Dáil Éireann debate -
Thursday, 16 Apr 1953

Vol. 138 No. 2

Committee on Finance. - Health Bill, 1952—Money Resolution (Resumed).

Mr. Cunningham

Before moving to report progress, I had pointed out that it is my opinion that the ordinary medical practitioner is willing to operate this scheme but that very severe pressure was being brought to bear on the people from the top and that the country was led to believe that the medical profession, in a 100 per cent. way, was against this Health Bill. From what I have heard in discussing the Bill with some of these doctors, I can assure Deputy Dr. O'Higgins that that is not the position.

There is one very important new section in this Bill, that dealing with chronically disabled people, people disabled from birth or people rendered disabled as a result of accident, who are not able to work or to provide for themselves or their families. Treatment will be provided in the case of children and young people and they will be trained in some suitable profession. In the case of older people benefits will be made available. The very large number of such persons one finds in any district is surprising. They are really deserving cases. Under existing legislation they are not entitled to unemployment benefit or unemployment assistance because they are not able to work. The only benefit available to them and their families at the moment is outdoor relief or home assistance. That was always very distasteful to Irish people as it smacked too much of the British régime in this country.

Another very distasteful thing that isbeing got rid of is the red ticket. A person entitled to free medical service who required the services of a doctor had to go to the warden and collect the red ticket and then produce the ticket to the medical officer. In very many dispensary districts that I know of the doctor looked down his nose at the red ticket and, if he was called late at night, made all sorts of excuses and usually postponed his reluctant visit to the following day. A Deputy on the Opposition Front Bench said that the only change contemplated in the Bill is a change in colour in the ticket. That is absolutely untrue. The patient or his representative will not have to go to the warden and subsequently to the medical officer on every occasion that the services of the doctor are required. He will be given a card. That is a very common thing in national health insurance and other social services. These tickets have become an accomplished fact and people do not object to having to produce tickets or to fill forms. It will not be a ticket. It will be some kind of card or form. We cannot very seriously object to adding another to those already in the possession of persons entitled to benefits under the Social Welfare Acts. It is misrepresentation, therefore, to say that only the colour of the ticket is changed. The whole system, thank God, will be changed. It is a system that was crying out for change. It is ridiculous that a person entitled to free medical service should have to go to the extremes that such persons have had to go to get the services of a doctor.

I know many rural areas where quite a large number of people were paying national health insurance where red tickets ceased to have any effect, where the vast majority of the people were not eligible for red tickets and those who were eligible for them were afraid to approach the medical officer with the red ticket. They postponed asking for the ticket as long as possible.

Another point—it is not a new one— is the extension of the school medical service. That is the key to the improvement of the health of the people. That is where the health problems should be tackled. It would be well to have anadvisory service or at least to make pupils of both national and secondary schools realise the importance of good health. They should be instructed on the importance of good health and the methods by which it can be attained and safeguarded. That is not included in the scheme.

The extension of the school medical service will mean that, where minor defects are discovered, immediate steps will be taken to remedy them. Defects which can be regarded as minor in children, if neglected over a long number of years, may entail hospital treatment, operations and so on, thereby placing a very heavy burden on our hospitals and on State finances. It is by nipping in the bud these ailments, ills and deformities which will be detected through the school medical service and by remedying them at that stage in the life of the citizens, that we will be taking the greatest step, first, towards cutting down on those ailments and, secondly, towards cutting the amount of money necessary to cure them when they have taken root from childhood.

Regarding school medical service as it is now run, no one can take exception to the manner in which it is carried out. It applies only to national schools at the moment. No one will take exception to its extension in the national school. Its extension to the secondary schools is something new and it may be that there will be some objection to having secondary school pupils undergo a medical examination. I cannot see that there should be any serious objection to that. I know from experience that it works successfully in the national schools. The only thing about it is that the medical inspection or examination occurs only once a year, which is not often enough and an extension there in the national school is desirable and urgently needed. I am very glad it is being extended to secondary schools.

As I said previously, Fine Gael seem to be giving moral support to the medical profession. It has been suggested by the upper five in the medical profession that the medical profession will not work this scheme, and through the medium of this House they are beingbacked up by Fine Gael in that attitude. A Civic Guard who recently required a specialist service for his wife and who was not able to pay the 120 guineas sought by the specialist and who therefore had to forgo making specialist treatment available to his wife, will not like Fine Gael's attitude in opposing every section of this Bill. There are many in that profession and in every other profession throughout the country who will not like their attitude.

We admit that this Health Bill does not do everything that we would wish it to do. We would like to see in some concrete form the scheme which Deputy Costello left very much up in the air at the conclusion of his Second Reading speech on this financial motion. We would like to see that scheme and we would like to know the cost of that scheme. As Deputy Dr. O'Higgins said, we would like to know if it is going to cater for the £1,000 a year people; we would like to know if it is going to cut out the farmer with his £50 valuation and his Chrysler car. These are things we would like to know about it. In this Bill we are improving on existing health services, extending them and adding to them. The cost of doing that will be a matter which will worry us and worry the Government when framing Budgets in the future. Deputy Costello started off by saying that he would like to know what the Government's scheme is going to cost. We would like to know what his scheme—which is supposed to be so very much better than this one—will cost.

In conclusion, I would like to say that the people should not be deprived of the benefits in this Bill. The Bill should go through quickly, but that does not mean that at any time in the future any Government is prevented from improving on it. That can be done.

Mr. Morrissey

This debate has been remarkable in its way for the fact that those members of the Fianna Fáil Party who have spoken so far—and in particular the Independents who support the Government who have spoken in this debate—have directedtheir remarks almost entirely, not to the motion or to the Bill but to a vilification of the Fine Gael Party. Every unworthy motive that could be imputed to this Party has been hurled at us.

Mr. Cunningham

I plead not guilty.

Mr. Morrissey

In fairness to the Deputy, he devoted a fair part of his speech to the Bill, and I will not say that, comparatively speaking, he was unfair in whatever criticisms he offered to the Party here—comparatively speaking. The Deputy would need to be born over again, of course, to stoop as low as some of the gentlemen Deputies of this House have stooped in this debate—gentlemen Deputies, some of whom were born and reared far from the poor law system and the red ticket, Deputies whose only concern with the public health, according to their speeches, is to poison the minds of the people against a particular political Party, Deputies who feel that they are free and ought to be free to come into this House to hurl insults at this Party and at individual members of this Party, to pour out vilification, deliberately to twist and misrepresent—deliberately so —what is being said, and to go so far as to invent statements and attribute them to people on these benches— statements which were never uttered.

These are the gentlemen who, when one hits back, start to squeal. I do not like personal abuse. I detest personal references, but I have never made any secret of this either inside or outside this House, that when I am unfairly attacked I am prepared to hit back and to give at least as good as I get. I am entitled to resent being lectured by certain members of this House who are themselves entirely to blame for the present position in this country, vis-á-vis our medical services, and for the fact that we have not a much better medical service in operation in this country before to-day than is set out in this Bill. They are entirely to blame because of their own pigheadedness and because, through arrogance, they took to themselves all the knowledge and all the virtues. I had to sit here yesterday and listen to DeputyDr. Browne spitting venom at members of this Party until the very air here was almost poisoned by it.

Dr. Browne

Apparently it hurts.

Mr. Morrissey

Injustice, untruths and unfairness always hurt, and why should they not?(Interruption.)Keep quite, you. Take your medicine. I told you what was going to happen. You can hand it out, but you cannot take it. You think you have the right to pour out abuse on Parties and individual members of this House, and when you get any back you begin to squeal. If the Deputy is inclined to squeal, he will have still further reason. The Deputy has a big responsibility and has a lot to answer for to the people of the country.

Dr. Browne

I put you over there and I will keep you there.

Mr. Morrissey

You put that Government there and you are keeping them there and taking the bread, butter and milk out of the mouths of the people of this country, making them more in need of medical services than they were before.

An Leas-Cheann Comhairle

The House is not discussing Deputy Dr. Browne.

Mr. Morrissey

With the greatest respect I submit, Sir, that you were in the Chair yesterday when Deputy Dr. Browne spoke here. You were in the Chair and you listened to Deputy Dr. Browne.

An Leas-Cheann Comhairle

Addressing his remarks to the Bill.

Mr. Morrissey

With all respect, Deputy Dr. Browne did not devote one-twentieth part of the time he occupied to the Bill. The time was devoted almost entirely to vilification and misrepresentation of this Party.

Dr. Browne

I will do it again any time you like.

Mr. Morrissey

He comes in here with all the arrogance of ignorance of Irish politics, and, may I say this, if the Deputy is asking for it, with all the medical inexperience and thearrogance which is born of that, and hurls insults at men outside who are medical authorities with experience and who have given long and good service to the people of the country. The Deputy lectured not merely the members of this Party and all the members of this House but the whole medical profession, and he tried to lecture and dictate even to the Hierarchy.

Dr. Browne

You cannot stop me. Is it not a democracy, in spite of the Blueshirts?

An Leas-Cheann Comhairle

Deputy Morrissey must be allowed to make his speech without interruption.

Mr. Morrissey

I am wondering who is being hurt now, who is squealing. He wants to go back 20 years. We could have had a health service here for the last three years infinitely better than is contained in this Bill.

Dr. Browne

You ran away from it.

Mr. Morrissey

Nobody ran away from it except the Deputy himself.

An Leas-Cheann Comhairle

I have already warned Deputy Dr. Browne to cease interrupting. Deputy Morrissey is entitled to make his speech.

Mr. Cunningham

On a point of order. If Deputy Dr. Browne criticised the Irish Medical Association, I do not think that Deputy Morrissey should come in here and rake him over the coals for doing it. He is entitled to do it.

An Leas-Cheann Comhairle

That is not a point of order.

Mr. Morrissey

Deputy Dr. Browne is entitled to rake the Irish Medical Association in this House and I am to be prevented from making any comment on what he said. You are voicing the whole outlook of Fianna Fáil. That has always been their outlook.

Mr. Briscoe

Fianna Fáil is a terrible bogey man here.

Mr. Morrissey

Not at all. I do not agree with Fianna Fáil; I never did; but I think I understand them. I canstand certain things from Fianna Fáil that I cannot stand from other people in this House. May I say that, on that point, perhaps Fianna Fáil and myself would be closer than ever we have been on anything else?

An Leas-Cheann Comhairle

Perhaps the Deputy will now address his remarks to the Money Resolution.

Mr. Morrissey

I submit, with respect, that I am entitled to attempt to counter every statement which Deputy Dr. Browne or any other Deputy has been allowed to make in this debate. I ask for no greater liberty than that. Deputy Dr. Browne, because he knew more about medicine and medical services than all the doctors in Ireland and because he knew more about the moral law than the Hierarchy, would not give us the Bill we could have had. If he had, we would not be discussing this Bill to-day. Deputy Dr. Browne, in his venom and bitterness and spleen against this Party, is backing a Party which he does not believe in for a moment. He is supporting a Bill which he says is not a Bill.

Dr. Browne

I will carry out the law on proper lines in spite of the Irish Medical Association.

An Leas-Cheann Comhairle

Deputy Dr. Browne must cease interrupting.

Mr. Morrissey

The Deputy should not allow his head to be so inflated. The Deputy had better get this into his head, that he will not be allowed with impunity to come in here and attribute unworthy motives to members of this House who can hold their heads at least as high as he can hold his and who have as much right to give expression to their views as he has to give expression to his. The Deputy displayed bitterness and spleen against this Party. Listening to him yesterday, I was wondering whether one should be filled with pity for him or disgust at him. The Deputy's present state of mind and his outpourings are due to the fact that he knows he made a cardinal blunder.

Dr. Browne

Putting you over there.

Mr. Morrissey

The Deputy who is mouthing about the malnutrition of the poor and the children let his spleen and his hatred, and hatred is the only word that describes the sort of speech we had last night from the Deputy——

Mr. Briscoe

This is not personal abuse?

Mr. Morrissey

I am replying. I said I do not believe in personal abuse but if personal abuse is used against me and I am insulted then I hit back.

Mr. Cunningham

Did he abuse you personally?

Mr. Morrissey

Of course. Some of the Deputies were not here.

Mr. Cunningham

I was here.

Mr. Morrissey

The Deputy is slightly prejudiced. Deputy Dr. Browne allowed that spleen and that hatred to carry him to the point of supporting a Government and voting for measures in the last Budget which took away from the already too little nutrition available to the very poor.

An Leas-Cheann Comhairle

That has nothing to do with the Resolution before the House.

Mr. Morrissey

It has, and I submit with all respect——

An Leas-Cheann Comhairle

The Deputy should not shout at the Chair and he should speak to the motion.

Mr. Morrissey

I want to assure the Chair that I have no intention or desire to be disrespectful to the Chair but I have yet to learn that there is any power in the hands of the Chair or in Standing Orders that gives the Chair power to limit the use of my voice. It may limit the use of my words.

An Leas-Cheann Comhairle

The Deputy is entitled to reply to any statement made by Deputy Dr. Browne in the course of this debate but he is not entitled to carry on personal abuse as he has done since he got on his feet.

Mr. Morrissey

I can only say again that if I am being disorderly or if I am out of order that is a matter for the Chair. Whether I am guilty of good taste or bad is not a matter for the Chair. That is a matter for myself. I was proceeding to say when I was interrupted that the Deputy supported motions and Resolutions by the present Government which by increasing the price of essential foodstuffs by millions took away to that extent from the tables of the poor that much nutritious food and to that extent put a bigger call, perhaps, on the medical services of this country. With all respect, if we were more concerned with feeding and clothing and housing our people properly and with preventing disease there might be less need and less concern for hospitalisation and specialist services.

Mr. Briscoe

Is the Deputy suggesting that Fianna Fáil did not do more than any previous Government on those issues? The Deputy is suggesting that and he knows it is not true.

Mr. Morrissey

I am not suggesting any such thing. I gather from the newspapers that Deputy Briscoe has been a quarter of a century in this House. May I say I hope he will be a second quarter of a century in it—in a minority of course? He is long enough here to know the ropes and he does know a trick or two. Coming back to these subsidies, the support their removal got, from whom that support came, and remembering that without that support the Budget could not be put through this House——

Dr. Browne

Faking your Budget to the extent of £4,000,000.

Mr. Morrissey

That is a lie and it is not the first lie the Deputy has uttered.

Dr. Browne

It is not a lie. Is it in order for a Deputy to say something is a lie?

An Leas-Cheann Comhairle

It is not in order for a Deputy to use the word "lie" and neither is it in order for a Deputy to interrupt the speaker in possession.

Mr. Morrissey

I withdraw the word"lie" and I give the Deputy his choice of "falsehood" or "untruth". Perhaps the Deputy would like an opportunity of making a second speech.

Mr. Cunningham

You missed out on the Second Reading.

Dr. Browne

That is where you were codded.

Mr. Morrissey

If the Deputy's conscience is hurting him I am not surprised.

Dr. Browne

At least I have a conscience.

Mr. Morrissey

The Deputy has a lot on it. It just shows what can happen sometimes in public life by some queer unfortunate accident: a man finds himself a Minister almost before he is a Deputy.

Mr. Briscoe

Is Fianna Fáil to blame for that too?

Mr. Morrissey

Does the Deputy require your assistance?

Mr. Briscoe

I am amused at your tricks.

Mr. Morrissey

The Deputy is not a bit amused and neither am I. I have listened to many speeches made in recent months on public health and public health services. I have read many letters and there is only one "Simon Pure"; we are opposing this Bill according to Deputy Dr. Browne and others because of a handful of doctors in Merrion Square. What is the allegation? Are we being bought by them? Is it suggested that they control so many votes that it would be worth our while? Perhaps some of us can speak with more personal experience of the medical services here and the red ticket system than many of the Deputies who grow so indignant about it. Some of us were not born with silver spoons in our mouth and some of us could not be brought to Merrion Square. Some of us when we needed medical services—and we did need them at certain stages of our lives— were glad to have a red ticket and the services of the dispensary doctor.

Deputies now want to put the wholefuture of the medical services here into the hands of the county manager and it will be the county manager who will determine the type of medical treatment the average citizen is to get. Some of the Deputies who have been talking like that here during the past two days would not go to the county manager to-morrow if they required medical or surgical treatment. They would go to some of the men on whom they have poured so much scorn and to whom they have attributed such base motives. That kind of tripe is, of course, all right for outside consumption by what were described on one occasion here as "a lot of neurotic old women of both sexes".

I thought some of the members of the local authorities in the Fianna Fáil Party would have spoken here and would in the brave way in which Deputy McQuillan did have stood foursquare for whatever this will impose on the rates in each county.

Mr. Fanning

We have stood up for it in other places.

Mr. Morrissey

I am not talking about other places. I am talking about here.

Mr. Fanning

Perhaps here, too.

Mr. Morrissey

The Deputy will be surprised at how much freedom he will get to speak here. I will undertake not to interrupt him even once. I want to hear the Deputy on that point. We were told by previous speakers that we were being asked to give the Minister a blank cheque. Actually we are being asked to give the Minister two blank cheques, one on the Central Fund, the other on the local authorities. Deputy McQuillan, I think, misunderstood the Minister if he understood the Minister to say that he would guarantee that the impact on the rates for the full implementation of this scheme would not be more than 2/- in the £. I want to be fair to the Minister. I do not think the Minister said any such thing. Was it not made clear in so far as anything was made clear during the Minister's visits throughout the country to the various county councils that, varying from one county to another, this might impact on the rates 2/-, 2/6, 3/-and3/6 in the £—and the full implication of it could take the impact on the rates to 5/- in the £? If all the additional services—buildings, beds and personnel—that would be required fully to implement this scheme were to be found then it will not stop at 5/- in the £.

Are Deputies going to go down and stand over that and support it and explain it in their own constituencies as bravely as they do here? It is all right for Deputy McQuillan to pass it over by saying that 2/- in the £ on a small farmer with a £10 valuation is only £1 a year and to go on to explain the services which he believes a farmer will get for that. Of course, he is not going to get those services at all. May I remind Deputy McQuillan that that extra 2/-, 2/6, 3/- or 5/-, or whatever it may be, will have to be paid by every rated occupier in this country whether it be an old age pensioner inhabiting a thatched cottage, a farm worker, a road worker, and so forth? Of course, our view on this matter is sought to be twisted. It is said that we are opposed to spending the money. We are opposed to spending the money on this scheme because it will cost, both centrally and locally, something in the neighbourhood of millions of pounds, and because, under this scheme, people will not get and cannot get value for that money.

Mr. Briscoe

How does the Deputy make that bit out?

Mr. Morrissey

How has the Bill been described? Deputy Dr. Browne described it. He has barely got his toe inside the door. He said that this is a very small moiety of the Bill he wants. Deputy McQuillan described this as a shadow without any substance. Deputy Norton——

Mr. McQuillan

On a point of explanation—a shadow of the Bill that we expected to see from the previous Government.

Mr. Morrissey

It is a great pity that the Bill did not come in. I agree with the Deputy there. Deputy Norton examined the Bill. He showed clearlymany major defects in it and where it will operate to the disadvantage of certain classes of the people. I should like to ask the Deputies who were present in the House this evening when Deputy Dr. O'Higgins was speaking what they thought of that speech. I think that any Deputy, unless he is completely blinded by prejudice, will have to agree that that speech was impressive. It came from a man who obviously spoke from practical experience. It came from a man who had a lifetime of experience as a dispensary doctor and as a county medical officer of health.

Dr. Ryan

And as a politician.

Mr. D.J. O'Sullivan

Of course, the Minister is not a politician.

Mr. Morrissey

The Minister is a politician. I hope he does not subscribe to the claptrap that we sometimes hear outside and that we hear of here, that it is something to be ashamed of to be in Irish politics.

Dr. Ryan

I do not believe it. I want to say that the speech by Deputy Dr. O'Higgins was purely a political speech.

Mr. Morrissey

I do not agree.

Dr. Ryan

It was, purely.

Mr. Morrissey

I do not say that it was not a speech that had not a political approach in certain aspects. I should say, in fairness to the Minister, that he was out of the House for the greater part of the speech: he cannot be in the House all the time. I think that Deputy Dr. O'Higgins examined the Bill, its possibilities, what it could do and what it could not do. He gave us a picture of the existing services in the country and how they operate. He gave us a picture of the hospitals we have in this country and of the number of beds that are available there. I thought it was a very impressive speech. I thought that Deputy McQuillan who spoke after Deputy Dr. O'Higgins would have adverted to it. He only adverted to it very slightly. As a matter of fact, I was more thandisappointed to hear Deputy McQuillan say, on a matter like this that is supposed to be of some importance, that the only reason he decided to speak was because—he alleged— Deputy Costello said something about farmers under £50 valuation riding around the country in Chrysler cars. Again, at the risk of being sneered at, I want to say that I want to see a first-class medical service in this country. I know the old medical services in this country. I am old enough to have been, for a period before their abolition, a member of an old board of guardians. My knowledge and experience goes back to that time. I had myself, in my upbringing, to take advantage of the poor law medical service and the red ticket: I know something about it. For a number of years I acted as a warden issuing red tickets and I know something about it. No Deputy in this House could use words stronger than I should like to use to denounce the dispensary service in this country and the so-called dispensaries in this country. We do not need this piece of machinery to deal with that or to remedy it. We do not want this expensive machinery or this blank cheque. We do not want a mere change of a red ticket for a white card.

Deputy Cunningham allowed his enthusiasm to run away with him when he said that, under this Bill, we were changing the whole system. We are doing nothing of the kind. The Minister himself does not even pretend to do it. What we are trying to do and what we are insisting on doing is to proceed to build up a medical system in this country, at the same time refusing point-blank to seek or accept the assistance of the only people who have real practical and technical knowledge —if I may use the word "technical" in this respect—of the medical services and their operation in this country. Every Deputy who has spoken from the opposite side of the House, and the Independents who have spoken, is an expert who considers that the doctors know nothing about it.

Mr. Briscoe

Are the majority of the doctors in this House not in favour of this Bill?

Mr. Morrissey

Have they spoken in favour of it?

Mr. Briscoe

They will speak with their votes.

Mr. D.J. O'Sullivan

Will the whip be off?

Mr. Briscoe

The majority of doctors here are in favour of it.

Mr. Morrissey

Do not put your colleagues in an embarrassing position.

Mr. D.J. O'Sullivan

That is not fair to them.

Mr. Morrissey

That has nothing whatever to do with what I am saying. I am saying you are refusing to allow the people who know and the people who will have to operate the scheme and without whose assistance this Bill cannot be put into operation, to assist in framing it. They are not merely to be rejected; they are to to be blackguarded—and that is the only word to be used—in this House. The doctors are to have no say in it. It is to be the county managers who will determine who is to get the medical service, who is to pay for the medical service and how much they are to pay for it.

Mr. Briscoe

That is not so. The local authorities decide that.

Mr. Morrissey

The local authorities have nothing to do with it.

A Deputy

He is talking about the City of Dublin.

Mr. Morrissey

The Deputy does not know what I am talking about.

Mr. Briscoe

It will not be applied to Dublin.

An Leas-Cheann Comhairle

Deputy Briscoe should allow Deputy Morrissey to continue without interruption.

Mr. Morrissey

I want to repeat that it is the county manager who will decide, and I also want to repeat that the Deputies who intend to vote for that would not put themselves or any member of their families in the hands of the county managers if they wereseriously ill. Those of us who have experience of it over a long number of years know quite well that county managers being, if you like, even overscrupulous with regard to their responsibility to the local authority and to the Minister will not sanction sending a particular patient to a hospital. Let me put it the other way, that a doctor dare not take the responsibility even in a case of emergency of sending a patient to a hospital in Dublin, Cork, Limerick or elsewhere in case the county manager would subsequently refuse to sanction the payment or to be responsible for the expenses. That has happened, and there is no Deputy in this House who has any knowledge of local authority work who does not know that what I am now saying is true.

We are asked to pass this Resolution committing this House to provide an unspecified sum of money out of the central Exchequer. In the passing of this Resolution we are asked to give the Minister the power to impose on the local authority the responsibility for an unspecified amount. I would not be frightened of the cost if I thought the people would get value for it. I am perfectly satisfied that under this proposed machinery they will not get value for it, and that neither this particular Bill nor any other Bill can be operated in this country fully and successfully and to the benefit of the people without the co-operation and the goodwill of the medical profession.

It is sheer nonsense for Deputies to be saying—and if they are trying to cod the people outside they ought not to be trying to cod themselves—that all the doctors in this country except a few in Merrion Square are in favour of this Bill. I venture to express the view that the Irish Medical Association represents and speaks for far more medical men in this country than a few doctors in Merrion Square. We will not get over it by a cheap sneer at the ten, I think, misguided physicians in the Irish Independent.Some of them are very eminent men.

Dr. Browne

Bad politicians and bad journalists.

Mr. Morrissey

The Deputy suggested that they were bad doctors and thatthey were only concerned with their fees and their cash rewards. Some of them are very eminent men and some of them are well-known men in this country. Some of them have saved many lives in this country.

Deputies

Hear, hear!

Mr. Morrissey

Some of us have personal experience and have reason to be thankful for their skill. I unfortunately have perhaps more often than most people had to throw myself on their mercy. Perhaps some people may think it a good thing but I have no hesitation in saying that if it were not for their skill—skill very largely acquired in our voluntary hospitals— I probably would not be bothering the Chair or certain Deputies of this House at this moment. If the members of this House are to have their ills and ailments, such as they may be in the future, attended to and confined to a scheme such as is set out here and subject to the approval of the county manager, there will be fairly frequent by-elections and that in itself might not be a bad thing either. There is one major operation that would settle all this and the sooner we get it the better.

Mr. Cogan

I suppose the responsibility rests upon me to endeavour to lift this debate out of the slough or cesspool of personal abuse, anger and hate into which the last Deputy has sought to drag it. We ought to approach this Bill in a serious way and that is the way in which I intend to approach it. I am against this Bill and being against it means that I will find myself for a time at least in rather bad company. I am against it for reasons which have not been stated——

Mr. Everett

The by-election.

Mr. Cogan

——by any other Deputy in this House. I am against this Bill and publicly declared myself against the proposals of the White Paper while the late Deputy Brennan was still a member of this House. I know Deputy Everett is worried about the election. His great worry is that he may be pushed out of this House and I have sympathy with him in that respect.

Mr. Everett

You are worried that you might be pushed out.

Mr. Cogan

I hope Deputy Everett will endeavour to conduct himself while I approach this Bill in a serious and in a responsible way. We heard the Leader of the Opposition deliver a long and violent speech in regard to this Bill. He pounded the desk and thumped the seats; he thundered against the Bill but when it was going through the House he could only whisper a faint "No" against it and whispered so faintly that even the Chair did not hear him. But apparently he decided to come into this House and endeavour on one side to capture as much support as he could from those who are opposed to the Bill throughout the country, and on the other side to try to placate the Labour Party. Thus he twisted, wriggled and turned right through his speech. He made no coherent statement and he gave no coherent reason why he would go into the Division Lobby to oppose this motion. He evidently thought that by a great display of sound and fury he could impress this House just as he makes an impression on simple jurymen who see him and hear him only once. We have heard and seen him so often that we see the hollowness of his thunder and lightning and the utter and complete insincerity of his remarks. He said he was opposed to the Bill, not because of its cost to the ratepayers and to the taxpayers, but every member of his Party who spoke in this House attacked the Bill because of its cost.

Mr. S. Collins

On a point of order. Is it in order for a Deputy to refer to the private avocation of another Deputy to his discredit in the course of a speech? The Deputy has suggested that the Leader of the Opposition was impressing simple jurymen who only heard him once.

An Ceann Comhairle

Deputy Costello does not need any commendation of his professional capacity in this House.

Mr. Cogan

We are not as simple as some of the people whom DeputyCollins tries to impress on certain occasions outside this House.

Mr. S. Collins

I thought the Deputy said that he was going to raise this debate out of the cesspool of personal abuse.

Mr. Cogan

I am trying to approach this debate with a sense of responsibility. I am trying to point out that the whole of the arguments of the Leader of the Opposition—and we must treat him with respect as the Leader of the Opposition—futile though they may be, must be treated as if they were advanced in a responsible manner. Deputy Costello said that he is against this Bill on fundamental grounds, but through the whole length of his speech he set out no fundamental issue upon which he is opposed to this Bill. Therefore, he failed to submit any fundamental objection to the Bill.

I want to say here and now that, unlike Deputy Costello, I am not trying to placate the Labour Party or any other Party. I want to say that I have an objection to this Bill on one fundamental issue and that is that it is tending to extend the sphere of State influence over the lives of our citizens. It is tending to advance Stateism further than it has ever been advanced. On that issue, and on that issue mainly, I am against the Bill in addition, of course, to the question of its cost which I think could be avoided if we were to approach this whole question in an entirely different way. There are too many people, far too many people, at the present time dependent on the State for their very existence, too many people eating out of the hands of officials and eating out of the hands of politicians if you like. That is what it amounts to. I think that our approach to socialistic legislation of this kind should be to limit the number of people who are depending upon State services for their existence and to increase the number of people who are depending on their individual efforts, upon their own industry and thrift, for their food, their clothing, and the medical attention that they require.

It may be said, of course, and has been said, that at the present time one-third of the population of this State are in the position of depending completely upon the taxpayer, the ratepayer and the public authorities for medical treatment. People say that since one-third of the people are so dependent and can manage to survive on that type of service, there is no reason why it should not be applied to the other two-thirds. I join issue with those who advance that viewpoint. I say that instead of having one-third of our population depending upon public funds for medical treatment, we should seek to release some portion of that one-third from that position. We should seek so to raise the real standard of living of our people that more and more people would become independent of State aid in regard to medical treatment. I think that is the fundamental approach we should make to this Bill. What advantage is there in subjecting an ever-increasing number of people to dependence upon State services for medical treatment?

Fundamental it is also that every citizen of this State, whether he be rich or poor, is entitled to the best medical, institutional and surgical treatment that can be provided. If a multi-millionaire and a tramp are knocked down on the road by a motor car, I hold that both of them should be taken to hospital and given equally good treatment, first-class treatment.

Captain Giles

Do they not get that?

Mr. Cogan

I think that is the position which should prevail, as far as we can manage it. It is better to make that clear because there have been suggestions that there are pauper beds, and pauper treatment for one section and another type of treatment for another section. I say that if that exists anywhere it should be eliminated.

Mr. D.J. O'Sullivan

It does not.

Mr. Cogan

The question then is how to finance that treatment and it is on that issue that I differ with the Minister. The proposal in this Billis that that first-class treatment should be financed to a larger extent by the general taxpayer and by the ratepayer. Again, the suggestion is made that the means test should be removed completely from public health services. I think we had better get our minds clear as to what we mean by the abolition of the means test. Those who advocate the abolition of the means test are mainly those who want to establish a socialistic system of administration in this State. They do not say that we must abolish the private ownership of property; they do not say that we must abolish individual enterprise because they know that these things are reasonably popular but they go another way about it. They say that we must abolish the means test. They know that once you completely abolish the means test in regard to the supply of essential requirements, you abolish private ownership of property, the individual ownership of enterprise and everything that is connected with free society. A campaign for the abolition of the means test all along the line is a campaign for the complete abolition of human liberty, the complete establishment of what is described as the Welfare State, or what is better known as the slave State. It is part of a general campaign for the socialising of all industry and of all means of livelihood.

No Deputy has approached this matter in a reasonable way and sought to give sound reasons why the means test in regard to medical treatment should be abolished. If, as Deputy Morrissey pointed out, the person has had the experience of being rescued from serious ill-health through the skill of hospital nursing and surgical and specialist treatment, surely the first person to pay for that service is the person who has received the benefit of that treatment and who has been restored to health, provided he has the means. If, as I said, a tramp and a multi-millionaire are knocked down on the road, they should both receive first-class treatment, but while the tramp could only thank those who rescued him and brought him back to health, the multimillionaire should be expected to contribute reasonably to the hospital andto the doctors who have treated him.

That principle should prevail right through our medical services. If a man has the means, why not let him pay? What is wrong in asking the man who has sufficient wherewithal to pay for treatment to pay the entire cost or a portion of it? Once you accept that principle you accept the means test. I do not think there is any alternative and I do not believe for one moment that there is any alternative to a means test in regard to medical treatment and many other things. People will go on to say that, once you establish the abolition of the means test in regard to medical treatment, you have thereby established a case for the abolition of the means test in regard to food and clothing. Logically, if a person is entitled to free medical treatment, without regard to means, he is equally entitled to free food, free clothing and free everything else, and you are moving directly towards the slave State in which everybody is fed, clothed and medically treated by the State and in which all the means of providing for these is collected from them by the State.

That is the fundamental issue upon which I am opposed to this Bill. Instead of proceeding further along the road towards socialised medicine, we should call a halt and should endeavour to establish a greater measure of independence and self-reliance amongst all sections of our people. I say that without suggesting for one moment that I am satisfied with existing health services. I am not satisfied that the dispensary system we have at present is proper to a Christian community. I believe that, whether a man is in a position to pay for medical treatment or not, he is entitled to meet his medical adviser in reasonably worthy surroundings. The dispensary, to start off, should be modern and up to date and every county council will agree that that should be so. There is at the moment an effort being made in that direction and it is an effort which should continue.

Let us have, right from the dispensary to the very top, the very highest and most expensive form of treatment, at least as good treatment for the pooras for the rich. That should fundamentally be our policy with regard to medicine, medical treatment and all forms of health services; but let us ask those who can pay to pay and give to those who cannot pay that service absolutely free. Let us give it free to those who cannot contribute anything whatever to the health services. That is the only reasonable way to approach this question. If we are to go further and do as has been suggested, give free medical services to those who can afford to pay for them, we are taking a step that will eventually lead to a demand for free clothing, free food and free everything by every section of the community who can afford to pay for them. That is a policy into which I do not think the House should allow itself to be rushed.

I have great sympathy with the views expressed by Deputy McQuillan, Deputy Dr. Browne and others. They are motivated by humane motives, but they do not realise, I think, the dangers inherent in the policy they advocate. It is always very easy to advocate and almost establish a case for bad legislation by citing hard cases. Hard cases, we are often told, make bad law and that is true in this respect as in others. Cases have been cited of comparatively poor people, people in the middle income group, who have had to pay very high fees for medical and surgical treatment. That will happen occasionally. On the other hand, I could cite instances of men in the same group who have received the highest form of specialised treatment and who have been charged very moderate fees. I have known cases of specialists who have spent hours and days treating particular patients and who have charged only a nominal fee, so let us not condemn the medical profession because of one particular case.

Let us weigh the whole issue carefully. If we do that, we will find that the medical profession on the whole try to implement the means test in a fair and reasonable way. They try to be lenient with those in poor circumstances and collect from those who, they believe, are well-to-do, higher fees. Whilst that means test operated by the medical profession, by thevoluntary hospitals and by the freelance specialists of the present day may not always be equitable and fair, it will on the whole be found, on examination, to be just as equitable and fair as any means test operated by a public authority, a county council, a county manager or the officials of the Department of Health.

Amongst the arguments put forward by Deputy Costello against the Bill was one which I would not for a moment advance and which I do not think any serious opponent of the Bill would advance. It was that this Bill would not receive the co-operation of the medical profession when it is an Act. I think that statement is a slur upon the medical profession as a whole. I think that when this Bill becomes law doctors, no matter how much they resented it or opposed it when it was going through, will endeavour to implement it conscientiously and faithfully in the discharge of their duties.

Doctors sometimes find on the operating table patients whom they may not personally like but that does not ever influence them in the slightest degree in giving those patients the benefit of their specialised skill. In the same way, when this Bill becomes law, I am quite sure that the medical profession as a whole will endeavour to make the best of it and implement it to the best of their knowledge and skill.

Another argument used by Deputy Costello which I resented was his contention that the contribution of £1 for the persons in the higher income group was a fraudulent subterfuge to get over the moral objection to a free-for-all scheme. In other words, he was suggesting that the Irish Hierarchy would be bamboozled in some way by this proposal. I think that is a highly offensive reference to the Irish Hierarchy. I do not think that it would be possible to mislead or confuse our Irish Hierarchy in relation to a moral question, and I refuse to accept that unworthy suggestion of Deputy Costello.

I think that he could have made a good case against this Bill, but he failed to do so. He failed not becauseI think he lacked the ability—we will all concede that Deputy Costello is an able man—but because he wanted to placate in some way those doctrinaire socialists of the Labour Party, Deputies Norton, Larkin, and those other men whom he felt he might have to try and co-operate with again in an attempt to form a Government. He was playing politics in his speech right from the beginning to the end. Because he was, he makes, I would say, a complete hash of the case which he was called upon to make against the Bill.

There is a case against the Bill on the lines which I have indicated—a case that we have gone far enough already in regard to socialised medicines, socialised welfare services and socialism of every kind in this country. We have got to turn back from that course. A case can also be made against the Bill on the ground that services of this kind are becoming too expensive. There are too many people depending upon State aid of every kind and too few people paying for those services through their industry and toil. Under those two headings a reasonable case could have been made against the Bill and a reasonable case could be made against it. I think that reasoned argument would be far better in dealing with a matter of this kind than the type of personal abuse in which Deputy Morrissey indulged.

I think there is no reason why anyone should go out of his way to attack Deputy Dr. Browne or Deputy McQuillan for the case they put up. I disagree with both, but at the same time I think they were sincere. I think they are absolutely sincere in putting their case forward, and I think they put it forward in a reasonable way. Not alone do I consider that health services have become too expensive, but I feel very strongly against the system by which 50 per cent. of the cost is imposed on the local rates. Some people will say that local rates are as fair a system of taxation as general taxation.

Brendán Mac Fheórais

More fair.

Mr. Cogan

That is an opinion but it is an opinion upon which we can afford to differ. It is a question upon which I differ very, very strongly from Deputy Mac Fheórais. I think that rates are a form of direct taxation and are levied upon people irrespective of their means. Very often you will find the person with a very small yearly income bearing a very high burden of direct taxation in the form of rates. It just shows how out of touch some leaders of political Parties are when we had Deputy Costello asserting that there are farmers in the country with less than £50 valuation driving around in Chrysler cars. I have never seen a Chrysler car in rural Ireland owned by a farmer under £50 valuation. Any cars that may have fallen into the hands of farmers are cars that have been rescued from the dumps of various garages, old Fords and baby Fords dating back to 1936. These would be the cars that Deputy Costello mistook for Chryslers.

Captain Giles

The farmers are not tramps. We do not accept that.

Mr. Cogan

I think that the chief Opposition Party—Fine Gael—would have done themselves more justice and this House more justice if they had approached this Bill in a more serious way and put up a more reasonable case against it. Had they done so they might perhaps—I do not say they would—have converted the Government to their point of view, but they approached the matter in a purely narrow political way, trying to capture as much support as they could from those who are against the Bill and at the same time trying to placate the Labour Party, who are in favour of it. They endeavoured to pursue in this House those two absolutely contradictory and mutually destructive policies and, as a result, they have made no case, so far, against the Bill.

I hope I have made the foundation of a case against it mainly on the ground that it is an advance in the wrong direction. It is a departure from self-reliance and independence on the part of our citizens. It is a step in the direction of State socialism and State medicine. I think there aremany things which we can do to improve the health of our people irrespective of and outside this Bill. I agree, of course, with a free-for-all service in respect of T.B. That was an argument that was used very strongly in favour of this Bill. When you are dealing with infectious diseases you must seek by every possible means to curb and eradicate them. But, in regard to the ordinary ailments to which human flesh is heir, I think it is better leave every citizen to pay his way if he can afford it, and if he cannot, then by all means go to his rescue with all the resources at your command and give him all the services that are at the disposal of the State.

I was rather sorry that Deputy Larkin did not intervene in this debate. He was one of the few who did speak on the Second Reading of the Bill, and on that occasion he made a reasonable case in support of it. He based his case not on political catchcries or on personal abuse, but on the solid conviction —on sincere conviction, I think, as far as he was concerned—that we ought to have a completely free-for-all socialised medical service in this country as a first step towards a completely socialised society in this State. I think anyone can respect a man who believes in a policy of that kind and is sincere about it, but I have no respect for men who, like Deputy Morrissey and Deputy Costello, try to face both ways, and at the same time try to cover up the futility of their arguments by personal abuse and by studied rancour, bitterness and hatred.

Brendán Mac Fheórais

The only reason why I have risen to speak is because of Deputy Cogan's intervention. I have no intention of defending any particular person in this House on this measure, because the Labour Party stand on it is the Labour Party stand and no more. I did listen carefully to Deputy Cogan. Having listened to him for 20 minutes, I must say that I do not know whether he is for or against the Bill. I know whether he is for or against Deputy Costello, the Fine Gael Party and the Labour Party, but still I do not know whether he is for or against the Health Bill.

Mr. Cogan

You will know when I vote

Brendán Mac Fheórais

I know how he is going to vote. He is going to vote against the Bill because the Government majority is assured by the support of the Labour Party. One can recall the many serious measures that went through this House in the last 12 months, notably the Budget Resolutions, and, because Deputy Cogan thought that the Government might fall, he consequently voted for all the Resolutions contained in the Budget. He is perfectly safe in voting against the Health Bill because he knows that the Labour Party, certain Independents and other Deputies are going to support this measure. Therefore, he can be a Simon Pure. He can go down to Wicklow and say that on moral grounds or economic grounds he protested against it and can talk about consistency. His consistency is very well linked up with those who support the Government.

I was amused to hear Deputy Cogan talk about the furtherance of State control. One would imagine that there were no qualifications required for the receipt of State assistance or local authority assistance in the case of people who are unfortunate enough to have to have recourse to either. One must be a widow in order to get the widow's pension, one must be unemployed to receive unemployment assistance or unemployment insurance benefit, and to receive any type of medical assistance or medical benefit one must be sick. People in this country, no more than in any other, do not take pleasure in being sick.

Every argument that I have heard Deputy Cogan make in this House over quite a long period has been an argument against the Welfare State. He is very tender when he is handling Deputy Dr. Browne and Deputy Cowan. To other Deputies, to members of the Labour Party, he attributed base motives to-night because they go out full-blooded in favour of a health scheme, one better than that which is before us. Deputy Cogan said that there are too many people depending on State assistance. He has often said that before. When he says that thereare too many people depending on State assistance then, by inference, he means people who are unemployed, people who are sick or who have injured themselves, widows and orphans and the like, but Deputy Cogan never complains about the State assistance that is given to the farming community. I am not against the State assistance that is given to the farming community.

Deputy Cogan talked about means tests. He speaks sometimes in favour of means tests and of how necessary they are, but if there is a premium, or a subsidy, to be given to the agricultural industry, it is given to the fellow with five acres of land and equally to the man with 5,000 acres. I do not see much justification in that. As regards the State assistance which is given to the people who ordinarily receive it under the Department of Health or the Department of Social Welfare, there are very strict qualifications which, first of all, have to be complied with. For that reason, I do not think we should allow ourselves to be scared by Deputy Cogan or by people who talk in the same strain about State interference and of the advance towards the Welfare State. As long as our people need assistance, whether it be in the form of cash or medical or hospital treatment, I say that there is still room for improvement.

While this measure does not fulfil everything that our Party would desire, we do say that it represents an advance, however small, on the health services that we have at the moment. One would think, according to Deputy Cogan, that it was a pleasure for people to be sick. He said that there could be malingering. A doctor very soon discovers whether a patient has a cancer, ulcer or is suffering from T.B. A person does not pretend to have these diseases merely for the purpose of going into a hospital bed and of being attended by nurses and doctors. Even as regards this Bill there are certain qualifications laid down. These health measures apply only to persons insured under the Social Welfare Act, to persons whose means are less than £600 a year, and to farmers whose valuations are £50 a year or less.

My complaint about our health services and their administration is that the people representing the ratepayers on the local bodies have never been generous enough. I would be prepared to subscribe, to some extent, to statements made in this House by some members of the Fine Gael Party, that if the medical services we have at the moment were administered to the utmost extent which the law allows, we might not need a Bill of this kind at all. We have seen during the last month or so, in practically every county, where, when the county manager, no matter what some of us may think of him, asked his local authority for a certain sum of money for roads, houses and health services, there was a cry from the two big political Parties for a cutting down of the rates, thus denying the people the services and the employment they require. We all know that the medical services of the country could be in a far better position and could be administered to a much fuller extent if those elected to our local bodies faced up to their responsibilities and did what they are charged with doing as members of a local authority—by providing the services they are allowed to provide under the different Health Acts which have been the law over many years.

As Deputy Norton said to-day, while we approve of this Bill and of the principle of it and welcome any advance that is in it for the prevention and cure of disease, we still feel that it contains many defects. We trust that the Minister will recognise that before the Bill leaves the House and will try to remedy them. The objections raised by Deputy Norton to-day cannot be denied. If the Minister wants to make this a better Bill and to obtain greater approval for it in the House and if the ordinary members cannot amend it in Committee he should take steps to remove the objections that have been pointed out.

I should like to emphasise, as Deputy Norton did, the importance of taking from the manager certain functions which he has, if you like, by default in this Bill. There are reserve functions for a health authority or a county council. These reserve functions must bespecified but, by reason of the fact that certain functions of the health authority are not embodied in this Bill, they must be functions of the manager or executive functions. For that reason I would appeal to the Minister, as did Deputy Norton, to consider the setting up of a health authority, if you like, the reintroducion of the old board of health. That board or a committee similar to that board would be in a far better position to advise the county medical officer of health, the county surgeon or the various medical people concerned as to the best way of interpreting this Bill and of administering the various parts of it in their functional areas.

Deputy Norton also raised the question to-day of the contribution of £1 to enable certain people with incomes over £600 to participate in certain parts of the scheme. I submit that that is pure fraud and subterfuge. The Minister in all decency should cut out that particular sub-section altogether and should not have any charge because the charge of £1 is so nominal as to mean nothing.

Another point which was raised and to which we subscribe is the care of infants up to the age of six weeks. Anybody knows that up to the age of six weeks one cannot say that the baby is out of the danger period. The child who is born with an ailment or who contracts an ailment within one, two or three weeks of birth does not automatically shed the disease after six weeks. It is considered to be a baby up to two years of age. If the Minister would not make it six years he ought to consider making it something like two or three years.

These are matters which would be better discussed on Committee Stage. I merely rose to refute some of the suggestions that Deputy Cogan made and to warn the House, although I do not think the House needs any warning, to have no regard whatever for any of the warnings that Deputy Cogan may give the House about State interference or progress towards the Welfare State. We have quite a long distance to go in this House with regard to social services and measures of this kind before we can becomeannoyed or before Deputy Cogan can become annoyed about having set up in this country any type of socialist or Soviet Government.

Mr. Fanning

I intend to be very brief. If it were not for my opposite number, Deputy Morrissey, I would not have intervened at all. Deputy Morrissey seems to think that everybody is afraid of losing a few votes in his constituency. That is his idea in saying that members of local authorities are afraid to get up and express their views. I have expressed my views at the county council, when we were opposed by the Fine Gael members. It was no surprise to me yesterday to hear the Leader of the Fine Gael Party, Deputy Costello, attacking this Bill although on the Second Reading it passed without a word. I am sure that during the Recess Deputies met local people, especially Fine Gael members on the county councils, who said: "You have let us down. You never raised a word. We made a great fight against the Minister at meetings in the country."

I did not hesitate in voting for the increase of 2/- at the county council meeting. Neither will I hesitate in voting for the Money Resolution here. I know the needs of some small farmers in my constituency. They are not the farmers of £50 valuation that Deputy Costello mentioned as driving Chrysler cars. Last Sunday a small farmer of about £20 valuation asked me if the Health Bill had gone through yet. I told him that it had not. This man had had a serious operation. He was removed to a private hospital. On coming out he was presented with a bill for £100. Such a person finds it hard to make ends meet.

I am not one of those who would abuse the Medical Association. I know that the doctors are a decent body of men. The doctors that I have talked with have never raised this question with me. I do not set out to abuse anyone or to indulge in personal abuse.

My colleague Deputy Morrissey seems to have a great fear of the county managers. I have had considerable dealings with the county manager for my area. At any time that I approached him in connection with aperson who could not afford to meet hospital expenses I always received a very fair hearing from him. The county manager is a human being and knows the needs of the people. Deputy Morrissey need not worry one bit. I am not a bit afraid of losing votes in my constituency.

Mr. Morrissey

I did not even know the Deputy was in the House when I was talking.

Mr. A. Byrne

This Bill is only a shadow of what was promised to the people. The ratepayers of Dublin have to pay their share of the cost. The moment the Minister demands 2/-towards its cost to be put upon the already overburdened ratepayers in the City of Dublin up will go the rent of every room-dweller in the city. In the case of the occupier of a single room, who can afford to pay only for a single room, the rent will go up by 2d. or 3d. There is no use in humbugging the people and telling them they are getting something for nothing. There appears to be a desire to put that over on the people. There appears to be a desire to induce the people to take sides one way or the other.

Take the case of the young man who has purchased his house recently or who has built it under the Small Dwelling (Acquisition) Act and who is getting certain remission of rates for a number of years. That young man is going to be faced with an increase by this Government of 2/- in the £ on his rates in the City of Dublin. The Minister has not told us what it is going to cost. I say the cost should be borne by a national Government out of national funds, through the Minister making available the sum necessary to carry it out.

What has happened in Dublin City? Every time we see a new hospital opening in the city or county, it is handed over to the municipal authority, which has to accept nearly all the expenses, I think, of running it. It is a good thing that the hospitals are provided, but the expenses are not paid from the proper authority, the national Exchequer. Dublin Corporation has 30,000 tenants and they will have to pay for this Bill, while many of themwill not need and will not ask for any benefit from it. Many wise people hope it will never be necessary for them to undergo long terms of sickness or surgical treatment and they will get no benefit from the scheme. They will hope to enjoy good health and get good employment at decent wages to keep themselves and their families without needing to avail of any provision under this Bill.

A Bill like this has been promised for the last three or four years, and it has to get a start somewhere. It is just one step in the proper direction, but it requires at least 100 amendments. I am going to support it, I am going to vote for the Bill, for the purpose of helping the various groups here to amend it and make it a decent Bill worthy of an Irish Parliament. If one votes against it and it chances to be defeated, there is no opportunity of improving it, and it will be held up for another year or two. I am hopeful that the Bill will be improved and that it will help the sick or surgical patient, who sometimes lives in dread of the bill of expenses that will be presented to him when he gets better. A week or two before he gets better, there is a means test to find out how much he can afford to pay. He cannot get better under those circumstances.

When the Bill passes this stage— because of Deputy Cogan's speech, it looks as if the Bill is assured a passage —it will require about 100 amendments, and I will support the suggested amendments in every division that takes place here. However, the Bill will get a start. I earnestly hope that the amendments will be carried, but we know that amendments are not usually accepted, or are accepted only in a few cases with very bad grace. I cannot see the Bill being approved other than by the acceptance of some of the amendments the Labour Party has promised to put down. I am earnestly hopeful that when the Bill does pass and also when a new Government comes in, we will have a Bill that will meet the requirements of the people without crushing the already overburdened ratepayers of the City of Dublin. By ratepayers Ido not mean only those with big properties or owning big shops: I am thinking of the people in this city who rent ordinary tenant dwellings and who will get a bill increasing their rents maybe by 3d. or 6d. a week to meet the Minister's demand on the corporation for 2/- towards this scheme.

I see nothing much in this Bill. The Minister and others have talked about changes and about dropping the red ticket. I have a good recollection of the red ticket. It is certainly a system that ought to go, but what are we going to get instead? If we are not going to have a red ticket, we will have a white ticket and what is the difference between them? There will still be forms to be filled in, telling about a person's means and the earnings of the family. Because of that, I see little change in the system under this Bill. I am hopeful that the country will wake up and give us a change of Government and that the inter-Party Government when they get back will bring in the measure that they promised to the country some time ago.

I am supporting the Bill because I believe it can be amended and will be amended. I am satisfied that the Minister will accept a few of the amendments. Even then, it will not be a Bill such as was promised to the people. Never do they hope to get the Bill that was brought out with a glorious flourish of trumpets, which was going to give them a free-for-all scheme. There is a means test in almost every section of this Bill.

There is a question I would like to ask. It must not be thought that Deputy MacEoin is the only one who wants to know whether there will be any objection made to this Bill by the Church authorities and organisations and by their journals that wrote against the last Bill. Are the things that they wrote about withdrawn? Has the Minister satisfied the Church authorities that there is nothing wrong in this Bill, nothing they can object to as being seriously wrong? Not one member of the House has said yes or no to that question yet. Has the Bill been accepted by the Hierarchy asmeeting the requirements of the general teaching of the Church? I am putting that point forward to get some information from the Minister, as no member of his Party has said yet what the position is.

As the Bill is assured of a majority, I earnestly hope that the Labour Party will press every amendment to a division and give us an opportunity of improving this shadow of the Bill that was promised to the country.

Mr. MacBride

It is unfortunate, I imagine the Minister will agree, that the discussion on this Money Resolution has not been conducted in a less acrimonious atmosphere. Unfortunately not merely for this House but for the country generally and for the health services, this whole question of health services seems to have become closely involved with sharp political issues. It is a pity that such an intolerant attitude should have been adopted in approaching the whole question. We here in this House should readily recognise that we are not by any means qualified to express categorical views on every subject under the sun, that we often would benefit by discussing objectively problems such as this and by taking advice, or by listening to the advice offered and examining it to see on what basis it rests. Listening to the debate, it occurred to me that valuable suggestions were made by Deputy Norton, the Leader of the Labour Party and also by Deputy Dr. O'Higgins. I do not know whether the Minister was in the House when both Deputy Norton and Deputy Dr. O'Higgins spoke, and whether he detected what I considered to be the basis for a possible agreement with regard to the whole health question. Deputy Norton suggested that the National Health Council, which has been in existence for some years but was not availed of, should be tied in with this Bill or at least with the health services which the Bill provides and given at least some statutory advisory function. If I did not misunderstand Deputy Dr. O'Higgins, he suggested that a proposal of that kind would go a long way to meet some of the objections which were being made against the Bill. It does occur to methat we should, at this stage, in a calmer atmosphere, seek to find general agreement on a proposal of that kind. No doubt even then there will probably be a great many points of disagreement in regard to the detailed provisions of the Bill, but I would think that the Minister would himself welcome at this stage some basis upon which a modicum of agreement could be found on the future development of the health service.

I know that probably in the first instance the provisions of this Bill were largely a matter of political expediency. But, irrespective of the original reasons which prompted the introduction of this Bill, I would hope that the Minister would appreciate the value of seeking to get some basis of agreement among all Parties in the House and also of the medical profession outside and other bodies interested in social matters generally. As I said before, I do not think any of us can claim to be the sole fountain of wisdom and knowledge in the country and therefore that we should welcome the assistance of outsiders in helping us to provide the best possible medical services.

I hope that the Minister will have an opportunity of examining carefully the proposal Deputy Norton suggested and also the echo which I seemed to find in the statement made by Deputy Dr. O'Higgins to-day. The difficulty, of course, about a measure of this kind when you get into the arena of acrimonious discussion is that one is inclined to lose sight of the main possibilities and the main objectives. It would be a mistake if that were done in the case of this Bill.

The Bill contains a great many provisions that are good and necessary. On the other hand, I think that the general approach to the question is unsound. In my view, the most fundamental question in regard to the improvement of our health services depends upon making available the physical facilities required. This Bill does not approach that question. It is agreed on all sides that the number of beds in hospitals is inadequate for present wants. It is agreed on all sides that our dispensaries are in many respects a disgrace to the wholemedical service. It is agreed on all sides that we have not got the clinics which are required to administer a proper health service. As I said, I think we ought not to make the mistake in matters of this kind of devoting too much time to the consideration of the theoretical aspect of the scheme instead of approaching it from a functional angle. I feel that the passing of a health service scheme of one kind or another in this House is to a large extent a waste of time unless we are prepared to make available the physical facilities required to implement it.

In that connection, I was rather shocked to find that within a few weeks of the publication of the present Bill an announcement was published in the papers that the Minister had abandoned the plans for the building of a maternity hospital in Limerick. That paradox illustrated to my mind one of the vices of the present situation, that we are spending a lot of time here discussing a theoretical Bill for the provision of maternity services while, on the other hand, we are apparently cancelling the building programme for a new maternity hospital. The thing just does not make sense. As far as the provision of medical services is concerned, as far as the provision of maternity services is concerned, I am sure the people of Limerick would much rather have a maternity hospital than a theoretical scheme on paper.

Likewise, one gets complaints the whole time as to the inadequacy of some of the existing public hospitals in the country. You also get demands the whole time for the building of additional hospitals in different parts of the country. Again, there, it seems to me that the objective should be to provide the physical facilities first and then begin to worry about the scheme if one finds that the scheme is necessary in order that the hospital beds should be occupied.

The only principle involved, in my view, with regard to the provision of health services is the lack or inadequacy of means and never to deprive any citizen of the best medical services that are available. But, ofcourse, that principle cannot be given effect to unless the facilities are actually available. We may talk until the cows come home about the need for better medical services, but, unless we provide the hospitals, the clinics and the dispensaries we will not be able to give those better health services.

Probably Deputies on both sides will agree that at the moment, for some reason which is not apparent, persons who are entitled to sickness benefits are not receiving them or are only getting them after an unconscionable delay. That is a matter that can be remedied, but it is certainly something that shakes one's confidence in the effectiveness of State services.

Our health services at the moment are completely inadequate. They require considerable improvement. I am not satisfied that this Bill will improve them to the extent it is suggested by those who support the Bill. I am not one of those who quarrel with the expenditure of money for the provision of proper medical services. I do not mind how much those services cost because I believe it is our first duty to make such services available to our people, and I want to ensure that the money spent on health services will be spent for the benefit of our people.

We are discussing here a Money Resolution for the implementation of this Bill. So far we have all failed to extract from the Minister any detailed analysis of how much he estimates the implementation of the Bill will cost. I want to again emphasise that I do not raise this question because I think we should cheesepare on health services. I raise it because I want to know where the money we propose to expend will go. I want to know how it will be utilised.

There is a lot of talk here about the medical profession, the doctors and their advocacy against this Bill. I have a shrewd suspicion that the people who will receive the bulk of the moneys it is proposed to make available by this Financial Resolution will in fact be the doctors. I would like to know how much we are about to make available to the medical profession. The Minister should be in a position to tell usthat unless he is deliberately avoiding that issue.

The Minister must have made some estimate of the cost of the services that he proposes to provide. I would like the Minister to give us an estimate— I think it is important that he should do so and my attitude in voting on this Money Resolution will be guided by the information made available by the Minister in his reply—of the total cost of the services to State funds and the total cost of the services it is proposed to provide which shall be paid for by the local authorities. These are the two main heads.

I would like the Minister to tell us what his estimate is as to the amount of money which will be paid (a) from State funds and (b) from local authority funds to the medical profession, be they specialists or ordinary practitioners. I would like the Minister to give us likewise an estimate of the amount of money which will be provided by local authorities for institutional treatment and the amount of money which will be provided from State funds for institutional treatment. I would like the Minister to give us an estimate of the money which will be provided from State funds for dental and ophthalmic services and the amount that will be provided from local authority funds for the same services. I would like the Minister to give us the amount of money which will be provided for maternity cash grants, the amount of money which will be provided for specialist services and the amount of money which will be provided for maternity services.

Surely the Minister did not embark on this scheme without forming some estimate of the cost of each of these services under the headings I have enumerated. For that reason I think it is not unfair to ask the Minister to give us these particulars. I am anxious to secure them because it is from these estimates the House will best be able to judge the value of the services it is proposed to provide.

The Minister quite fairly said in the House yesterday that the lower income group will get little under this Bill that they have not got at the moment. I would like the Minister togive us an estimate—I am sure he has made such an estimate—of the exact cost of providing services for the lower income group, the middle income group and the higher income groups under each of the headings that I have enumerated. I do not want to tie the Minister to the estimates he gives us. I appreciate that there will be flucuations, and that many factors may in fluence the cost of these particular services. I can appreciate that the estimates the Minister may give us will only be rough estimates, but I think the House and the country is entitled to have these estimates because they will to a large extent enable us to judge whether or not the provisions of this Bill are worth while. I have a shrewd suspicion that if these estimates are produced they will reveal that in the main the bulk of the moneys provided will find its way into the pockets of the doctors.

I know from friends of mine in England that, on the whole, the doctors on the other side have done extremely well out of the health services. I have no objection to the House providing moneys for the medical profession if it is necessary but if the alternative is to be the provision of moneys for the medical profession as against the provision of additional hospital beds, as against the provision of dispensaries, as against the provision of clinics, I would opt in favour of the provision of beds, clinics and dispensaries.

I do not think—again I want to repeat this so that there will be no question of misrepresentation—that we should put a ceiling on the amount of money which it is necessary to spend to improve our medical services generally. On the other hand, I think we should be careful of how we spend that money so that we will get the best result possible for the people. Let us take extreme examples, if you like. You may often have to face the alternative of whether you should cut down on State expenditure that provides employment and produce a situation where you have 90,000 people unemployed or whether you should refrain from providing health services that are not absolutely necessary at that time. These are decisions that we have tomake in this House but, in order to make these decisions, we have to have the basic information available to us.

I have already dealt with one of the suggestions which Deputy Norton made to-day—the suggestion that the National Health Council should be tied in, in an advisory capacity, with the health services provided by the Bill. I think that such an arrangement has operated satisfactorily in England. I do not see why it should not operate here. Whatever acrimony may have developed between the medical profession and the Department of Health, whatever unwise provocation may have been given by either side, ultimately it is quite obvious that some solution, some via media, will have to be found and some basis of cooperation between the medical profession, the Department of Health and the local authorities. It would be much better to do it at this stage and to do it in a way that will avoid further acrimony than to allow the situation to become worse.

The other suggestion made by Deputy Norton—a suggestion which I think is eminently wise and which would improve this Bill very considerably—is that the health services should be administered locally as far as possible through a county committee of health —a committee, I suppose, somewhat similar to a vocational education committee. I think that there is a danger in leaving the administration of the health services entirely in the hands of bureaucrats. The whole trouble that we have had in a lot of these discussions on the health services has been due to the feeling that bureaucratic dictatorship is the solution for everything. Frankly, I am afraid of too much bureaucracy. I am afraid of it, particularly in services of this kind which require flexibility. It is really not immediately that the evil results of bureaucracy will show themselves; it will be after a fairly long period of time.

You will find that the tendency would be for the administration of the health services to become more and more the prerogative of civil servants and bureaucrats and to become hemmed in with all the top-heavinessand red tape which, unfortunately, surrounds most of the work of Government Departments. The establishment of local health councils, county committees of health—call them what you like—would, I think, tend to prevent the tendency towards bureaucracy which is inevitable in the Bill as it stands. I hope, therefore, that the Minister will give Deputy Norton's proposals in that respect very serious consideration. It would, I think, make the Bill much more acceptable to people generally throughout the country.

As I said before, some parts of this Bill are good. On the other hand, I am afraid that the Minister has resorted too readily to the application of rigid means tests rather to an adherence to broader principles. I can see that there will be a tremendous amount of difficulty in determining what constitutes a public assistance or low-income group person. I can see that there will be considerable difficulty in determining what constitutes a person in receipt of a family income of less than £600 a year. At first, the figure of £600 per year may sound big but, on examination, it is quite a small figure. It means that—take Dublin, for instance—probably in a household where two persons are earning, they will exceed the £600 a year ceiling and will not, therefore, come within the provisions of the Bill. I think that that ceiling should have been increased very considerably. I always thought that a ceiling of that nature should be in the region of £1,000 a year if you are having it on the family income ceiling.

The provision which enables a local authority to make available services free or at a nominal charge for persons who are suffering from a long or expensive illness is, I think, a good provision.

I would rather have left the provisions of the Bill in a more flexible position in regard to the means test. I can appreciate the difficulties in administering any legislation which is flexible. The only way in which it could be administered satisfactorily from that point of view would be by a local health committee. I do not think it would be wise or feasible toleave a matter of that kind entirely at the discretion of some official. The official must have guidance. A great many matters come into play—local circumstances of one kind or another— and it is very hard for an official to determine this question. I think the combined wisdom of a local committee would have been much more satisfactory.

While there are a great many provisions in the Bill which I dislike thoroughly, I propose to support the Bill because it does provide some things that are good and some things that are necessary. Cash maternity benefits are essential and overdue but I have considerable doubt as to whether I will vote for this Money Resolution at all unless the Minister is prepared to make available to the House the information which I have sought. It is unfair to ask this House to vote for Money Resolutions of this kind without giving any indication of the estimates which the Minister must have made and must have in his departmental files. It would be the height of irresponsibility for a Minister to embark upon a scheme of this kind without having those estimates. As I have indicated before, I want to have these estimates because I believe they will be the best guide the House can have as to the worth of the provisions in the Bill.

Most Bills of this nature depend largely on the way in which they are administered. It would be a good indication of what the Minister hopes to be able to achieve if he made available to us the payment he expects to have to make in a full year in respect of each of the different services I have enumerated. I repeat I have a very strong suspicion that, when all is said and done, with all the fighting between the doctors and the Irish Medical Association, it will be found that the bulk of the money which this House will provide will find its way into the pockets of the medical profession. I have no objection to the medical profession being paid, but if I have to choose between making a couple of million pounds available to the medical profession and making a couple of million pounds for building of hospitorytals, I will choose the building of hospitals.

Mr. Larkin

Like other Deputies, I already had an opportunity of making a speech on the Second Reading. I do not propose to take advantage of this although it has turned out to be a Second Reading debate. I want to touch upon the question of the Money Resolution, the cost and one other item mentioned in the course of this debate. I feel that Deputies, whether they be on the Opposition or the Government side, who are asking the Minister to give them information in the way of a loose estimate of the cost of the services to be provided under this Bill are being very innocent and very naïve for the reason that I do not think the Minister has, at the moment, the slightest idea of the type of service he proposes to provide.

That situation flows from the Bill itself. The Bill is not a statement of health principles at all. It is, in fact, an indefinite series of regulations which can limit the type of services that will be made available. I frankly feel the reason the Minister is not prepared to commit himself is that he does not yet know how little he is going to get away with. The more you read the Bill the more you see that every possible loophole has been put into the Bill to make it possible to reduce to the minimum the service to be provided and, where services are being provided, to secure the highest possible charge that can be extracted.

The Labour Party has indicated its support for the Bill but at the same time has not commended it. The main defect I personally see in the Bill is its complete lack of any kind of philosophy or social approach to health questions. The charge has been made that the Bill has been introduced mainly as a political manoeuvre. Leaving that to one side, I think it is correct to say that the Bill has no kind of social or philosophical approach to the people's health and that it is a purely utilitarian attempt to meet what has become a very popular question of widespread interest because of the manner in which it has attractedcomment during the last few years. Whether the Government feel they will receive support for the introduction of this Bill or not I do not know but it seems to me that the Bill is here only because they feel there is sufficient public pressure in respect of health matters to require that some step, however meagre, should be taken.

Mr. Briscoe

It is because we believe in it also.

Mr. Larkin

Believe in what?

Mr. Briscoe

There is need for further steps.

Mr. Larkin

Yes, but what steps?

Mr. Briscoe

Many.

Mr. Larkin

Even the Minister cannot tell us what we are going to get because it depends on the regulations to be made.

Mr. Briscoe

And the local authority.

Mr. Larkin

Agreed. We also know from experience that the operation of this Bill will not be in the hands of the local authority but in the hands of managers and the managers, in the final resort, are the officers of the Minister. That is one of the objections I have to this.

Apart from that aspect of the matter the outstanding feature is the application of innumerable means tests right through the Bill. I have no objection to that if that is the approach, that when a sick man or woman is going along to receive necessary and urgent attention for some physical disability, they have got to be examined for their means first. If that is the approach, that is all right. However, it seems to me in regard to this essential question of health we are refusing to apply principles that we are applying in other walks of life and with which I will deal later. The only point I want to make at the moment is that while I am voting for the Money Resolution it is not on the basis that I agree in regard to the amount of money that is entailed, because we are completely in the darkas to what is going to be the final outcome of this Bill.

The more I read the Bill the more I notice its very careful drafting and the very careful manner in which powers have been taken under every possible section to maintain saving clauses by regulation. The type of institutional service will be determined, the type of special service will be determined, the class of persons to be granted these services and those to be excluded, whether these services are to be given in one or another institution, what the charges are to be, the various groups of persons to come within the various scopes—right down the whole of the Bill we have nothing but a series of regulations.

In the course of the debate and in the literature from the doctors there were many references to bureaucrats. I was surprised that even Deputy MacBride fell into that particular trap. The interesting thing about bureaucrats, so far as the civil servants are concerned, is that whatever bureaucracy we do have comes from the top, from the Government and the Ministers. Every one of us knows that a bureaucrat is not a peculiar kind of animal that always exhibits the same traits. Bureaucrats differ in their approach. There are good and bad bureaucrats, and I think Deputy Briscoe will agree with me that in many respects, so far as the City of Dublin is concerned, especially in regard to health, we have the advantage of having some good bureaucrats. In other parts of the country they have the opposite experience. It applies equally to Ministers and Governments and when we find that certain measures are being administered in a way to which very often we object, and to which we are frequently opposed, we do not start to look at the bureaucrat; we start to look at the top where policy is decided and from which instructions are given to the bureaucrat to operate that policy. We have no better example of that than the social welfare system recently introduced under which we have had a mass or regulations issued; as a result of which the whole scheme has been twisted out of all recognition. You cannotblame the officials for that because policy is decided at the top. That is why I say that it is to be regretted that nowhere in this Bill does the Government or the Minister tie themselves definitely to certain accepted principles in regard to health matters. They are leaving themselves completely free to deal with vital matters by regulation and to decide how subsequent policy is going to be applied.

In the course of the Second Reading debate I mentioned that we in the Labour Party were generally supporting this Bill and that we hoped to introduce amendments. We have already discovered what has happened in that regard. We put down a number of amendments but half of them have been ruled out of order so that our opportunities to improve this measure, as we would like, will be rather limited. In the course of the debate certain viewpoints have been put forward in justification of the opposition to the Bill. I can quite understand a member of the House being completely opposed to any effort to improve health measures at all on the ground that improved facilities should not be granted to ordinary people. I could quite understand an objection to the Bill on the ground of costs and lack of equipment but the objection I do not understand has come outside of this debate and has come particularly from the doctors. They seek to justify their opposition to the Bill, and to the health scheme on which it was based, on the ground that it introduces what they call a system of socialised or State medicine. That is the basis of their approach to the proposals contained in the Bill.

In speaking on the Second Reading debate I paid tribute to the doctors. I am not going to withdraw that tribute now. I still think that the medical profession render a greater service to the community than any other profession we have. That does not apply to every individual doctor nor does it apply to the professional associations but, in general terms, it is correct and it is a tribute in which we all gladly join. I should like to say however that a most regrettable feature of the debate on the Bill andof the whole discussions that have gone on in regard to health matters in the last three years has been the way in which the whole situation has been bedevilled so that the one section of the community with whom we should be most concerned—sick persons and persons liable to be sick—have been completely lost sight of. The situation has been completely bedevilled and I want to say that no greater responsibility for that complete confusion and bedevilment of the situation rests upon anybody than upon the doctors themselves. It has happened because in the presentation of their opposition to the various proposals for a health scheme they have embarked upon such an unbalanced, exaggerated and intemperate campaign that it is difficult for their closest friend to find any justification for that attitude or to support them in their view.

A document has been circulated to Deputies which has been issued by the Irish Medical Association and which is entitled "The White Paper on Health Services." It starts off with the statement: "State Medicine is bad Medicine." May we ask why it is bad medicine? Why should State medicine which will be administered by the same doctor as would attend a private patient be bad medicine? Is it to be taken that a doctor who would prescribe medicine for a private person in his own house will not have the same concern for the interests of his patients if he is employed by the State, the municipal authority or the local authority and that the tenets of professional conduct of doctors will undergo some change when they are administering State medicine? Is that the best way to approach this problem?

Further, they go on to show in the introductory paragraph that they are completely confusing their professional responsibility as persons charged with the custody of the welfare of the community with their personal and private positions. They are perfectly entitled to protect their private and personal interests, but in doing so they should not try to "kid" us and fool us into the belief that they are concerned only with the welfare of theprivate citizen. I think anybody who reads this paragraph will agree that the statements contained in it are completely exaggerated and are put forward in an attempt to confuse the whole situation. It says:—

"The Government White Paper, if adopted, will mean a great step forward in the control of medical services by the State. It would be foolish to suppose that, while your doctor may worry about this trend, it is none of your affair. A State stranglehold on the practice of medicine places the whole structure of family life in the same immediate peril."

In what peril are we placing family life because we make greater provision for the health of the family through the State? Are doctors going to be a menace to family life, because we provide them with increased facilities to carry out the duties of their profession in regard to families? I know that many of them will agree that the present facilities are so limited and the present equipment of hospitals so inadequate that it is very difficult to provide even post-graduate courses and that, with the limited facilities at their disposal, they cannot do their best. If, therefore, the State steps in in an effort to provide the very best equipment that modern medical science can offer and makes it possible for the patient to take advantage of that, does that mean that we are imperilling family life?

Then it goes on to say:—

"In exchange for heavier taxation, loss of privacy and chaotic services, you will be deprived of the very keystone of your individual liberty."

In other words, the working man and woman condemned to live in a tenement room in one of the bad slum quarters of Dublin, can preserve their individual liberty to die of some curable or preventable disease; they are to preserve their individual liberty rather than be afforded the best medical service that can be given by the medical profession. If these facilities are to be made available, notmerely to the individual citizen but to the members of the medical profession themselves, is the individual citizen to refuse to avail of them and the doctor to refuse to operate them? Is there anything more fantastic than that kind of approach to this problem? Right down through this whole document which was publicly circulated and which was specially addressed to Deputies we have this mass of exaggerated statements, many of which I would say are untruthful.

The document goes on, on another page, to put forward a number of points in regard to what the White Paper offers. Point No. 1 says: "Treatment only in public wards of hospitals," and point No. 8 says: "End of assistance to insured persons for private or semi-private maintenance in hospitals." What is the Medical Association concerned with? Is it concerned with the persons who are able to pay for a private ward or with the sick person who has to be treated, whether in a private or a public ward? Is the person in the public ward entitled to the same treatment as the person in the private ward? Reading this document, it seems as if our main concern should be to ensure that certain groups of citizens will still be able to continue to take advantage of the private or semi-private ward, but that we are not to bother about the people who have to go into the public wards.

Mr. Briscoe

There is nothing degrading in the voluntary hospital public ward.

Mr. Larkin

I agree, but if the Deputy has read this document, as he probably has, he will see that it is quite clear that, in the eyes of the medical profession, there is something very degrading in being in a public ward. It is about time they changed their outlook. Number 2 is "The birth of your children in public maternity wards"—again, the same approach. I do not know whether that is medical snobbery or ordinary class snobbery, but it is not something which should come from men who are charged with professional responsibility. The next is: "Your doctors ordered around by layofficials"; and another, "The red ticket goes and a ‘coloured card' comes in." On the opposite page there is: "Your doctors know your health problems better than the bureaucratic planners." I suggest to the doctors that they should bear this in mind, that for many years the question of the health of the people has largely lain in the hands of the doctors. They have known more about health problems than anybody else. May I suggest also, that whatever progress has been made in bringing the advances of medical science to the masses of the people, in giving them access to the professional training which has been made available by the community to the doctors, has not been the outcome of any great effort on the part of the doctors or of the profession, but of the effort carried on by progressive laymen and women in all political Parties and all walks of life? If we are to judge by the approach of the doctors to some of the simple questions that all members of the House have to concern themselves with, their record is not very good. In our voluntary hospitals for many years, the doctors have largely determined the attitude of these hospitals to their nursing staffs and to their young doctors.

I wonder if the leading members of the Irish Medical Association take any pride in the status which ordinary nurses were given for many years in this country, the conditions under which they had to work, the salaries they received and the treatment accorded to them, which meant in many cases that the young girl going into a hospital found herself in an atmosphere more like that of a jail than a hospital. In the case of the young doctor who graduated, who walked the wards, receiving £30, £40, or £50 a year, were any protests made by leading members of the profession against that degradation of their own profession and of the ancillary nursing profession which our girls entered?

I, personally, have no knowledge of any such protests and I am aware that time after time any efforts made to improve radically the general over-all treatment of sick people by giving proper status to the nursing profession,and even a proper status to the medical profession itself as a whole and not to the individual members, has been the outcome of a gradual progressive outlook which has more and more been acquired by the general mass of the citizens and particularly the more progressive individuals, who, from time to time, inevitably form public opinion. Doctors should bear that in mind and should realise that whatever views they may have on this Bill, or whatever the general approach to the health question, those of us who are concerned to get a more enlightened approach to health problems are doing the job that the doctors should be doing. To the extent to which we succeed, the doctors as a profession will be able to live closer to their professional responsibilities, to give better service to the community and, in turn, the members of the community who require the services of the profession will be able to receive it in the form in which the doctors should be the first to insist it should be extended to every sick person.

On the question of State medicine, I want to close on one note, particularly as Deputy Cogan is here. Everybody seems to object to State medicine and socialised medicine. So far as I can see, the objection is always that so long as I am getting something out of the State, it is all right, but so long as the other fellow is getting it, it is all wrong. Is there any section of the community getting more from the State than the farmers, and contributing less? We are dealing here with a section of the community who, because of their health problems, are in most immediate need. I should like to put a very simple question: if to-morrow a house goes on fire in the City of Dublin and a member of the Civic Guard is passing by, do we not expect that Guard to go into the house, and, at the risk of his life, rescue the people in it? Before he goes in, does anybody expect that he should apply a means test, that he should be asked to check on the income of the people and see whether they are in a position to pay for a private fire service or policeman? Is it not the same with regard to the sick person?

As I said on Second Reading, whatever principle we decide on in respect of the financing of the health scheme, it should not be a principle which places a civil servant or an official of the local authority with an official form in his hand, at the door of the sick room and which demands that, before the sick person can have the doctor whose services he requires in, a means test must be applied. There are other ways of doing it, and there are ways of securing that the members of the community make their contribution to the financial cost of the health services on the basis of their means, their income, their general financial standing. It should not be done in the way it is being done—a way which means that if a person requires a doctor to enter the house and see a sick child or other member of the family, he must first see if there is a 10/- note in his pocket.

Equally, it should not be done in a way which means that, before a person can go into a hospital to receive specialist service or even to receive the services of a general practitioner, his means must be investigated and that the first condition of service is not his need for medical attention but his ability to pay. We can deal with that in another way. We have done it in large measure in respect of social security and the same principles could be applied. I still feel that those who are raising the cry, particularly the doctors, and basing their objection to the health scheme on the question of State or socialised medicine should bear in mind that all the progressive legislation that has come before this House and other Parliaments in this generation was met with exactly the same outcry—that the State was interfering too much, invading the privacy of the home, and that the individual citizen should be able to provide these services for himself and that we should not support an extension of State influence in private life.

Nobody wants the State to interfere. Everybody will agree that it would be preferable if every man and woman were able to support themselves by their own industry and able to provide all the services they require for theirfamilies—proper houses, proper education, proper medical services and proper opportunities in life—but they are not, and, until there are, as Deputy Cowan lectures the Labour Party continually, radical changes in the system of society that we have, the ordinary individual citizen is not going to be able to provide these things. Therefore, the community has to step in, as it steps in in regard to the provision of a State military force to protect the community,a State police force, a State post office, State education, State agricultural schemes and even State tariffs for the industrialists and carries burdens which are greater than the individual citizen can bear. I see no moral objection to that.

Progress reported.

The Dáil adjourned at 10.30 p.m until 10.30 a.m. on Friday, 17th April.