It is with a certain amount of timidity that I follow such a distinguished and knowledgeable medical man as the Deputy who has just spoken and who has left the House. He not only knows all about what is best for the health of the country but what has improved the health in certain aspects. He knows more than that, however. He knows what is in the mind of every one of the doctors, even though the doctors express their minds very vehemently and very differently from what he interprets as being the minds of the doctors.
I am not standing up here as an advocate of the doctors, but there is one thing clear to everyone in the House, that in the most emphatic and in the most unanimous way that ever was heard of in medical history the medical men as an organised professional body are against this measure. They are not against this measure because it affects their material interests. There has been no squabble so far between the medical profession and the Minister in regard to fees, salaries or remuneration. The controversy between the Minister and his Department and the organised medical profession in this country is that themedical men, the workers in the hospitals, the workers in the districts, the people who have to deal with the human beings lying in bed in their homes or in the hospitals believe that this Bill does not meet the requirements of the present situation. They believe it is a bad Bill and they believe it is a Bill which will be detrimental to, instead of assisting to improve, the health services.
As a Deputy, I am opposed to the Money Resolution sincerely and conscientiously because I believe we are not entitled, any of us who are free Deputies, to impose this huge burden of new taxation and increased rates on the community in order to achieve what: chaos and disorganisation in the medical services of this country from top to bottom. I am opposed to this Money Resolution because never in my experience of a quarter of a century here as a Deputy did I ever see a Bill more covered with camouflage, more shrouded in fog, more fraudulently and dishonestly presented to the public. This Bill has been presented to the public with an amount of expensive political propaganda costing tens of thousands of pounds to raise hopes in the breasts of the people which anybody conversant with the situation existing knows must be dashed to the ground, shattered in pieces.
How did the Minister introduce this Bill? If you read any one of the Minister's speeches inside or outside this House in relation to the Bill what was the gist of his speeches? All the grand hospitals that are to be built, £17,000,000 worth of new hospitals, all the new dispensaries that are to be built, the child welfare clinics and the improved inspection of children. What has this Bill to do with any of them? If we want those things and want them badly and urgently it is because of the negligence of the Minister and his Government for 20 years back. The building of hospitals was part of the programme since the Hospitals' Sweepstakes were established 20 years ago. Legislation with regard to child welfare clinics and all that kind of thing was there before the State was born. The dispensary system has been theresince 1864. School medical inspection has been in operation since the earliest date of this State.
But what has happened under the Minister and his predecessors, his pals and his chums in the Fianna Fáil Government? Every one of these services has been starved. You have the same dispensaries as you had 50 years ago. You have the doctor and the midwife and the Minister's Department preventing them from getting a substitute for a midwife if she is sick because they will not give enough to pay for the lodgings of her substitute. The public health services are starved. School children are only inspected once in four years because an extra doctor or nurse cannot be got to carry out the inspection. The job which should be done every year is only done every fourth year as the Department refuses to sanction any extra assistance for the work. But not one of these things requires this Bill. All that is required to expand or extend the facilities inside the dispensary service or the public health service is a little more of a liberal outlook, a little more of a sensible outlook, a little more of a health outlook from the Minister and his Department, and this Bill, which is calculated to produce nothing but strife between the Department of Health and the organised medical profession, is featured and presented to the public as an essential instrument for the building of hospitals and the provision of the services I refer to.
These services have no connection with this Bill. This is a political Bill, a Bill dictated by political expediency, a Bill that the Minister dare not put in front of Dáil Éireann in the presence of Deputies in all its ugly nakedness. It must be camouflaged with all this fraudulent propaganda as if it were going to do things which the Bill is not required to do at all and which should be done without the Bill.
Let us get down to the Bill. The health of people in any country is of the utmost importance and the people who know most about health and the health requirements of the people are undoubtedly the medical profession, the medical profession working in thehospitals and the field. Yet here you have a Health Bill drafted from beginning to end with every representative of the medical profession locked outside the door. At the end of a period of acute controversy and bitterness, the Department and the medical profession were locked together, locked together, sitting down together with a common mind to make proposals for the better health services of the people of this country. Doctors from all over Ireland were working there week after week, busy men travelling to Dublin every week and sitting down with the officers of the Minister's Department, working towards success and towards producing a really workable Bill which would be in the best interests of health and at the same time not too severe a penalty on the ratepayers and taxpayers who, the Minister's leader says in one mood, are already crippled with the extra weight of taxation. Those doctors and those officials were working towards accomplishing something.
The Minister comes along and takes up office and before he knows what they are doing or whither they are driving he scatters the lot. He locks the doctors out, takes away the clerical assistance and he says to the doctors: "If you like to keep working yourselves I will consider the results of your efforts." If those medical men were looking for a row and if they were the kind of contemptible politicians that the Minister has labelled them as being, playing politics around sick bodies, they would have been peeved at treatment of that kind and they would have chucked the job of work. The Minister tells them to go outside and work along on their own. He tells them that: "As soon as you have a scheme or some proposals to offer I will consider them." The doctors continued to work. They continued to travel to Dublin week after week. They got advice and information from the greater part of the world and they worked out a scheme. This was the scheme the Minister had promised to consider. After months of labour they worked out a scheme and they sent that scheme to the Minister on a particular night. The second next day they got the Minister's Bill and hisWhite Paper. That is the consideration their scheme received. That is the consideration the doctors received from the Minister.
Now, we have Deputy "Specialist" Burke referring to the Minister as the most democratic and the most benevolent Minister there ever was. He will consider any proposals that are made. Why did the doctors not go to him? The doctors are there all the time. There is one thing they do not want; they do not want strife and rows. They merely want to get on with their work and see people getting better instead of dying. One would almost be led to believe it would be inside their minds and in their hearts to give advice to any Minister that would not be in the direction of achieving success in the practice of medicine. The doctors advice is there. Their voices will not be listened to. If they put up anything awkward to the Minister, then they are no longer doctors; they are just contemptible politicians, playing politics around health and more concerned with fees than with their patients' well-being.
That is the attitude of the Minister and that is the reason why we are in the mess in which we find ourselves to-day. That is why this Bill is thoroughly unacceptable to the medical profession. They believe it is unworkable, laden down with false promises and stirring up hopes that can never be realised.
What is all this propaganda of the Minister's? Let us take it little by little. The Minister can be very wacky at times. He can be very lazy at other times and he can be very dumb on occasions. He is supposed to have studied this Bill very, very profoundly over a number of months. He is supposed to have gone into all the aspects of the Bill, both on the health side and on the financial side. Why does he come before Dáil Éireann now with the whole financial side of the Bill a complete secret? How many Deputies know from the Minister's statement how much any section of this Bill will represent in pounds, shillings and pence? All they know is that for every 1/- the Ministerpays, the ratepayers will pay another. The furthest the Minister can be drawn towards giving any picture of the cost is that it will represent something like 2/- in the £ on the rates.
Imagine a man who has been a Minister of State for the best part of 20 years and a Deputy of Dáil Eireann for 30 years saying that a Bill such as this will represent 2/- in the £. If the Minister knows anything about health—I doubt if he knows very much about it—he must know that if one takes two counties of equal population the health expenses in each county will be approximately equal. In the poorer county they will be a little bit more. The Minister must know, too, that 1d. in the £ in some counties will only bring in £500 or £600, while in others it will bring in £2,000 or £4,000. When he talks about 2/- in the £ does he mean the poor counties will only get one-eighth of the services that the wealthier counties with the same population will get? Of course, that was merely a way of evading an answer to a question that should have been answered in so far as representatives of county councils are concerned.
I asked him what was his estimate with regard to the farmers under £50 valuation. They were to go into hospital. First of all they were to be free, but later on there was a fee of two guineas per week. That was represented as a tremendous boon to these particular people. I ask the Minister what income he had got from such people over any completed year in the past. That information would give one an idea of what the cost of that service would be and what the benefit to these particular farmers would be. What answer did I get? Away back in last October I was told that it would be too much labour to find the answer to that question, to find out the valuation of farmers that had gone into hospital. I told him from my own experience that, through any county council office, you could get that information—anybody— in an hour or less. In my public work as a doctor I had very frequently to go to the county council office to get the valuations of 30 or 40 people scattered throughout the country. But no, it would take too much time. I pointedout that, in the admission book of the hospital, their occupation was there and their address was there. In the rate-books across the way, made out in electoral districts, the names of the people were there alphabetically. A few minutes would get the valuation. I waited three months. I put down the same question again. No answer could be given: he had not the information. The only way you could arrive at an estimate of the cost of this Bill either to the ratepayers or the taxpayers—and that was one of the big factors in the Bill—would be to find out in back years approximately what the income was from such people.
Then we come along to the side with regard to maternity—to the "free maternity service for all." We asked: "What is your provision for that? How many maternity beds have you in public wards? Are they sufficient to meet the requirements that are there at the moment?" I got two answers in the same day—absolutely incorrect—with regard to the number of beds. Even when I tried to correct the Minister, according to his previous answer, he stuck to his guns and said that there were 150 more beds in public wards than are actually there. I put down the question again a week or two later and I got back the correct reply—the one I told him was correct. That is an example of the slovenly way in which the build-up of this Bill has been done. Everybody who has been in touch with medicine knows that there are grossly insufficient maternity beds in the public wards of this country at the moment. It is a disgrace, particularly in our cities, how few beds there are for maternity cases. Every leading man in that line of medicine for years back has been referring to the shortage of beds and referring to the fact that the infant mortality rate is, to a great extent, due to the fact that the mothers and the newly-born infants can be kept in a hospital for too short a space of time. They have to be turfed out of the beds to make room for others. Yet, in that situation, we have the Minister proposing to throw those public wards open to every woman in thecountry in childbirth. How can it be done? You cannot put more water than a pint into a pint bottle. If you inject more into it then you shift some of what is already there. If you invite people who in the past made provision elsewhere to queue up for the public wards of our maternity hospitals, you can only do it by excluding the poor—and it is insufficient for the poor as it is. There is no other way of doing it. Yet the propaganda is that every woman will have her baby in a hospital. Sixty-six thousand births a year and 954 maternity beds.
In the County Kildare, which has a birth rate of 1,000 a year, there are eight maternity beds—and you are going to invite many many more to queue up for those beds. The propaganda and the speeches give the impression that every woman will have a hospital bed, or any that desire or require it—and they pay £1 a year. What is the heading of the advertisement? "Free Choice of Doctor". When you read closely into it, what do you find? You find that they have no choice of doctor at all. You find, in fact, that they have no doctor at all. They have their babies at home if they cannot get into hospital. A doctor will only be called—read the brackets—"(if required)". In other words, if the midwife is up against it, if there is subnormality or something peculiarly difficult, then and only then will that unfortunate woman get the service of a doctor. How many women outside realise that that is the position under the Bill? "Free Choice of Doctor" has been featured. We had the brochure and the picture of the lady in a bed in a beautiful hospital with a little cradle beside her and a beautiful child in it. You have no beds. You have no cradles. You have not even the doctor except in a very exceptional case.
I said that the Bill was fraudulently presented. It is unfortunate that health legislation in this country has got so deeply involved with political controversy. Political controversy tempts a Minister—he is only human—to engage in exaggeration, in misrepresentation and in propaganda. This Bill, such as it is, is deep-deluged and hidden awayby the amount of false propaganda that is there. You have farmers up and down this country reading the speeches. They think: "Oh, if I am under £50 valuation I shall get medical attendance free." He will get medical attendance if he is sent to hospital and only if he is sent to hospital. He will get it in the hospital then for two guineas a week. A very big proportion of the farmers under £50 valuation are men under £15 or under £10 valuation. Those people are not paying two guineas a week at the moment: they are not charged that amount. But the Minister refuses to give the figure. Was a Bill ever presented to this House before that would put an imposition of upwards of £1,000,000 a year on the taxpayers and a minimum sum of 2/-in the £ on the rates of the country without the Minister showing how that money would be expended and what return the people would get for the expenditure?
We heard from the Minister himself that, as things are, something more than one-third of the population of this country come within the dispensary category, the low income group. When you add to that the people insured under national health insurance, these two bodies together make up 40 per cent. of the community. Everything that is in this Bill, they have at the moment and they have it free. The Bill does not give them anything more. All the lower income group and insured people have at the moment everything that is in this Bill. Pass this Bill and what will happen? You have more people feeding out of that dish. The dish is not any bigger, but you have more people feeding out of it and there is less for them, so that those in the lower income group, with regard to hospitalisation of one kind or another, in regard to attention of a medical man in his district, are obviously going to get less.
Then we come to the people in the next income group, the people who are taken in up to £600 a year. Where do they come into this Bill? If there is one class crying out for aid and attention in this country it is the people of the middle income group, the peopleover the dispensary level, we will say, £900 or £1,000 a year in the case of families. These are the people who want assistance when illness strikes them, when they have to go to hospital or if they are having a baby. That person's wife will go into a private hospital and be there for a few weeks; nurses and hospital alone will come to 12 or 14 guineas a week; there is a bill of £60 or £70 to be met.
These are the people who really require assistance. If the Minister was out to assist these people he would not drive them into a public ward where they merely push out of that ward another poor woman. If that public ward is going to cost, by way of rates and taxes, four guineas a week, we will say, he could give the four guineas a week to anyone, poor or rich, towards their maintenance in a private ward or in a private hospital. It would not cost the taxpayer any more but it would be of assistance to people in the middle income group or what is called the white collar group. That was done in the past. It is left out of this Bill. You are going to ensure in this Bill that anybody who pays by way of rates or taxes above the lower income group will be financially induced by the new payments they will be called upon to make to queue up for a bed in the public ward for the beds that are at the moment, entirely insufficient.
Is that good health business? Is it in the better interests of health of either poor or rich? Why not the other? Why not aid them irrespective of their wealth? Why not say: "If they require hospital assistance we will assist them to the tune of whatever it may be, say, four guineas a week?" That would be a genuine gesture showing you were thinking of the white collar workers and people of that class. Why would it not be done? The answer is this, that the Minister knows very well that all this talk, this fraudulent propaganda, of providing for mother and child, irrespective of income group, is thoroughly dishonest but that that Bill will have to be in operation for some time before people realise the dishonesty and fraud of the whole measure. The beds are not there. Theprovision is not there and the services are not there. What is there is the political propaganda and the false promises. It is the most disgusting bit of attempted legislation that I have ever come up against in my life. It is pure shiftiness from beginning to end, a refusal to give any information.
Other sounder schemes were condemned by the Minister and his colleagues because the financial details were not given. What details are given in this? The Minister ambles in here and tells us that the £1 a head for the maternity business is going to bring in approximately, he says, 50 per cent. of the total cost of that end of the scheme. What does he reckon the total cost of that end of the scheme will be? How many does he reckon will pay the £1 a year when they know what they get for the £1 a year—the services of a midwife, and a doctor only if required, and a bed in a public ward if there is room, number one, and if those below them in social status are not demanding it in front of them.
How can any one of those get into a public ward when, as I say, there are in the neighbouring counties, eight, ten or 12 beds, and birth rates of 1,000 and upwards. Would it not be better to be honest with the people? Health is not a matter to trifle with. It is the last thing around which this political game should be played. The Minister, belonging to the profession to which he does belong, should be the last man to go in for that kind of thing, but he goes ahead on these lines. The doctors can tell him nothing. The doctors can teach him nothing. The doctors know nothing about the health of this country. He locked them outside the door and when he has his Bill through and when it is the law of the land, he will talk turkey to them. Then he will tell them what they must do. In the meantime, we have all the hurried talk of the politicians, no compulsion, free choice of doctor, if required.
No compulsion? Are you going to compel your dispensary men to work this Bill whether they like it or not? Will they be compelled as part of their job? Will the voluntary hospitals bestarved of funds if they do not toe the ministerial political line? Will there be compulsion on the hospitals, compulsion on the dispensary doctors? If there is not compulsion, if they are left as free agents and they feel conscientiously that this is a bad Bill, not of service to the health of the country, that with a little bit of discussion between the Minister and the profession a really sound measure could be produced, and they say: "We will not participate in a sham. We will not co-operate; we will not volunteer to work. We will just do our job the same as ever before," then where is all this free choice of doctor; where are your participating doctors?
Would not any businesslike Minister, sitting over any important Department, who was a responsible Minister first and a cagey politician after, get in touch with the workers in the particularly big field that they were going to affect by their legislation? Do you think his colleague, the Minister for Industry and Commerce, if he intended to carry out a revolution in the building industry, would do it without discussion with all those most closely concerned and with life-long knowledge and experience of that trade? Does he think any one of his colleagues would go gom-acting the way he has gone, playing politics in regard to hospitals? In effect, he says: "These people who have to run hospitals, who spend half their lives in hospitals, have nothing to teach me; I have nothing to learn from them."
Words fail me in denouncing the insanity of this particular effort of the Minister. It is going to produce one thing; it is going to produce chaos up and down this country. It is going to produce chaos in the health services. It is a kind of chaos that could be avoided, a kind of chaos that should be avoided. The organised profession are more interested in health than ever the Minister was. They are not interested in politics; their whole life is devoted to health. They want a sound health scheme. They are crying out for better health services. Material interest is completely subordinate to them but theywant to be able to contact the Minister in his Department, to be listened to, not to be assembled just once and told: "We shall consider that; go home," and never assemble again. They do not want to talk to a figure on top of a pedestal. They want to sit down and talk this over with the departmental officers concerned, to work out a scheme and to advise. Above all they want to ensure that they are not to do their work in future as Civil Service driven officials, rather than medical attendants attending the poor and others. The terror of their lives is writing out papers, documents, returns. The man who is away travelling on the road by night and by day, when he comes back to his house at night, is to be put sitting down to make out returns, to fill up books, yearly, weekly and monthly returns and ledgers.
The efficiency of a doctor is judged— I know that myself—at headquarters by his efficiency on paper, not by his efficiency in the hospital or in the bedroom of the sick. The fellow who makes returns can bury them in plenty; he is efficient; but the man who works at home conscientiously, who does his job, worries about his patients, who visits the bad cases once or twice every day, who goes out at night if he wants to take a night temperature—that is the man you will never get filling forms. The dread of every doctor's life is to be ridden by officials. That is one of the things they dread in this Bill. They want the Minister to be a buffer between the man practising his profession and others. They want the Minister to be advised by people who understand the work at the periphery and not just the work at the top. They want a real advisory health council, not a sham council, not a council that will be convened once in a couple of years by the Minister and then packed off. They want a council of doctors and others who have a direct day-to-day experience of health problems, hospital conditions and so on, a council that would give them the right of assembly under their own steam and the right to approach the Minister, and the Minister only, and to advise the Ministerwith the right to make an annual report.
They ask to have that reproduced down the country on a smaller scale in the different health areas and not to be left entirely in each administrative area under any gauleiter such as a manager. We have good managers and we have bad managers. We have very successful managers who understand the peculiar problems of professional work. We have others who think that, because they are managers, they are super-everything—super-engineers, super-doctors, super-everything else. They do not want that kind of thing, but that is what the Minister lays down. I am not advocating a medical council; neither does the profession. They want a council that groups doctors with public men, representatives of the county councils or the general council of county councils, people such as Red Cross workers, people interested in social work of one kind or another. If a peculiarly medical problem came up, then if the council thought wise they could refer that to a medical sub-committee. Is there anything unreasonable in a scheme like that?
Even at this stage I believe that a generous approach to that suggestion would launch the Minister's Bill in a better atmosphere of harmony and understanding than it is likely to get otherwise because if he conceded that much, enough trust, faith and confidence would be generated at such a council, around these medical men, for everybody in the practice of medicine to believe that once they were free to get and to give advice, to meet and study various problems, then the other difficulties in the Bill would be surmounted in time.
I have only one further word to say and I am saying it as a representative of the City of Cork. That is that I deplore that Deputy McGrath, the Lord Mayor of Cork, the first citizen pro temin the City of Cork, should have made use of this Assembly, the nation's Parliament, to launch a slanderous attack on the surgeons, physicians and others who labour day after day in Cork's voluntary hospitals.Cork unlike Dublin has not had that immense development of private hospitals. There are few private hospitals in Cork. Many well-to-do people have to go into public wards or go without hospital treatment. The vast majority of the beds are occupied by poor people and the surgeons and others do their work around all these beds equally skilfully. If one person who can well afford it gives the doctor a fee, is the doctor not entitled to live just as much as the plumber, the carpenter or anybody else? The Deputy went further in his jeering and sneering to say that they pressurised patients to get money out of them. I do not represent Cork in the dual capacity that he does but I am familiar with conditions in Cork. I am familiar with the people of Cork, familiar with the hospitals in Cork and I spent more time in Cork hospitals than ever he will spend. I am familiar with the professional men in Cork, and that was as foul a slander as could be uttered against a very decent, highlyrespected and well-liked body of men and women.
