say that the treatment of a person for T.B. is now finished, could add: "We hand this person over to the rehabilitation authority or committee." as the case may be. He is then taken charge of by the rehabilitation centre and they decide whether he should still get the allowance, whether they should get some light work for him or what his future position should be. Unfortunately, we have not got this rehabilitation organisationall through the country. There are voluntary bodies acting, as I pointed out in introducing the Estimate, in Dublin, where they are doing excellent work. There is also one in Galway doing great work, but they are doing only a small part of the work which could be done. I am very anxious that this rehabilitation system should be extended. There is a clause in the Bill now before the Dáil which will give more power to local authorities to attend to the rehabilitation of patients. I am afraid we must wait for that before we can get over the difficulty to which Deputy Corish referred.

Deputy Corish spoke of employment exchanges pronouncing men as unfit for work. I must say I cannot understand that. Of course it is a question that does not exactly arise on this Estimate, but I should like to get more information from the Deputy to see what exactly he has in mind. Another Deputy—I think it was Deputy Hickey in fact—deplored the fact that the allowances payable in the case of T.B. patients are not payable in the case of other diseases and he mentioned rheumatoid arthritis. I agree with him. I think that where you have a person suffering from chronic disease which is apparently incurable and where the man or woman concerned is not likely ever to be able to earn a living again and is without means, something should be done. In the Health Bill at present before the Dáil, there is provision for that also and that matter will, I hope, be looked after as soon as that Bill goes through.

I gave a fair outline of what has been done with regard to dispensaries in a recent speech in the Dáil and when I was introducing this Estimate, I referred to that speech. I said that I did not want to cover the ground again, but I am afraid that Deputies have short memories, because practically every Deputy who spoke complained of the state of the dispensaries. I want to repeat, therefore, that, having considered the position with regard to these dispensaries, I came to the conclusion that, so long as we were insisting on the local authorities building rather elaborate dispensaries and building them at their own expense,we were not likely to make very much progress. I therefore introduced a scheme some time ago under which I sent out plans for a very simple type of building, a four-roomed house, much on the style of a labourer's cottage of the bungalow type, which would probably cost £1,100 or £1,200 to build. I undertook to give a grant of half the cost, up to a maximum of £600. That circular was sent out last May and I am glad to say that, since then, we have got proposals in from the various local authorities and they have undertaken to erect 294 new dispensaries or dispensary depots. Some of these are in process of being built and they will replace the old and condemned dispensaries which have existed up to now.

We previously had come to the conclusion that about 330 of the dispensaries and about 158 of the dispensary depots should be replaced, and, even in the 12 months since the circular was sent out last May, the local authorities have made proposals which would cover more than half the condemned dispensaries and I hope that within a year or two all the bad and condemned dispensaries will be rebuilt. I want to repeat that the building of dispensaries is a matter for the local authorities and I ask Deputies, especially those who are members of local authorities, to turn their guns on the local authorities and not on me, and to try to get them to proceed with this matter. So far as I am concerned, I am only too willing to help by giving the necessary grant.

Deputy Mulcahy asked me to give more particulars about this sum of £4,500,000. It is estimated that the total expenditure from the Hospitals' Trust Fund, into which this sum of £4,500,000 has been paid, will amount to £5,824,000.

General Mulcahy

That is, for the coming year?

Dr. Ryan

Yes, for the coming year. This total is made up of (1) building grants, £4,799,000—I will analyse that in a moment; (2) contingencies (works and miscellaneous grants not specifically provided for in the building programme),£245,000; and (3) miscellaneous grants, including deficits of voluntary hospitals, Medical Research Council, Hospitals' Commission expenses, B.C.G. vaccination, Hospital Library Council, etc., £780,000. This gives a total of £5,824,000.

General Mulcahy

Could the Minister say what the deficit sum is?

Dr. Ryan

Almost £700,000. The sum of £4,799,000 which is estimated will be spent on building grants is divided in this way: general hospitals will take £1,119,000 and, of that, the local authority hospitals will get £926,000 and the voluntary hospitals £267,000; maternity and children's hospitals, £530,000, of which the local authorities will get £105,000 and the voluntary hospitals, £424,000; fever hospitals, £193,000; mental hospitals, £128,000; institutions for mental defectives, £359,800; clinics and dispensaries, £252,000; and T.B. schemes £2,141,000. To meet these charges amounting to £5,824,000, the Exchequer is providing £4,500,000 by means of the Grant-in-Aid shown in the Estimate and the balance of about £1,300,000 represents the anticipated income of the fund from sweepstakes.

As to the future, in the year 1954-55 the position, so far as we can see at the moment, will be approximately the same as it is expected to be during 1953-54, so that in that year again, we shall probably have to ask for a subvention of £4,500,000 from the Exchequer. After that year, however, expenditure on the building programme, which will be nearing completion, will begin to diminish and the Exchequer contribution will accordingly fall from that year onwards. The position is that of the £15,000,000 I mentioned which the Exchequer will have to subscribe to the fund, £9,000,000 will come in the coming year starting on 1st April and the year after, and the other £6,000,000 will tail off in the following three years.

A number of Deputies spoke of school medical examination, and I quite agree that it is the first and most important matter to which we should attend in our extended healthservices. It is my intention to urge the local authorities, in so far as I can, to get that part of the scheme going with the greatest urgency.

A Deputy asked about the position of anaesthetists for county hospitals. That is a matter to which we have given a great deal of consideration. It is not an easy matter to find a qualified anaesthetist and to find work enough for him in all the hospitals we have because some are rather small and we, therefore, cannot have a general scheme applying to all hospitals. We are, however, trying to work out three or four different alternatives which could be applied to a hospital according to its size and its proximity to a city or large centre. I can assure the house that it is a matter which is receiving very careful attention.

With regard to mental defectives, we are restricted to three orders who have undertaken the care of mental defectives in this country. On the male side, we have two orders and, on the female side, only one. The Department, however, I can assure Deputies, has not put any limit on the amount of funds that will be made available. I can tell the House that, when I put my programme before the Government of what I needed, I said there was one condition I had to make and that was that if more was needed for mental defectives I would have to come to the Dáil for a Supplementary Estimate. I feel the thing is so necessary and urgent that we should make the money available. I can assure everybody here that it is not a matter of money but the orders, as I say, are few that will undertake this work.

I think Deputies will agree that men and women who are joining religious orders must have a real avocation for that work because it is certainly a work of charity and love. Therefore, we must depend on these orders. When they find suitable houses, it takes some time to convert them. Building new hospitals takes time but that, again, is not the big hold up. The hold up is for personnel. That personnel must, in turn, train other personnel. Theyare doing that as rapidly as they can in the existing institutions and they will be available to take charge of the new institutions whenever they can be found.

We have made fairly good progress. We expect to have a few thousand new beds ready by the end of the coming year. I think it was estimated at one time that we might eventually require 6,000. I am not sure whether that figure was correct but we will have a fair idea, I suppose, as time goes on. I think it was Deputy Paddy Burke, when talking about the mental defectives, who said that any Christian Government would be expected to look after all the people. I am not sure whether that is good theology but we will have to leave it at that.

A number of Deputies talked about the treatment of nurses. We should not exaggerate the position of the nurses. They enjoy much better terms than they did but I am not in a position to say whether they are absolutely satisfied but I think they are more satisfied now than they were five or six years ago. They are certainly very much nearer the conditions that apply elsewhere outside this country than they were some years ago. Their terms were reviewed last August and the cost of living was taken into account. A settlement was reached. When there is a vacancy in a hospital for a number of nurses, there is now no great difficulty in filling the vacancies. Nurses are available here and those who emigrated for some reason some few years ago are definitely coming back so it does look as if nurses are more content with their conditions here now than they were. I think we should not exaggerate the position in the Dáil by trying to persuade the nurses that they are badly treated.

Their conditions are bad in some cases. We have, as everybody knows, opened palatial nurses' homes in many places throughout the country. Where-ever these are everything is good but some of the nurses are living in old quarters in the old hospitals and are certainly living under very poor conditions. These things will be made right as soon as possible. I want to tell the Dáil about the difficulty in regard tosome of these cases. Not long ago, a proposition came before me where a local authority had the choice of improving the hospital from the point of view of the patients or improving it first from the point of view of the nurses. The local authority, I think very properly, took the view that the patients should be their first consideration. I think they were quite right.

We must all remember that in regard to hospitals we are aiming at getting good conditions for the patients. The other matters are only secondary. If it is necessary to give good conditions to nurses to get them to stay such conditions must be provided. If it is necessary to give good conditions to the doctors that, of course, must be done, but the whole object is to see that the patients are treated properly. Deputy Martin Corry gave us some figures which were supported by Deputy Hickey, but that did not make them any more truthful. I was one time asked by Deputy Corry what was the total cost of all the hospitals that were contemplated in Cork. I think I told him that it would be about £4,000,000. He asked what the architects got, and I said about £200,000. Now he has come to believe that we have spent the £200,000, although we have not spent the £4,000,000 at all. He quoted those figures for the Dáil.

Mr. Sweetman

Nobody, least of all the Minister, minds him.

Dr. Ryan

However, it is a lesson for everybody to be more careful in regard to the truth. Deputies tell me that health has become a political question. Why do Deputies say that? I must say that I find it hard to believe that health is a political question in this country because no country could claim to be more united on a health policy than we are. In 1947, the Fianna Fáil Government brought in the 1947 Act to enable the Government to extend and improve the health services. As a matter of fact, that Bill got through the Dáil with a large measure of agreement from all Parties. Whether it did or not, in 1948, a Government, composed of all the otherParties, came into office and they agreed to a health scheme. There is no doubt about that. Some of them may have gone back on it afterwards.

We came back again and we brought in a scheme. The point is that we have a scheme before the Dáil now with which the leaders of every Party agreed when in Government. That is a very important matter because you will often have an Opposition Party agreeing with a thing with which they might not agree when they are a Government. In this case, the leaders of every Party in the Dáil, Fianna Fáil, Fine Gael, Clann na Talmhan, Labour, Clann na Poblachta—now absent— agreed to the health scheme that is now before the Dáil. How could you have a more united country on a health scheme than that? Yet we are told by Deputies that we are making this a political question. We are not.

There is another organisation in this country, the Irish Medical Association, which opposed this scheme. There is a slight attempt, not very much I admit, by Fine Gael, to justify the Irish Medical Association on that. It was a slight attempt on the part of Fine Gael to get the sympathy of the Irish Medical Association. To that extent, if you like, it is made a political question but that is not very important. Fine Gael may play these little political tricks from time to time but they do not amount to very much and it is not going to make this a political question at all. When we talk about making health a political question, we should try to find where the responsibility lies.

Deputy MacBride and other Deputies, including Deputy Hickey, made the point that the building of hospitals is a costly matter now and that it would have been much better if they were built ten years ago. That is to say, in 1942 or 1943. Naturally, I do not want to pin the Deputy to 1942 or 1943 because he probably meant pre-war. There were very many hospitals built pre-war. I think any fairminded Deputy would admit that the momentum we were gathering in those years in the building of hospitals was quite creditable. Were it not for the war,hospitalisation in this country would probably have been very well catered for six or seven years ago but the war interrupted matters and there are still hospitals to be built. Maybe there is no great harm in saying that they are going to cost more but now that the local authorities are completing their housing schemes, the building of hospitals may be very welcome to those engaged in the building trade. If we go on with them, I think it will do a certain amount of good in the way of employment as well as improving the health services in the country.

I was asked about geriatrics. Since there was a lot of talk about the treatment of old people in this country, I would like to give my views on the matter. Those old people are now in the county homes. Everyone knows that, in addition to them, we have in the county homes other classes of people. We have unmarried mothers; in some of them we have imbeciles; in some of them we have vagrants because the local authority is bound to admit any vagrant who claims admittance at night. In addition, we have able-bodied vagrants in them. If we want to treat these old people well we should try, if possible, to get homes where they alone would be accommodated, and where they would not have to see the distressing side of imbeciles or be bothered with the able-bodied vagrants who come in. Our first effort, therefore, should be to see that the old people are placed in more congenial surroundings, and placed there alone.

My idea, I must say, is that the county home should become a chronic hospital, and that it should be used only for the chronic sick, including, of course, old people who will, I suppose, nearly drift there in the end. A considerable period, however, may elapse between the time the old person leaves his home and the time when he must be accommodated by the local authority. That is the time in which the old person is ambulant—able to move around. In regard to that, I would like to tell Deputies that through the local authorities we havebeen doing quite a lot in making old people ambulant. These were old people who were not able to move around at all, but we got some very good expert advice and, since some medical men started working on them, it is extraordinary how some of those old people have been able to leave their beds and walk around—not, of course, as well as they were able to walk years ago. At any rate, they are able to get around from one place to another—that is people who had been in bed maybe for some years, and who thought that they could never walk again. That work is going on now in some of our bigger county homes, especially in St. Kevin's. I would like to see that ambulant class put in special homes.

I have mentioned to certain county managers and to certain local authorities—we have had conferences with the county managers and the local authorities on this matter and will again in the very near future—that I would like to see them try the ideas that were given out here in this debate. In the first place, I would like to see them try the idea of the big house in the country, that is taking it over and making it a home for either men or women, and in which there would not be more than 16 or 20 old people. I do not like that as well as the second alternative, which is the building of a special colony, not a very costly one, for the old people, if you like on the lines of a labourer's cottage, with, say, three or four rooms, where each old person would have his own room and where there would be a common room as well.

I do not think that the running of that would cost the local authority any more than the county home is costing at the moment. The capital required would not be very high. I have undertaken, on behalf of the Government, to pay half the capital cost if any local authority likes to produce a scheme of this kind. I am very anxious to see it tried, and I am very hopeful that some counties will try it and see how it will work out. Deputy Dr. Browne spoke of the system in Sweden. I saw it some years ago, and I agree with Deputy Dr. Browne that these old people—well, I am afraid they werereally too well looked after, because, as he said, they are as well looked after there as a person would be in a first-class hotel in Dublin. I am not saying that the treatment was too good, but the treatment was such that I am afraid it is beyond our reach for the moment.

Deputy MacBride mentioned the Lansbury colony in London. I saw it within the last week. I think it is the sort of thing that we should aim at here. There each old person has a room to himself, and there is a common room and a sitting room. I think that the capital cost of running such a scheme would not be very big. I do not think we should run it on the Lansbury style. I think we could make economies without taking in any way from the comfort of the old people. I think that the running of such a colony could be kept within reasonable limits.

In the White Paper which we issued on county homes we had all that in view—that they should be broken up. We had in view, first of all, that the unmarried mothers should be sent to special homes, that the imbeciles should eventually reach the homes for mental defectives, that there should be some special place for able-bodied vagrants or tramps, and that then the county homes should be made chronic hospitals. I have already pointed out that special homes should be provided for ambulant old people.

The estimate that we made of the cost of doing all that was about £5,000,000. Maybe that estimate is too low—I do not know. I think we could do a lot on £5,000,000. In our circular to the local authorities we undertook to bear half the interest charges on the loan which they would raise for the purpose. If we take the figure of £5,000,000, and if that is distributed over all the counties in proportion to the population, and if half the cost of the interest charges is paid, it will only cost the local authority somewhere about 2½d. in the pound to look after the old people in the way that I have described. I think every Deputy will agree with me that if we could do all that for an extra 2½d. in the pound— that is to meet the capital cost over the next 40 years—there is no memberof this House who would oppose a scheme of that kind.

We had some discussion about the voluntary hospitals. They have played a great part in the development of medicine in this country. As a matter of fact, we knew no other hospitals when I was a student. If we go back 40 years, there was no such thing as a local authority hospital. There was the workhouse hospital. It was of a type which could hardly be described as a hospital, and, in addition, we had at that time small infirmaries throughout the country. Therefore, one could hardly claim that we had anything in this country except the voluntary hospitals at that period, so that it is not an exaggeration to say that the history of medicine here is bound up with the voluntary hospitals.

The voluntary hospitals have changed very much in character since that time. I am speaking now of 40 years ago when the voluntary hospitals depended entirely on subscriptions and on what they charged their patients. If they did charge them anything, it was only a few shillings. Now the position is quite different. The voluntary hospitals get very few subscriptions, but the local authorities now pay capitation fees for the patients they send into them. The local authorities, in that way, are making a very big contribution to the upkeep of voluntary hospitals generally. The State organisation—that is, the Hospitals' Sweep Fund—pays the hospital deficits, so between the two—the local authority capitation fees and the State organisation paying the deficits—the voluntary hospitals are depending on these two sources practically for their total income.

There is quite a change in that way. The voluntary hospitals first got their names as voluntary, I take it, from the fact that they got voluntary subscriptions for running them and voluntary labour for working them. The doctors were voluntary and, of course, the religious who were in them were voluntary and there were very few paid people in the hospitals at that time. Now the staffs, except the doctors, are paid, and many of the patients pay, subscriptions have practicallygone and the State, through its organisation, is making up the deficit.

It is true, as Deputy Dr. Browne pointed out, that there is no democratic control. They are run in various ways. Some of them have members of local authorities on their boards. Some of them have not. Some of them have life governors. Others have a large circle of subscribers who elect a board. They all have a different system. But it is true to say that there is no democratic control, and it is true also, as Deputy Dr. Browne pointed out, that there is no way in which the State can interfere with them. The Minister has no power to investigate any charge of incompetence or negligence. He has no power, as a matter of fact, to enter a voluntary hospital at all on a matter of that kind.

I do not mind these things. The one thing in respect of which I do feel the voluntary hospitals might have been more co-operative is the matter of economies. Some Deputy put it to me, what economies can they make. I think it was Deputy O'Higgins who said: "You do not want to pay the nurses less; you do not want to pay the domestic staff less; you do not want to give the patients less food." Certainly not. Even so, is not it a strange thing that, taking A and B hospitals in this city, A, as far as I can find out, is paying its nurses the same as B, paying its domestic staff the same as B, giving as good food to the patients as B, giving as good drugs and treatment as B, and yet the cost of the bed per week in A is only half what it is in B?

The deficit is becoming a very serious problem. It is going to run up to £700,000 practically this year. I do not think that any Government can afford to let this thing go without question. Without finding any fault with the voluntary hospitals, I do not think a Minister would be doing his duty if he were to say: "Whatever you incur by way of deficit I will pay it." He is bound to ask questions and to suggest that they might be able to cut these deficits in some way or other.

One suggestion we made was thatthey might make their purchases through the combined purchasing scheme. As Deputies know, you have there experts, if you like, in the examining of tenders, to advise anybody where they should buy. I do not think we could be accused of interfering with a voluntary hospital in the management of its own affairs by advising them to adopt this system. Yet, what was the result?—23 agreed and 12 refused. We have to go on paying the deficits. I suppose we will have to try some other way of getting them to cut their losses in order to reduce this huge bill for deficits.

I agree also with Deputy Dr. Browne on the question of appointments. I think that in the question of appointments to local authority hospitals we have as perfect a system as human beings could devise. In every way it is designed to get the best person for the particular job, whatever it may be. The people who are considered to be the best to advise on the particular position are put on the selection board. They are not interested; they can take an objective view of the candidates put before them and they can show us the best person for the particular position. We have all had experience enough now of that system to be able to say that over the years it has been successful. I admit that I did not like the system when I came in first.

Mr. Sweetman

You must have heard me making an aside.

Dr. Ryan

I did not like it at first. I did not think it was necessary because, as far as I could see in my own part of the country, the local authorities were making good appointments. Experience has shown that it is a very good system and has given very good results. We may have had a wrong one appointed now and again but, on the whole, it gave great results.

I am not going any more of the road with those who want to change the system of the voluntary hospitals. I am a great believer in voluntary effort. I think we have very little of that voluntary effort left in this country. I would be very sorry indeed to do anything that would destroy voluntaryeffort such as it is. Therefore, I would do everything to help the voluntary hospitals to carry on.

As a matter of fact—I am sure Deputies will not believe this but it is true—I insisted on a voluntary hospital remaining a voluntary hospital when they tried their utmost, with threats and everything else, to get themselves handed over to the local authority. I succeeded in the end in getting them to reconsider their position and to remain a voluntary hospital because, as I say, I am so interested in voluntary effort. I think voluntary effort is disappearing too rapidly out of this country and I am not going to do anything to destroy the voluntary hospitals. I would like them to be more co-operative in making economies and to reduce these deficits.

General Mulcahy

I would like the Minister to understand that, so far from wanting to throw any doubt on his statement, we completely welcome it but it is just as well that he has cleared the air as well as he has cleared it.

Dr. Ryan

I do not think the voluntary hospitals themselves could have any doubt from any conversation I had with them. The reason the first couple of speakers in the debate gave for wanting to have the Estimate referred back was that I had not maintained the relations I should have maintained with the Irish Medical Association, that they were dissatisfied with me as Minister for Health for that reason. I am glad to say that, after the first two speakers on the Fine Gael side, they forgot about that. Evidently, the men who came on to speak afterwards were not reminded of why they were referring the Vote back. As a matter of fact, by the time we reached Deputy Dillon, he told me to have nothing to do with these doctors, to throw them aside and remember that they are our servants and so on. I am not going to go as far as that. However, I am glad to see that Fine Gael are not altogether united in thinking that I am altogether in the wrong and that they are altogether in the right.

Mr. Rooney

That is distortion. That is all it is just distortion.

Dr. Ryan

A consultative council was spoken of. In the first place, I think Deputies will agree that it must be a consultative or advisory council. That was the first dispute. It must be a consultative council. The Minister for Health must have the last word. Under our organisation of Government, Deputies know that the Minister of any Department is the administrator and executive for that Department and he cannot have any council coming in and telling him he must do such and such a thing, irrespective of what the Dáil may wish or of what the Government may wish or of what the Minister himself may wish. Eventually I got that point fairly clear, that it will be an advisory council and not an executive council.

That consultative council, such as it is, had two meetings. We discussed the Health Bill and I told the council —being a good constitutionalist and a good democrat—that the Dáil had unanimously approved of the Bill, so there was no use in their saying they would not have it. I told them the only thing they could discuss, therefore, was the amendment of the Bill. I am sure the Dáil will applaud me for that, that I did not let them down, after giving that unanimous decision. They put up certain amendments and we discussed them. I said that I could agree to some of them and not to others. I do not see what other attitude anyone could take with a consultative or advisory council. I am sure Fine Gael would not expect me to agree with everything the Irish Medical Association put up, because if I did I would be no longer Minister for Health but an agent or spokesman in this House for the Irish Medical Association. My immediate predecessor, Deputy Costello, played that role for a while, but if he had remained long enough in that office he would not have stuck to that role—probably he would have changed his mind.

I also told the council that this Bill, when it goes through and becomes an Act, will be followed by regulations and that I would discuss all these regulations with the council. They appeared to think that was all right. They asked about other things. Theywanted to have regular meetings and I said I agreed to that. They wanted to have the right to call meetings on their own initiative and I said I agreed to that, that if a certain number, to be decided on, signed a requisition, a meeting would be called. They wanted to issue an annual report and I said I would have to consider that. I think we were getting on fairly well.

On that consultative council there are many doctors—a majority of doctors, as a matter of fact, and there is a good representation of the Irish Medical Association. I want Deputies to be very clear that there is a great distinction between doctors and the Irish Medical Association. As some Deputy reminded me here to-day, there are probably too many doctors on it. One Deputy to-day gave his opinion of a consultative council when he said there should be doctors on it, dentists, chemists, nurses, and then representatives of employers and labour, and I think he said consumers and the local authorities. I think that is quite right, they should all be represented—a lot of them are—and I mean to broaden the representation to bring in those not already represented on that council. Employers and labour are not directly represented and I mean to have them included. Then I think we will have a good representative council and can discuss these health matters as they arise.

At any rate, while we were discussing these matters, when this consultative council was meeting and discussing various amendments to the Bill and when I thought the doctors on the council appeared to be getting more reasonable in their attitude—probably they say that I was getting more reasonable—it came as a bombshell to me to know that the Irish Medical Association had met and said they rejected the Bill entirely. It is rather hard to know what I should do next. Members of the Medical Association were meeting me and discussing amendments, but the full Medical Association meets and says they will have no more to do with the Bill. I do not know what to do with them. We are going to meet early in May andby that time I might see some light as to what is the best thing to do.

General Mulcahy

Whom is the Minister going to meet?

Dr. Ryan

The consultative council. I do not want anyone to think I am up against the medical profession. Any time I met them we got on very well. I find them reasonably easy to get on with, but a strange thing is that when they meet as an association they seem to neutralise one another's common sense and one another's reasonableness and they become unreasonable and condemn anything in the way of a Health Bill or anything else. It is a very serious thing to do. I do not think Deputies have looked at this as they should. Remember that the Dáil unanimously passed the Bill on Second Reading, yet this association comes along and says: "We will fight it to the end". If an ordinary trade union of manual workers did that, if they met and passed a resolution like that, that they would sabotage any Bill passed through the Dáil, you would have the doctors throughout the country saying "Socialism" and calling them Socialists. But these men, we are not to call them Socialists, we are to think that it is ethics in their case, not Socialism. If that were not so funny I would say it was serious, when they talk about ethics.

I think that responsible Parties in the House—like Fine Gael, which is very responsible—should take a serious view and not take the side of these people. They should say to these people that if the Dáil passes a Bill unanimously it is a very serious matter for a body of men to come along and say they will not have it. If they were in certain countries, it would be called sabotage and they would not be seen any more. We do not want the same thing done here, but it is a thing we should not have here, that sort of flouting of a Dáil decision by any body of responsible men; and I do not think a Party here should support them in that effort.

I am not too worried about the decision of the Irish Medical Association. It is a rather annoying thingwhen you have friends—and I have a lot of friends there—coming to you and trying to persuade you to put certain amendments in. I hate refusing people. I would be inclined to give in rather than refuse; but now I am under no obligation, we can go on with the Bill and see how we stand, as the Irish Medical Association is out of it and will not bother about this Bill any more.

When I came back into this office early last year, the Irish Medical Association before very long boycotted some position which had been advertised and had been approved by me. I was rather surprised, as I thought I was on good terms with them. At a public gathering afterwards, I appealed to them and said: "Do not do anything like that again, do not go boycotting but come and talk before you do anything drastic like that." They did not, they went on with the boycott; but, even so, men were appointed to the boycotted position. They were good men, the best we could get—but what did the boycott amount to? It amounted to this, that no responsible or eminent man in the profession would go on the selection board. The local authority and the Department of Health had to try to supply men to these selection boards. Maybe they were not as good or as eminent in the particular line that was being filled as you would find here in this city; so the only result we are going to get from the boycott is that we may sometimes not get as good a man because we have not the selection board for it; but we will get a man to fill the post and if they want to take responsibility for that, let them carry on the boycott.

Is it not strange, as someone has said here, that Dr. Ward came along and brought in certain proposals and he was opposed by the Medical Association; Dr. Browne came along and he was opposed by the Medical Association; and now I come along and I am opposed also. Well, we are not very similar types, the three of us are very different types, yet we meet with the same hostility from the Medical Association. That is something the people should consider, that everysingle Minister, whatever his ideas may be, whatever his proposals may be, to whatever Party he belongs and whatever sort of fellow he is himself personally, meets with that hostility.

I was over in London last week and I met some of my friends over there. Thinking I might get some indication as to why they were against the scheme over there, I asked: "Why did you oppose your scheme?" They said: "We did not like it." One of them told me: "88 per cent. voted against it, but we accepted it in the end because we had to." I asked: "How is it working now?" He said: "It is working fine. We are making more money, but we have to pay more income-tax and that is the only difference." I do not know whether the doctors here are afraid of income-tax or not, but, at any rate, that is as far as they have gone on the other side.

I have tried to deal with this matter by stating my position with regard to the Irish Medical Association. I have no hostility to them, none whatever. I have never refused to meet them at any time. They asked me to meet them. As a matter of fact, as I told the House, I appealed to them often to come to see me to discuss the problems which were there so that there would be no such thing as boycotting. I am prepared to meet them if they want to discuss the matter, but if they say: "We will oppose the Bill tooth and nail," and if they ask Deputies to oppose the Bill, there is no great hope that they will come to see me about the Bill. But, if they change their minds, I am prepared to meet them and discuss whatever difficulties there may be.

Fine Gael have asked to have this Vote referred back. I think that was on the point that I had not dealt as diplomatically as I should with the Irish Medical Association. They have heard the whole story now. If they vote against this Estimate, you all know why they did it. They cannot do it because I have been unreasonable or because I have been wrong. They can only do it because they want to get the support of the Irish Medical Association.

Question—"That the Vote be referred back for reconsideration"—put and declared negatived.

Vote put and agreed to.