I was concluding my remarks when I moved to report progress at 6 o'clock. I repeat that my principal reason for opposing this Resolution is that at the moment what we need is more employment. We lawyers know of a disease known as "pre-settlement". We find in the case of workmen's compensation, in running-down actions, that the plaintiff never fully recovers until a settlement has been reached.
Committee on Finance. - Health Bill, 1952—Money Resolution (Resumed).
You would not allow it.
I am speaking as a solicitor for the defence. We find this pre-settlement neurosis very often setting in. The plaintiff is worried; he does not recover. Unfortunately, the same thing is happening in the country. If there is a deterioration in the health of the people generally, it is through lack of proper and full employment. I say that the money which we are voting, or which the Minister asks us to vote for this Bill, would be much better spent on giving full employment, on slashing the cost of living, on the restoration of subsidies—which would be as good as medicine to the people, which would feed them, which would give them the opportunity to buy butter and the other commodities on which the subsidies have been cut.
I agree that the health services are not 100 per cent. perfect, but there is no great outcry at the moment against those which are being provided. If there is one particular subject on which we could spend more money, it is on cancer research. Some of that which would be spent on the administration of this Bill would be muchbetter spent on cancer research. If the present Government did for cancer what Deputy Dr. Browne and the previous Government did for T.B., it would be much more beneficial to the country generally. Those are my main reasons for voting against the Bill. As I said at the outset. I agree entirely with Deputy Larkin that this is not a Health Bill but merely a Bill to enable the Minister to make regulations governing the health services.
To take up where the last speaker left off, I am in full agreement with Deputy Larkin's statement, which has been quoted by Deputy O'Donnell, that this is not a Health Bill, but a Bill to enable the Minister to make regulations. If this were a Money Resolution asking this House to vote money to improve the health services, the present hospitalisation, the Minister would have the support of Clann na Talmhan. As it is, Clann na Talmhan is going to oppose this Money Resolution. The Minister was challenged here to-night to show where the Health Bill would improve hospitalisation or health conditions and the Minister did not answer. I have read the Bill and while I cannot say I am a doctor or say I was able to go into the Bill as finely as a medical man would, I think it will not by any means achieve what it sets out to achieve— apart from the objectionable features in it. If the Minister was asking a specified sum of money, instead of an unspecified sum, to improve present health conditions and hospitalisation, he would be getting our unqualified support.
The opinion of this Party is that the present hospitalisation is hopelessly inadequate for maternity accommodation. The death rate, particularly on the maternity side of the medical service, is rather high and is capable of reduction if we apply ourselves to the task. The Minister will agree, as most doctors will, that there is a high death rate amongst babies and mothers that we could and should tackle at once. That is a thing the Minister could do without any Health Bill since there is ample scope for itunder present legislation. Also, hospital accommodation in the various counties is not adequate. There again the Minister does not need a Bill such as this—a contentious Bill which is occupying the time of the House pretty long and which I presume will occupy us longer. He does not need a Bill for that. If the Minister tackled these things and asked for money for them and if these two urgent and pressing problems were eased off—I am only asking that they be cased off somewhat; I am not asking he should work miracles or do impossible things—then we could turn our attention to other aspects, which may be contained in this Bill, and see what could be done about them.
There are three outstanding things that must hit anyone in the eye who examines the health of the nation at the present time. One is T.B., one is cancer, and one is something seldom spoken about but making an awful inroad on the lives of the people, namely, rheumatism in its many forms. We should do our best to tackle these problems first. If money were being sought for them, no Deputy would be so inhuman as to consider the cost of our attempt to master these problems that are pressing on us.
I want to refer to the statement made by the Parliamentary Secretary to the Minister for Health here in the Dáil last Friday concerning my county. The same Parliamentary Secretary is given to making wild statements.
To whom is the Deputy referring?
To Deputy Kennedy.
He is not Parliamentary Secretary to the Minister for Health.
He is Parliamentary Secretary to the Minister for Social Welfare.
The Minister has disowned him.
In this particular case the Minister has a dual political personality, seeing that he occupies two portfolios. On Friday last, as reported in column 338 of the Dáil Report, theParliamentary Secretary, speaking on the subject of doctors' fees at the present time, said:—
"That is occurring in every townland in the country. Deputy Browne talked about the red ticket not being used in County Mayo. It is used in Westmeath. In Mayo they have to bring the ass-load of turf or bag of potatoes. The doctor does not demand it, but the eggs, chicken and turf are brought as aquid pro quo.”
I want to say that that is a complete slander. There is not a single shred of truth in it. I am in a position to speak for the people of Mayo and the conditions in Mayo a lot better than Deputy Kennedy and I never heard of that. It comes very ill from a member of the Government deliberately to slander the people of Mayo in that way. I suppose it is in keeping with some of the statements he made at the by-election in North Mayo this time last year, when he told the people of North Mayo, because the food subsidies had not been removed at that time, that they would not be taken off and asked them did they think poor Dev would do that to them.
That is not relevant.
Except that the statement he made about the people of County Mayo as a whole is just as accurate as the one he made this time last year. Then we find him making a remarkable statement a short time ago at a meeting of the Westmeath County Council. As he is a Parliamentary Secretary who is more or less under the control of the Minister now in the House, I wonder how this statement was prompted. Speaking during a discussion on the Health Bill at a meeting of the Westmeath County Council he said:—
"Thirty years ago, they had shook the Bishops at the Republican Party and threatened them with excommunication but that cock would not crow any more."
It has crowed several times but not inthe direction you want it. A lot of popes and cardinals over there are dragging religion into the political mire.
I ask the Deputy what proof has he for the statement he made about the people of Mayo paying the doctors in this way. He said:—
"The doctor does not demand it, but the eggs, chicken and turf are brought as aquid pro quo.”
Quote the full paragraph in column 338 of the Official Report. Do not be quoting bits of it like Deputy Mulcahy did to-day.
Suppose we take the case of Deputy Davern, a Deputy for whom I had a fair amount of respect until I found him trying to blacken his political opponents by quoting extracts from the Dáil Debates. I had a certain amount of respect for him until I caught him at that shady trick, and it was nothing more than a shady trick. If Deputy Kennedy wants the rest of the quotation, here it is: —
"They do not use the red ticket, but that other practice is understood. Is it not time to end all that nonsense and come to the relief of 150,000 persons, many of whom are heads of families who are living on a small valuation?"
Does the Deputy want me to go further?
After that there is a lot of nonsense.
It is not.
I do not think I need quote any more.
Take a chance. It is not an effective policy for you.
The Deputy went on:—
"Every thatched house that falls down, every holding that is grabbed by a grazier and every holding in Donegal or Mayo that disappears is a loss to this country."
That is a most profound statement. He rambles away from the question of health services into a matter which concerns the Irish Land Commission. We all know that every house that disappears from the countryside is a dead loss. The Deputy never turned his mind to that subject until Clann na Talmhan came into the House and exposed some of the laxity of his Government in connection with it.
Did you not plant them all round him?
I am sorry I did not plant more of them round him. I should like Deputy Kennedy to explain what he means by the statement that that cock will not crow any more.
You are misquoting me again.
I quoted it word for word as it appeared in theMidland Heraldfor 2nd April. If the Deputy thinks he was wrongly reported he had a right to correct it and I would not then be misquoting him.
That is not theMidland Heraldyou are quoting from.
It is a quotation I got from theMidland Heraldwhich is in the Library for anyone to see. If I am quoting one word which does not appear in that paper, I will withdraw it.
Here is theMidland Heraldif you want it.
You are very well briefed over there.
I will quote it from theMidland Heralditself in case my extract may have been wrong. The Deputy said:
"Thirty years ago, they had shook the Bishops at the Republican Party and threatened them with excommunication but that cock would not crow any more."
I want to say to the Minister that I am very sceptical about rumours, but a rumour has been going about since last week-end and I believe there is a good deal of substance in it.
Since last Wednesday.
It may have been going round since last Wednesday but I did not hear it until Sunday.
They did not tell you about it.
I believe there is foundation for that rumour. I think it ill behoves the Minister, particularly on account of his connections, to make a joke of that particular matter here in the House.
I am not making a joke of it.
I am not making political capital out of it like you.
I am not making political capital out of it. I do not know whether there is any foundation for the rumour or not, but the Minister does. If there is foundation for the rumour, I ask him to withdraw the Bill at once. It will take a certain amount of courage to do that, but I do not say the Minister has not the necessary courage. I do not know how his Party will take it or how certain Deputies backing him will take it. I would say, however, that the Minister would gain very much more admiration for doing that than for the shuffling tactics adopted now to cloak the real truth about the matter. I am asking the Minister to have the political courage to withdraw the Bill now and not to do the damage, which he is better able to measure than I am, which will result. I am trying to speak seriously and I do not like to see the Minister turning this matter into a joke. If it were the Minister for Finance or the Minister for Posts and Telegraphs, I would not mind so much, because I know their calibre fairly well by this time, but it ill behoves the Minister for Health to be carrying on in that particular way.
I believe that the Bill has been condemned lock, stock and barrel. I believe that sooner or later, when the truth comes out, if it does come out, it will be seen that there is a good deal of truth in the rumour which is going about, that it is not exaggerated orfalse. I believe that the Bill has been condemned. The Minister will probably try to steamroll it through the House. If he does, that is a matter for himself, but I would advise him not to do so. If he does steamroll it through the House for the sake of political expediency and for the sake of holding on to office and power, then I say he is doing irreparable damage to the country and damage that a Catholic Minister should not be prepared to support or stand over. That is as far as I will go on that particular matter. I shall have more to say, perhaps, on another stage.
One of the arguments used by Deputy McQuillan in favour of this measure, and he, no doubt, sees some advantage in it, is that its implementation will only cost the small ratepaying farmer 2/- in the £. The Minister quoted 2/- in the £ as being the cost of the Bill. I would like to know how he arrived at that figure.
He came down to 1/6.
I never went over 1/6.
If he said 7/- in the £ he would be nearer the mark. In the course of two or three years the cost of implementing this Bill will be nearer to 9/- in the £. I think the Minister's 2/- is nothing more nor less than a shot in the dark and an illdirected shot at that. He told us that 2/- in the £ would be the cost borne by the ratepayers. Let us examine how that calculation will work out because obviously Deputy McQuillan is quite captivated with the idea.
In County Roscommon there are 16,298 farmers under £30 valuation. There are 993 with valuations between £30 and £50. There are roughly 16,300 farmers against 1,000 farmers. I want to bring to the Minister's attention now something that may not have been brought to his notice prior to this. For the first time the small farmer with £2 and £3 valuation will be asked under this measure to pay both by way of rates and taxation for the treatment of those who hitherto always paid for themselves. That is one of the glaring injustices of thisBill. For the first time in County Roscommon 16,300 farmers, approximately, will have to pay under this Bill. I want to make that quite clear to Deputy McQuillan. If we take the figures for the whole country there are 316,496 under £30 as against 30,000 with valuations between £30 and £50. The farmers on that latter valuation have as keen a sense of independence as any other section of the community and they have in the past always paid their own way. Now for the first time the small farmers under £30 valuation will be asked to pay for the medical services of those who hitherto have always paid for themselves. I cannot see any advantage in that to the small farmer. This scheme was not devised by accident. It was cunningly devised to blister the small farmer with an added burden of rates and taxation and I want to take this opportunity of exposing that. I am certain that some of the officials in the Minister's Department or in the Department of Local Government have slipped that across on him with a certain amount of cunning.
The Minister has asked for an unspecified sum of money to implement a Bill that has been condemned in its entirety. I believe he is asking for money to implement a Bill that will never become law. Had the Minister come in here to ask for more money to increase the present accommodation in hospitals for maternity cases we would have been the first to support him. This Bill is nothing more than a piece of political expediency. I cannot see any benefit accruing from it. As a neighbour of mine described it the other day: "The Bill, as far as I can see, is like a man shearing a pig; there is a lot of noise but very little wool".
Minister to conclude.
Not to conclude. We are in Committee.
The Minister, as the mover of the motion, has the right to conclude. When no other Deputy offers the Chair calls on the Minister or the mover of themotion to conclude. That is the Standing Order.
With all due respect, I submit that is not the correct interpretation of the Standing Order.
It has been the accepted practice of the House for 30 years and I see no reason why it should be departed from on this occasion.
Surely the Minister will now make some statement about the developments in the last few days. Surely we ought to have an opportunity of hearing what those developments are so that we may then express our views on them.
Deputies have had an opportunity of speaking on this motion and, since no other Deputy has offered, it is the duty of the Chair to call on the Minister or the mover of the motion before the House to conclude.
Surely the Minister ought to give the House the benefit of whatever views he has on the developments in the last few days.
That is not a matter for the Chair.
Might I point out that this matter was raised to-day and I understood the Ceann Comhairle to tell Deputy Norton that this business was in Committee and would be treated as such. That is my interpretation of the Ceann Comhairle's remarks to-day.
The Deputy will appreciate that even in Committee there must be some finality and, if no other Deputy offers, it is the duty of the Chair to bring the debate to a conclusion.
I submit the motion can conclude only when the last speaker has finished speaking on it. If the Minister intervenes now it is then open to any Deputy to intervene subsequently if he offers. The Minister can now speak and, if no Deputy offersto speak after him, the motion can be put.
If the Chair calls the Minister to conclude no other Deputy can speak afterwards.
That is wrong.
Minister to conclude.
Before the Minister concludes I want to make the position of the Labour Party to the Bill and the Money Resolution quite clear in the light of the situation that we are told has developed within the past few days. I want to make the position quite clear so that there can be no future ambiguity as to where the Labour Party stands in the matter.
I have not been supplied with a copy of the document which, I understand, the Cardinal and certain other bishops have sent to the daily newspapers and a copy of which, I also understand, is in the possession of the Government but has not been made available to us in order that we might consider the document against the background of the Money Resolution and, in particular, against the background of the Bill.
Whatever the merits of the document or the Bill may be, it seems to me a rather extraordinary situation that Parliament should be asked to discuss a Bill of this kind while a document of vital importance in relation to the Bill is being suppressed from Parliament. I do not know who is responsible for its suppression and the question of responsibility does not matter at this moment. What is important is that there is available a declaration of the Irish Hierarchy in connection with this Bill, and Parliament, which ought to have the fullest possible information on the matter and, in particular, any information emanating from the Irish Hierarchy, is now in the position that such information is not available to it and apparently the document in question will not be released for the information of Parliament.
Without taking sides one way or the other on this issue, that is truly an extraordinary position and I cannotsee what purpose is being served by failing to disclose to Parliament—
(1) Whether the Government received such a document?
(2) If it did, where is the document now?
(3) Had the Government any discussions with the Hierarchy in relation to the document?
(4) If so, has it reached agreement with the Hierarchy and have any questions relating to Catholic social principles and Catholic social teaching been resolved to the complete satisfaction of the Hierarchy, on the one hand, and the Government on the other?
Am I unreasonable in asking that Parliament should have that information on a matter of such vital importance to the people? What purpose is being served by withholding that information?
In any case, we in the Labour Party have got to take cognisance of the fact that this document is in existence. We have to take cognisance of the contents of the document so far as one can glean them without actually having a copy of the document. I understand that the document in question contains a declaration that the Hierarchy are in favour of a satisfactory health service and that then it goes on to express views on the Health Bill. We on the Labour Benches have expressed very definite views on the Bill. I could make a strong case in many respects against the miserable cheese-paring and niggardly methods that have got into the drafting of this Bill. Earlier, I pointed out some of the obvious flaws in the Bill. For example, I pointed out that people with 24/- and 50/- a week are being expected by the local bureaucrat to pay charges up to two guineas per week for hospital treatment and that they are expected to pay that money out of these miserable pittances which they will receive in the form of——
On a point of order. Are all the Deputies in the House going to be allowed to repeat the speechesthey have already made on the Money Resolution?
The Chair is not aware that Deputy Norton is repeating his previous speech.
I have pointed out that this Bill will give the local bureaucrat —the county manager—power to charge fees in respect of treatment in a county hospital or even in a voluntary hospital and that these fees will be fixed by the bureaucrat without any advertence whatever to the viewpoint of the representatives of the local ratepayers and without any regard whatever to the income or the capacity of the persons concerned to pay the fees.
I have pointed out also that one of the big flaws in the Bill is the absence of a general practitioner service. That is the point, so far as ill-health is concerned, where some of the biggest bills arise for the ordinary working man throughout the country.
I pointed out that denial of medical services to secondary and vocational schools is needless parsimony.
I pointed out that the proposal to treat children up to the age of six weeks instead of up to school age, when they could then be taken in under the school medical service, represents a miserable paring down on health services—services which, in my view, ought to be extended.
I complained that one of the biggest difficulties which the Labour Party has about this Bill is that its administration will be left to the county manager. He is the gentleman who will have all the power and all the authority under this Bill. It is he who will prepare regulations. It is he who will railroad the people into hospital. It is he who will collect the money which he decides to charge people for undergoing hospital or specialist treatment—and, under the Bill, he will do that without any reference to the local authority. We have to remember all the time that this local bureaucrat is solely responsible to the Minister who can compel him to do anything the Minister wants him to do and the local authority will merely provide a grandstand audience when they see the county managerimplement the directions given by the Minister for Health.
The Labour Party submitted a number of amendments designed to remedy many of the blemishes in this Bill. For example, we desire that some of these cheese-paring methods will be eliminated from the Bill and that there will be a broader and more understanding approach to the economic difficulties of persons whose only income is that derived from a week's wages and whose only shield against poverty is their ability to toil regularly for 52 weeks of the year. We have urged, in respect of those people, that whatever grading of contributions is to take place under this Bill will be done with due regard to the inability of men in receipt of an income of 24/- or 50/- per week to pay for hospital or specialist services. We have urged, in respect of ordinary workers coming under the Social Welfare Act, that there shall also be a recognition that they just cannot pay for hospital services and that if they do manage to pay it is only at the expense of depriving themselves of food or clothes or of letting their weekly bills or rent run into arrears. We have urged that we ought not evolve a health scheme which compels them to pay fees charged by the county manager—fees which can be paid only by sacrificing many of the necessaries of life.
We have urged, in an amendment to this Bill, that the patient should have a choice of doctor. In the White Paper on which this Bill was supposed to be based, provision was made for a choice of doctor by the patient. There is no choice of doctor in this Bill. The patient will have Hobson's choice—and Mr. Hobson, as we all know, was a gentleman who had a lot of horses for hire: you could have any one of them but you had to take the first one. The patient must take the doctor whom the county manager prescribes. We have submitted an amendment to the Bill in an endeavour to secure for the patient a choice of doctor—a choice which was promised in the original White Paper.
Many of the amendments which we have submitted are designed to remove flaws and imperfections from the Bill. We wanted to ensure that the Billwould be far more liberal in its approach to the economic difficulties of working people and that, in certain respects, it would be more liberal in its approach to children. We desired that it would provide services for young persons attending vocational and secondary schools in the way services are provided for children attending national schools.
We wanted a choice of doctor and we wanted to make quite sure that so far as the administration of this Bill is concerned—at the point where the administration of the Bill meets the ordinary patient—the county manager would be required to set up a health committee consisting of representatives of the medical profession, of local administrative staff and of the majority of members of the county council concerned. We wanted to ensure that that body would approach this problem of health services from the point of view of the economic and human needs of the person concerned, of endeavouring to get satisfactory health services and of ensuring that the people's representatives would be allowed an adequate voice in the framing of local health services and the charges which would be imposed on persons availing of such services.
I understand, with regard to the letter from the Hierarchy, that one of the complaints is that patients are not being permitted a choice of doctor. The Minister can tell me whether or not that is so. I understand the position as reported to me is that one of the complaints of the Hierarchy is that the patient is denied a choice of doctors under this Bill. We agree that is a flaw in the Bill and it ought to be remedied. We have submitted an amendment to that effect. We understand, too, that one of the complaints of the Hierarchy is that they, like the Labour Party, object to the administration of these services locally being in the hands of one man who is tied back to the Minister and obliged to carry out the directions issued by the Minister.
Another complaint I hear is that there ought to be a better or a more satisfactory scheme of grading charges in the Bill. If there are to be chargesin the Bill, then the charges ought to take cognisance of the inability of people in receipt of ordinary weekly wages to pay the charge which can be imposed on them by the county manager under this Bill and which can even be imposed on them notwithstanding the fact that they are endeavouring to subsist on sickness benefit payable under the social welfare code.
So far as my information goes, therefore, many of the complaints which have been made by the Labour Party during the discussion on this Money Resolution and on the Bill proper are complaints about flaws, imperfections and deficiencies in the Bill which apparently are covered also in the document issued by the Hierarchy. Just as they seemingly desire the Bill amended so as to conform with their views as to the relationship of the Bill with Catholic social teaching, we in the Labour Party also take the view that the Bill ought to be amended in these aspects because if the Bill goes through in its present form it is denying to the Bill that democratic element which is essential to the administration of a free and responsible health service.
Our vote on the Second Stage of this Bill was a vote not for any doctrinaire health scheme or for any particular view as to what shape the health scheme ought to take. Our vote then was, just as our vote now will be, a vote in favour of a satisfactory health scheme. We want a comprehensive health scheme. Above all, we want a health scheme which will take note of the inability of large masses of the people to make any contribution for hospital treatment except to the extent that they deprive themselves of the necessaries of civilised living. We want a health service which will be democratic in its concept and democratic in its operation by tying into the administration of the service at a high level a properly constituted national health authority, not one that will meet when the Minister wishes it to meet and never to meet if the Minister does not wish it to meet, but one which will meet regularly and be composed of professional people and sensible people who will give to the Minister either when requested by himor of their own volition advice on essential health matters concerning the community.
While we want that at the top, at the bottom where the service impacts on the local persons, we want a health councils—so as to ensure that this body is representative of the will of the persons, county managers, county surgeons, county medical officers of health, a couple of practising doctors and perhaps a nurse—the professional knowledge all tied in with a greater number of members of the county councils—so as to ensure that this body is representative of the will of the people expressed in the local elections and will be able to bring to bear on the operation of the health services that humanitarian outlook and that understanding of people's difficulties which is often absent from the physical and mental make-up of the county managers.
Our vote on the Second Stage has been, just as our vote on this Money Resolution will be, a vote for a decent health service, for a scheme which will take cognisance of the necessity for moulding our health legislation on the lines I have indicated. We want to see a comprehensive scheme. We want to see an efficient scheme and one through which breathes an appreciation of people's difficulties and a democratic approach to the application of the scheme. Our vote on this Money Resolution will, therefore, be a vote in favour of the provision of a health service. We will seek on the Committee Stage to secure by the votes of this House some of the essential amendments which we have tabled. We shall also seek by argument across the floor of the House to persuade the Minister that in matters in which we cannot move amendments he should do so in order to ensure that the Bill will be moulded and shaped to suit the needs of those who are genuinely concerned with the passing of a satisfactory health service which can be administered without irritation and without the red tape which at the outset must seriously impair he proper implementation of any genuine health service.
While we would vote for this Money Resolution, that vote must be interpretedas a vote for a satisfactory health scheme. We will strive to have the Bill amended by our own amendments and by arguments which will be advanced in the course of the debate on the Committee Stage. I hope that when he is concluding, the Minister will indicate that no sense of punctilio will induce him to stand over a Bill which he knows from an examination of its merits and which he knows from advertence to the document he has received from the Hierarchy, will not represent a satisfactory Bill if it goes through this House without amendment.
I hope, therefore, the Minister will take this opportunity of indicating what he proposes to do to meet the amendments which have been tabled, and to meet the other amendments which he has been asked to make. I hope that no sense of face and no sense of artificial rectitude in these matters will prevent the Minister from agreeing that in a Health Bill which is of such tremendous importance to the whole people, we should be prevented from securing the greatest possible measure of agreement by any reluctance on the part of the Minister to depart from the provisions of the Bill which he has brought before the House.
Our desire is to see, and our final vote on the matter depends upon this, how far the Bill is made satisfactory from the point of view of those on whom the Bill impacts as patients, No. 1; and we want to ensure also that the Bill will not pass this House doing violence to or being in any way contradictory to Catholic social principles or Catholic social teaching. If the Bill conforms to those two tests, that it is in conformity with Catholic social principles and Catholic social teaching and, at the same time, is a Bill which we can stand over in the competency of the administrative measures recommended in it, then the Bill will ultimately beget our full and final support. At this stage our vote is a vote for a health service and we must judge the situation during the Committee and other stages of the Bill. We will endeavour to amend it then hoping ultimately that we can get asatisfactory Bill and one which does not do violence to Catholic thought and Catholic social principles.
I find myself largely in agreement with the views expressed by the Leader of the Labour Party, and I do not propose to detain the House by reiterating our views. We have tabled a number of amendments, too, dealing with the Committee Stage of this Bill. I would like to make one final appeal to the Minister. I already made an appeal of this sort to him speaking on this question the other day. Anybody who has the welfare of the health services at heart should deplore the discussion of this Bill in the atmosphere of the issues that have arisen and in the atmosphere of sharp Party conflict.
I should like to appeal to the Minister to leave over the further consideration of this Bill for, say, a fortnight and to circulate whatever amendments he proposes to put forward. He could then appeal to the House to resume the discussion in an objective atmosphere when we would have an opportunity of enacting the best possible Health Bill.
I think the Minister must give credit to Parties on all sides of the House for genuinely desiring to promote a good Health Bill and to improve health services generally. The Minister has to remember, too, that all Parties are committed to providing whatever moneys are required to make proper health services available. I would appeal to the Minister therefore to leave over the further discussion of this Resolution and the Committee Stage until such time as he has had an opportunity of considering whatever amendments he wishes to introduce himself and of circulating these amendments to enable Deputies to consider them. I ask also that he should, as far as possible, indicate at an early stage which of the amendments already tabled, both by the Labour Party and by Clann na Poblachta, he is prepared to accept and discuss. I think it would be of assistance to the House to know that. It is unfair, in my opinion, to ask the House to proceed with a further discussion of the Bill until theHouse has had an opportunity of knowing what amendments the Minister proposes to accept. I shall not go into any further detail, but I think the Minister should accept the suggestion I am making.
Mr. A. Byrne
I would ask the Minister has the time not arrived to withdraw the Bill and to bring in a measure that will satisfy the Hierarchy? We have not been told either by the Taoiseach or the Minister the nature of the correspondence that has passed and some of us are being asked to vote in the dark. As Deputy Norton has stated, we want to vote for a health service but this is not the Bill we want. I cannot see Deputy Norton or anybody else amending this Bill to make it a suitable measure and I would ask the Minister to consider the advisability of withdrawing the Bill and of introducing one that will satisfy all Parties.
This Bill has been discussed at great length and I shall be very brief now. Some Deputies have expressed the view that we are at a serious disadvantage in discussing the Bill in the light of the rumour or information that the Irish Hierarchy have made certain requests to the Government. I personally feel that I am at a great disadvantage also due to the fact that rumour has it—and the rumour seems to be well-founded—that some communications have passed between the Hierarchy and the Government. If that is so, I should like to have the views of the Hierarchy before I would be in a position to speak fully and openly on this Bill. However, the Leader and members of our Party made it clear quite a long time ago, on the occasion of the meeting of our national executive at Limerick, that we were opposed to this measure.
I come from a poor rural constituency, North Mayo. I go around the constituency quite a lot and I meet all types of people—the working class, many poor people, perhaps better-off people and some members of the wealthy class. I have not met any constituents so far who were in favour of the Bill. I feel that in the circumstances I must oppose it. I am veryconversant with the health services generally in the county for the reason that I am a member of the Hospitals' Visiting Committee there. I had an opportunity some months ago of discussing with the county surgeon and the county physician the question of hospitalisation in the county. They expressed the opinion that our hospitals were already overcrowded and that if any new measure of this kind were enacted, we would not have sufficient accommodation to facilitate the extra patients.
That opinion was expressed by the responsible medical man and the responsible surgeon in my county. Having carried out inspections of the various institutions in the county on a number of occasions and having seen things as they are in our various institutions, even within the last fortnight, I am perfectly satisfied that we cannot hope to accommodate any additional patients in these institutions. I quite agree with the viewpoints of the doctors who say that they are not able to cope with this extra work if it is imposed upon them.
Is the suggestion, then, that people who need hospital treatment must go without it?
That is not the suggestion. I have put the situation plainly and in understandable language. One of the doctors who has given expression to that opinion is a brother of a Fianna Fáil Deputy for Mayo and a responsible doctor. If you care to visit our county hospital in Mayo, you will find that that state of affairs does exist. In that institution we have patients lying on the floor on mattresses. If the Parliamentary Secretary cares to have the statement I am making here investigated, I am sure he will find that it is true and correct. I am not stating any lies or trying to put something across the floor of the House which is not true. I am conversant with the facts.
I am not suggesting that the Deputy is telling lies.
As a matter of fact, I was on a number of deputations to theMinister in connection with this matter and the Minister knows that what I am stating is correct. He realises our difficulties and in fairness to him I should state that, to a considerable extent, he has been sympathetic to our representations. Quite apart from the question of the attitude of the Hierarchy, I feel that if this measure goes through we shall not be able to accommodate additional patients.
I want to take this opportunity also to make a protest against a statement made by the Parliamentary Secretary to the Minister for Social Welfare. He stated here on last Friday morning that doctors in County Mayo were accepting ass-loads of turf, eggs and chickens as payment for their services to people in County Mayo. As I have already stated, I am already fully conversant with conditions in Mayo and I feel that that statement is absolutely untrue. There is not a semblance of truth in it.
I feel that the Taoiseach should ask the Parliamentary Secretary to withdraw that statement and to apologise here in the House where he made that statement. I have on more than one occasion criticised the system which operates in the county and perhaps I said hard things about medical men in the past, but I can say this much to the credit of the Mayo doctors, that, taking them through and through, they are a decent, honourable and charitable group of men and are certainly not of the type that would accept a bribe of an ass-load of turf, of eggs, of chickens or anything else and I think it is a disgrace that such a statement should have been made in this Parliament and by a Parliamentary Secretary.
If this Bill is passed, it will be one of the worst Bills that has passed through the House in my short time here. It is rather difficult to speak at any great length on this subject when it is so strongly rumoured that the Irish Hierarchy have intervened with the Government and when members of the House have not been made aware of the communications which have been received. Other Deputies have expressed the same point of view, that it is very difficult to discuss a matter of this kind in the absence of such information, and I think it is verywrong and very unfair that the Taoiseach and the Minister should deny such information to the House.
If there were no ethical or moral issues in connection with this Bill—and we do not intend to discuss the Bill from that angle— and if the Bill were acceptable to the House in its present form, we would have to protest very strongly against the principle which the Minister proposes of asking the local authorities to provide 50 per cent. of the capital for the administration of this scheme. The Minister will appreciate that we are highly rated in my county, and, no matter what county council is in existence there, I cannot see for years to come any inclination on the part of the councillors to impose an extra burden on the ratepayers.
We are one of the heaviest rated counties of the 26, and, coming from County Mayo, we would find it very difficult to accept the principle involved in the Bill, even though the Minister would wish us to believe that it will mean only an extra 2/- on the rates. We do not believe that. It is our belief and our contention that, when this Bill becomes law and is put into operation, the ratepayers of Mayo will be asked to provide anything from 2/- to 10/- in the £ extra. It is well that the Minister should be clear on this issue that the ratepayers of Mayo are in no position to provide that increase.
Like other Deputies, I should be only too glad to see a Health Bill in operation which would be of benefit to the people, but, as a member of the local authority for the past eight years and more, I have not yet discovered a patient who wished to avail himself of hospital treatment and who failed to do so. I have not discovered any patient who wished to have treatment at the hands of the best specialists or doctors in the country who failed to secure it. If these people who enter our county hospitals find that they are unable to pay, everything is made all right, and at no time have they been embarrassed or held up to public odium because they were unable to meet the charges arising out of the treatment they have received. Thesame applies to extern treatment in the City of Dublin when a patient is sent up here for certain treatment or an operation which is not available in the county hospital and I think that the House will find it very difficult to justify a Bill involving such heavy costs for the ratepayer and taxpayer such as this Bill or another Bill which may be introduced in the very near future. I agree that quite a lot of improvement could be carried out in relation to the renovation and extension of our institutions. The matron of our county hospital informed us a short time ago, on the occasion of a visit we paid to the county hospital, that, over the past few years, the number of maternity cases has quadrupled and that sufficient accommodation is not available.
There is need for the provision of an extra maternity block for that institution, and, if such an extra block is essential without the operation of this mother and child scheme, what are we entitled to visualise will be required when the Bill has been a year or two in operation. The Minister is aware from the information given him when we visited him in his office recently that the outlay which the ratepayers were asked to provide amounted to £250,000. That expenditure came before the county council in the course of the discussion on the annual estimates and it was left aside, because, irrespective of our political affiliations and looking at the whole thing as elected representatives—on the Mayo County Council, we co-operate very reasonably in trying to do the best we can for the ratepayers—we could not take it on ourselves to saddle the ratepayers with the provision of an extra £250,000, notwithstanding that we realised the necessity for the extension of some of these institutions.
There is, as the Minister is aware, need for a modern clinic attached to our mental hospital and for a female nurses' home there also. That has been an outstanding necessity over a period of years. There is need for a maternity block and a clinic attached to our county hospital, and for a nurses' home. There is need for the renovation of the county home whichhas been discussed time and time again by the county council. All these works amount to something like £250,000. If this Bill or any other Health Bill is put into operation and the ratepayers of Mayo are asked to provide 50 per cent. of the cost, I can assure the Minister and the House that the ratepayers will refuse, no matter who is on the council, to make this extra provision in the form of an increase in the rates. Apart from the ethical or moral principles involved in this measure, if there are any—I am not going to rely on rumour until we hear what the Minister has to say—I judge this Bill on the cost it will entail on the ratepayers of my county.
Will the Deputy answer a question for me? If the charge on a small farmer with a valuation of £6 in County Mayo will be 2/- in the £, what will it cost him for maintenance and specialist treatment in the year?
I appreciate Deputy McQuillan's question whether as a small farmers' representative—I am a small farmer myself—I would consider it good value that the small farmer of Mayo would be able to secure the best specialist and medical attention that goes with hospital treatment. I appreciate that question, but I should like to point out to Deputy McQuillan that we have got no guarantee from the Minister that it is only going to cost 2/- in the £ on the rates. Deputy McQuillan is not too young in years and not so innocent as not to know that this Bill, when in operation, will cost much more than 2/- in the £. As I said a few moments ago, the matron informed us that the number of patients seeking accommodation in our county hospitals—I speak only for our county hospitals. I know nothing about the county hospitals in other counties, but I assume it is the same with them —has quadrupled over the years. The demand made upon us at the present moment—I am not speaking of the increased demand which will come about when the Bill is in operation—is very great. It is on that evidence that I have to oppose this Bill.
If the moneys essential for the administration of this Bill and for the provision of specialist, surgical and medical treatment were provided from the central purse I would look at it from a different point of view. But faced with the position with which we are faced and having regard to the fact that the farmers are poor, their valuations small and that they are saddled with a heavy rate, I would be failing in my duty if I were, by my vote, to impose any further burden on them. I am not antagonistic to the Minister or the Government. I appreciate that the Minister is, perhaps, doing his utmost to provide the people with better social services. I also appreciate that his intentions may be the very best, but my reason for speaking is to indicate both to the Labour Party and to the Government that that is the position. I do not know how these people stand in relation to their own constituencies but quite a number of them, I understand, are members of local authorities. If they are in the same dilemma as we are in at the present moment, then I can hardly understand how they are going to justify their conduct before the ratepayers. At their annual meeting next year they will have to strike the rate to provide money to administer the provisions of this Bill. That is my main grievance. That is the reason why I will walk into the lobby to-night to vote against this Money Resolution.
Will the Deputy answer another question?
I will, if the Chair permits it.
This discussion cannot go on by way of question and answer.
I have a right to speak. I am going to speak very briefly.
Is the Deputy speaking?
If the Chair does not allow me to ask a question, I would like to speak. I want to point out the fallacy in Deputy Cafferky's argument.He referred to poor people being presented with bills for treatment by the county hospital. Is it not a fact that the money has to be paid by somebody? Is it not a fact that if it is not paid by the poor person himself it goes directly to the ratepayers? Can the Deputy not see the fallacy in his entire argument against this Bill on the basis that the ratepayers are being burdened?
Deputy S. Flanagan.
——will appreciate that for every two patients who make application to the local member of a county council there are four who pay their way. Those four will not be a burden on the ratepayers.
I hope the Minister will tell us what we are waiting to hear. I hope he will tell us what the Taoiseach was asked to-day.
I have been kept for four days from telling Deputies what they are going to hear. Perhaps they will listen now. The debate was a very long and unpleasant one on a Money Resolution of this kind. It is very hard to know why it lasted so long. I am sure Deputies will realise that it would be impossible even were I to speak until 10.30 p.m. to deal with all the points raised. Many of the points raised should properly have been made on Second Reading. If some of the Parties were caught out in some way and did not make Second Reading speeches they kept them for this. Many of the points raised can be more properly dealt with on the Committee Stage.
I am puzzled as to why Fine Gael are going to vote against this Money Resolution. I know they are going to vote against it to show that they are against the Health Bill. Usually when a Party opposes a Bill, they oppose it for a certain reason or for a number of reasons but when you have members of a Party opposing a Bill for directly opposite reasons it is very hard to understand it. It does appear, I think, very evident that Fine Gael made up their minds that they were going tooppose the Bill and thought of the reasons afterwards. That is quite evident because some of them said they were opposing this Bill because it was not a good Bill and that they did not mind the cost. Others said it was only because it was so costly they would vote against it. Others said that on no account would they support it it was so bad. While others, with a slight amendment here and there, said that the Bill would be acceptable. That, I think, should be sufficient to show any intelligent person why Fine Gael met hurriedly last Wednesday, made up their minds they had made a mistake in letting the Bill through, made a mistake in providing the money for the Bill by letting the Estimate through the week before last and then had not time to say why they were going to oppose it. They came to the Dáil and each man made up his own mind on what he would say against the Bill. It is not very easy to deal with an Opposition like that—a conglomerate number of individual Deputies, each man thinking of his own constituency, each thinking of political opportunism, each opposed to the Bill for some reason of his own but not sticking to the speeches of their Leader, Deputy Costello, because Deputy Costello condemned the Bill through and through. He said it was wrong in every respect that any man could think of.
Deputy Collins, for instance, said that the only reason he was going to oppose it was because it would cost too much. Deputy Esmonde said that if he knew what the cost was and thought it was not too much he would support the Bill. Speaking here to-day, Deputy O'Donnell said that only for the cost he could not see any great objection to the Bill.
You had member after member coming along and speaking, and yet they did not know what Deputy Costello had said. They gave their own reasons because they were told by the Whip: "Go in and oppose the Bill; it does not matter what you say." That is because there is no Fine Gael policy. The only Fine Gael policy is to oppose the Bill. Why did they make up their minds last Wednesday to oppose the Bill and agree to it on the SecondReading? I have the Official Report here which says: "The Bill is agreed." Why did they come in on the Estimate and vote £500,000 for the working of this Bill? Again, there was no objection to the Estimate. It was agreed.
There is not a single penny in the Estimate for this Bill and there could not be.
There is £500,000 in it for the Bill.
If there is it has no right to be there.
The Deputy did not mind about the Estimate because he did not know the reasons for opposing the Bill at that time. He was not aware of the reasons at that time. That is quite obvious. Their reasons cropped up afterwards and then they had a hurried meeting. They said to Deputy Costello: "Go in and oppose the Bill, and oppose it vigorously; hit the table; oppose it up and down and give us a lead." But they did not take the lead. They were not able to take the lead because they thought up some other reasons, some of them on the grounds of cost and others of them on some other ground—because there was something left out.
Deputy Dr. O'Higgins, the principal speaker amongst them, made a most denunciatory speech, but he wound up by saying that if I could provide a proper consultative council that, well, things would be different, that the Bill could be knocked into a shape which they could accept. You had all these various reasons for rejecting the Bill, all of them speaking with divers tongues, but at the same time sticking to the Whip to oppose the Bill. Why did the Fine Gael Party let the Second Reading through? It is recorded in the Official Report that the Second Reading was agreed to.
Why did the Fine Gael Party let the Estimate through, an Estimate which provided £500,000 for the implementation of this Bill? The Estimate was agreed to and went through. What did they hear on Wednesday morning that made them change their minds, and why was there such a hurriedmeeting that they must oppose it, and talk it out for three days? Why all this opposition? I go outside sometimes for a smoke when some Deputy is talking who is not interesting and there are a few of them in this House. I saw Fine Gael men coming up and one saying to the other: "You talk next". That went on the whole week. They were just talking it out. Why did they talk it out for a week in view of the fact that we have a lot of business to do in this session? The Estimates have to be put through, and why was it necessary to talk this out for a whole week? They never gave any reason. The only thing they said was that they were voting against the Money Resolution. They wanted to give the impression that they were against the Bill, but they did not give that impression on the Second Reading. Why did they change their minds, I wonder? None of them has told us.
Then they did a thing which is not usual. They brought in Deputy McGilligan to-day. They had him here on Friday and had him here to-day at Question Time to make a speech. I do not know why there has been such terrible commotion about a Money Resolution. Usually, a Money Resolution goes through the Dáil in five minutes. As a rule, it is a formality. They agreed to the Second Reading of the Bill, and they agreed to the Estimate.
Under that Estimate they agreed to give me, as Minister for Health, £500,000 to work the Bill, but now they will not let the Minister for Finance give me the £500,000 which they had already voted to the Minister for Finance for that purpose. Was there ever such a silly vote in this House? They agreed to the Second Reading of the Bill and agreed to give the Minister for Finance £500,000 to finance the Bill. Now they say to the Minister for Finance: "Well, you have the £500,000 but you must not pay it over." Does that Party want to stultify itself by going on like that because they must give some reason? They have not given any reason so far. I suppose we are not going to get any reason, and so we might aswell proceed and get on with the business.
Will the Minister say under what heading does the £500,00 appear in the Estimate? It is not in the Estimate.
The Deputies were so uninterested in this Bill and in the Estimate when it was going through that not a single one of them asked us if there was a shilling in the Estimate for this purpose. There was no interest whatever in the Bill at that time, but they are so interested now that they have taken four days to talk it out, bringing in relays to talk it out. On that occasion they had nothing at all to say.
Will the Minister answer my question?
Yes, as soon as I get the information in the book: "Extension of Health Services, not provided for in the Foregoing Estimates—£600,000."
What page of the Estimate does that appear on?
On page 392. Deputy Rooney has said something. I am sure it was something very intelligent this time.
We want to hear what you have to say.
That is better.
We are waiting to hear what the bishops said.
Deputy Flanagan is interested in the bishops.
I do not want to be troublesome. I have the Book of Estimates here and what the Minister says does not appear on page 392.
If the Deputy will look at the details given under "Miscellaneous Grants" he will find the information which I have just given to the House. Then we had Deputy McGilligan. Deputy McGilligan made a very long, tedious and venomous speech against the Bill here to-day. I suppose I need hardly say that it was venomous, because it would be hard for that Deputy to make a speechwhich was not venomous. It was a long, tedious speech. He spoke for over an hour denouncing the Bill. Anybody listening to Deputy McGilligan would think that he could never have seen anything good in the Bill. Deputy McGrath quoted Deputy McGilligan here before, and it is no harm to quote him again. On the 20th March last in this House Deputy McGrath said something which drew this remark from Deputy McGilligan, speaking at column 958: "I did not speak against the Health Bill." That was correct. The Leas-Cheann Comhairle then said that Deputy McGrath was entitled to be heard, and Deputy McGilligan replied:—
"Is he entitled completely to misrepresent? I did not say anything against the Health Bill."
Lower down, on the same column, Deputy McGrath came back again on the subject, and Deputy McGilligan said: "I am not against it." Imagine that Deputy, who is not against the Health Bill, making the speech he made here to-day. What changed him? Why did he change around to make that long venomous speech against the Bill that he is not against? Deputy Mulcahy chipped in and said that it was not against the Bill they voted, that is, the Fine Gael Party, but in favour of an amendment introduced by Deputy Dr. O'Higgins. He did not want it to be said that the Fine Gael Party voted against the Bill.
I did not want them to get away from the point.
I am getting back to the point now. I am getting back to this point, that Deputy Mulcahy said it was not against the Bill that the Fine Gael Party voted. At that time the Fine Gael Party were not too sure what they should do. They did not vote against it. Deputy Mulcahy was balancing the thing nicely—we voted for the amendment but not against the Bill. Did Deputies hear the speech Deputy Mulcahy made against the Bill? Why did he change? Why did they all change like that so completelyaround to opposition to the Bill? They have not told us.
One thing is enough at a time.
We did not recognise it. We do not recognise it.
I suppose there is no use in my trying to get a reason from the Fine Gael Party as to why they are going to vote against this Money Resolution to-night, because they find it very difficult to explain to their own followers down the country why they do such and such a thing and it is too much to expect that they would explain it to me.
Deputy McGilligan made a very long speech here which was interspersed here and there with references to the suppression of a certain document and, in the course of his speech, he told us that in 1950 there was a Minister for Health there, that Deputy McGilligan does not like now—he did not say anything against him then, of course——
You did not like him then.
Maybe last thoughts are better than first. I am not like Deputy O'Leary. Deputy McGilligan says that the Department of Health, through this Minister—I do not know whether this is true or not—put up a proposition that they would make the dispensary doctors work the scheme whether they liked it or not and that then, of course, the other fellows would have to follow. He denounced that here to-day as a shabby scheme but we heard nothing about that until to-day. Deputy McGilligan did not come into this House at that time and say: "There is a most disgraceful proposition put up to the Government to deal with the doctors". He was in the intrigue himself, I suppose. He did not mind taking part in the intrigue. Now, when it is all over, he is able to quote it as a thing that the Department of Health is capable of doing. Why did he not expose that? Why did Deputy Mulcahy not expose it? Or Deputy MacEoin? Deputy MacEoin above all, should expose it—a man of his views. None of them did. Theyallowed the thing to go on, that sort of intrigue of compelling the dispensary doctors to accept the scheme and then, of course, the other men must follow suit and everything would be all right.
I do not know whether the Department of Health put that up or not but Deputy McGilligan says they did and, by implication, he allowed us to believe that he and the other members of the Government were parties to the proposition and, I suppose, agreed to it without any great objection at that time.
There were many objections raised to this Bill which are objections that have not been raised in the past. I want to put it this way: We have the same county hospitals, the same county staff, the same county manager, the same public wards. There was no objection made to these things as long as the lower income group were concerned but all these speakers got up in this debate and objected strongly to the public wards and to the sort of service we have and to the county managers' interference, when the middle income group are concerned. Deputy McGilligan spent quite a while on that to-day. I detest that Fine Gael snobbery. Deputy Hickey would probably call it bourgeois mentality but, whatever he would call it, I detest it. I know Deputy Hickey detests it too. It is Fine Gael snobbery.
The Minister is only telling Deputy Hickey what he thinks of us.
It was all right, there was no complaint whatever, as long as they were dealing with the poor people in the lower income group but now, when the middle income group are coming in, they deserve better treatment, according to Fine Gael. It is all right to put these other people into a public ward but surely, they said to me, you are not going to put the middle income group into a public ward. According to Deputy McGilligan, and some of the other Fine Gael speakers, it is not good enough for them. Although the county manager was all right, as they say, to herd thelower income group around—there was never any complaint about that—when it comes to herding the middle income group around, that is quite a different matter and Fine Gael will not stand for it.
We should try to get away from that snobbery and try, if you like, to give better treatment all round. I know, of course, that some of the people over there talk about this egalitarianism— bring people down. I think we are making an effort to bring people up.
After 18 years.
The Deputy was a while there too and he knows the difficulty. He is a member of a public board. There is a big improvement in the services that are being supplied and that improvement is still, I hope, going on.
There was a lot of talk here about my friend, Deputy Joe Kennedy. Things can be said, approached in a very different way. I have a very distinct recollection of a doctor friend of mine—I will mention his name outside this House to anybody who asks me his name—telling me only a few months ago that he was sorry he left Mayo because, he said, they were the decentest people in the world, they never bring you a ticket; they bring you a creel of turf, a chicken, or something like that. Is not that a nice compliment to the people of Mayo?
That is well cooked up.
It is not. I will give the Deputy the doctor's name and he can ask the doctor.
Deputy Cafferky should not run down his own county.
The Deputy can ask Deputy Eugene Gilbride, who was present at the conversation. He will tell you who the doctor is and knows what I am talking about.
Will the Parliamentary Secretary withdraw what he said?
The Parliamentary Secretary can speak for himself. There wasa lot of talk here about a means test. I have never from the beginning said there was no means test in this Bill or in this scheme. If I had no means test, it would be a free for all. It must be very obvious, even to Deputy O'Leary, that if there was no means test it would be a free for all, like the English scheme but it is not like the English scheme.
You are trying to satisfy Deputy Dr. Browne.
There are means tests all over the place—many of them—and we are not denying that the means tests are there. Why should Deputies waste the time of the House by saying there are means tests in this Bill? They might as well say that there are 66 sections in the Bill. That is obvious.
You promised Deputy Dr. Browne that you would introduce one with no means test.
I did not promise him anything. He did not ask me to promise anything.
That is what he told the country.
The Deputy thinks that this was brought in to please Deputy Dr. Browne.
Of course it was.
I am very pleased to have Deputy Dr. Browne with me.
We know you are.
Yes, I am, because in the break-up of the last Government I consider that there was one honest man amongst a lot of thieves. Now, take the red ticket.
For going against the Bishops of Ireland, you say he is an honest man?
I do not know what the Deputy is saying. Of course he is an honest man. Everybody knows that. There is talk about the red ticket——
An honest man who throws every principle to the wind.
——that we got rid of the red ticket by giving a white ticket instead. I never claimed that we were making a change. I said there would be a white card for convenience, so that the person would have that card in the house and would not have to go for the doctor any night a child got sick. I did not promise anyone would get free service who was not compelled to get a red ticket at the moment. I will tell Deputies what I can do—I can give a red card instead of a red ticket, so that we can cut out the play on the red and the white.
This is statesmanship.
There is more red over there.
Many Deputies ask—and it is a fairly legitimate thing to ask —why not improve the existing services before we bring in new ones. I can understand that point, but I do not think it is always necessary to wait, to complete one chapter absolutely before you go on to the next. There is always a little overlapping. It will take some time to effect the improvement of the present services that we have in mind, and in the meantime we can be building up the services that are outlined in this Bill. I do not see why that should not be done.
No Deputy here can accuse the Government of not being out for the improvement of the existing services. After all, in the Estimates you will find £4,500,000 for capital expenditure and added to that will be the proceeds of the Hospitals' Sweeps. That will be sufficient to go ahead with the building of hospitals—you do not build hospitals in a year—and the reconstruction of some existing buildings. As well as that, it will be possible to replace half our dispensaries; they will be rebuilt or reconstructed during the coming year. When Deputy Dr. O'Higgins was talking, he more or less anticipated what I am just saying. He said this reconstruction was necessary owing to the neglect of this Government overthe last 20 years. But why did he not talk about the ten years before that, when Cumann na nGaedheal was there and when nothing at all was done?
They were building bridges then.
I am not using that just as a phrase. Literally, nothing was done.
They were building a few bridges.
Ask Deputy MacBride.
Keep off that subject.
Deputy Norton and others said this Bill was not as good as they would like it to be, I can assure Deputy Norton I, too, would prefer it to be a better Bill. It is not for the love of the thing that I am keeping the Bill down to the level at which I am introducing it; but I think that, in the circumstances, it is as good as we can produce at this moment. The ratepayers have to pay half the cost; and every Deputy who spoke on that point complained that the rates were already too high. The taxpayers will have to pay the other half; and there is no Deputy will say that taxation could be increased for this or any other purpose. We have to keep in mind that the ratepayers and taxpayers are heavily burdened already and therefore we must keep the cost down to what we think will give a reasonable service for the time being.
Then there are those who want a better scheme. Deputy Costello, for instance, wants a comprehensive scheme. He says our present services are not nearly good enough and he desires much better services than we have. I do not know why he would not vote for this Bill and take it for the time being. I do not know why any man would not take half a loaf while waiting for the whole loaf to be prepared—why he should starve in the meantime. Why will Deputy Costello not take this Bill as it is and say that he hopes that, if Fianna Fáilremains in power—as I suppose they will—they will produce something better?
That is the best joke of the day.
If Deputy Costello comes over, he can produce something better, as he promised.
Marshal Tito's bread.
Why does Deputy Rooney not speak out?
Deputy Costello says, as given in column 50 of Volume 138, No. 1:—
"I am fully aware and realise that the particular stand that we take here to-day on this Resolution will be misrepresented by our political opponents."
Let me not try to misrepresent him, because if I were an able politician and quoted Deputy Costello exactly in the country I could do him more harm than hours of misrepresentation. If one goes through his speech, one will find no necessity to misrepresent Deputy Costello, as he misrepresents himself through contradictions up and down his speech. One could prove anything out of that speech without misrepresenting him at all, so there is no necessity for that appeal to fair play. He lays down principles. He says:—
"Could we not agree on principles —(1), that it is nothing but a fraudulent pretence to suggest that there is any such thing as a free service for any section of the community."
Well, of course, that is so elementary that I am surprised at a grown-up man making the point. Surely we know that services or money do not come down from the air. Someone must provide the money and no one would say that the Leader of a Party like Fine Gael should think it necessary to lay down a principle like that. Maybe it was necessary for some of his Deputies, like Deputy Rooney, but for ordinary intelligent men it appears tobe ridiculous. Then he comes to the next principle and says:—
"Every Deputy in this House stands for the principle that no citizen of this State is going to be deprived of all necessary medical, surgical and nursing appliances and attention, merely because of lack of means."
Who has ever denied that? Is there any Deputy, or will there ever be one, who will deny that principle? It is so self-evident that it is hardly necessary to lay it down. He asks: "Could we not agree on these two principles?" Of course we can. We will all agree that they must be paid for and that we will not deprive anyone of medical services for want of means. That is what we are all striving to do. I do not know why he should go to the trouble of making them first principles.
The 2/6 turf for the poor is off and finished with for the summer.
Deputy Costello's speech was interspersed with some of these expressions "fradulent pretence" and "subterfuge" and "niggardly service." These things are the stock-in-trade phrases of a man who intends to make a fairly long speech but has nothing much to say. After all, he was asked to make a denunciatory speech and if he could not do it in the quality of his speech he supplied it in the quantity, by speaking for over an hour. If one were to go back over his speech to try to find out why he was against it, even an intelligent man would find it hard to make up his mind. The only thing I know that might have affected it was the circumstances, that he had little notice but an order from his Party to oppose the Bill and he came in and did it well.
It is not fair to a man like Deputy Costello to use him like that. In years to come when the history of this country is written and somebody reads about the great statesmen who existed, if anyone comes across this speech he will say that Deputy Costello was not a very able man. It is not fair to Deputy Costello to be giving him tasks like that to perform. I advise DeputyMulcahy, who is the Leader of the Party, to get somebody else to do that job in future.
I hope they will not read the Minister on agriculture, anyway.
I laid down some great principles when I was in agriculture that Clann na Talmhan are following now. We will come to another point.
We can read all that in the Official Reports.
Did not Deputy O'Leary come in to listen to me? Deputy Costello went on, as reported in column 56 of the same volume, to say:—
"Under this Bill there is not a choice of doctor, of hospital, of maternity service or of anything else. In theory, there is a choice of doctor. Neither in theory nor in practice is there a choice of hospital."
Deputy Norton said the same thing. That is wrong. Deputy Norton is not a lawyer, but Deputy Costello is. Deputy Costello protested in advance against misrepresentation. He is the Leader of the Fine Gael Party and, admittedly, a very eminent lawyer, and yet he made that statement that there was no choice of doctor.
For the information of Deputy Costello, Deputy Norton and others, I may say that Section 15 provides for a choice of doctor. I am advised by my legal advisers that Section 15 gives that authority. But I do admit and, therefore, I do not blame Deputy Norton because he is a layman, that it is not as plain to me as I would like it to be, but it must be plain to Deputy Costello who is a lawyer and to Deputy MacBride who is a lawyer that choice of doctor is provided for under Section 15.
In order, however, that Deputy Costello, Deputy Norton or anybody else may not have any misgivings with regard to this, I am prepared to consider the amendment suggested by Deputy Norton and Deputy Larkin, I think, subject to redrafting.
Deputy Costello again says that not only choice of doctor but choice of hospital is not provided for. Deputy O'Higgins also mentioned the same thing. I am not concerned in this with the question of the ward or private home. There has been a point made by certain Deputies in regard to choice of a hospital, and I intend to have an amendment prepared to cover the point. I do not want, however, to be misunderstood. It is not possible I am afraid to give a full choice of hospital to everybody. It cannot be done for various reasons which can be discussed when we come to the section concerned. It will, I hope, be feasible to give a subvention to certain people who are prepared to subscribe a certain amount themselves for hospital treatment. That means, of course, as far as the choice of hospital is concerned, that it will not be very much use to a person who cannot pay something for himself.
Deputy Costello also said, as reported in column 47 of the same volume:—
"We are against the proposals in the Bill and the expenditure of money on those proposals because the principle of the Bill, in so far as there is any principle at all in the Bill, is merely an extension of the dispensary services, merely an extension of the public assistance services to a great number of people and different classes and because, based as they are upon that dispensary system, which is the product of an alien Administration in this country, the proposals in the Bill are an enlargement of State control and the forerunner of socialist medicine in this country."
Deputy Costello in another part of his speech condemns the dispensary system. I should like to say that there is another side to that picture and I think it is well worth going into. I do not want to go into too much detail, but some of the Deputies on the other side did approve of the dispensary system and stated it was necessary to retain it and improve upon it. As Deputy Costello devoted a lot of hisspeech to regretting my attitude in not getting advice from the Irish Medical Association, it might be well to give the House some idea of what was got from the Irish Medical Association on this question in the past. As far back as 1944, the Irish Medical Association were asked for a report. In that report they say that the dispensary service would continue basically as at present in rural areas with considerable modifications. What are the modifications? That we should provide health centres adequately staffed with one or more nurses, a compounder and secretarial assistance, a fully equipped waiting room and consulting room, laboratory and X-ray, and that the wardens should be replaced by properly trained sanitary officers or almoners. I was surprised when I read that some time ago. I said to myself that surely any Deputy from a rural area who would read that report would say, "You cannot expect to get any sort of decent advice from that particular body of people". I am referring to the idea of having X-ray equipment and a laboratory in every dispensary in the country and replacing wardens with almoners all over the country.
I went on to read about this matter and what was the history of this whole question of dispensaries and I found they made another recommedation, that district midwives should be appointed, one to every 1,000 of the population, which would work out in public assistance cases that every midwife would have three or four cases to look after in the year. In 1949, again, the Irish Medical Association submitted their recommendations. They were much the same, except that they dropped the X-ray equipment out of the rural dispensaries.
In the contributory scheme put up by the Irish Medical Association they stated that the conditions of service and the statutory rights of the dispensary doctor must be safeguarded. He would continue to treat the indigent persons in his district. The association was asked whether the public assistance classes would be provided with a choice of doctor. They replied that they regretted they could not find a means whereby a free choice of doctorin the case of public assistance classes could be reconciled with the statutory authority on local medical officers to guarantee full medical assistance for these classes.
I am not satisfied with the dispensary system. My predecessor, Deputy Dr. Browne, was not satisfied with it. He met the Irish Medical Association and put up three proposals to that body. I am sure any Deputy will agree that they were fairly simple and ought to have been accepted. He suggested, first of all, the abolition of the red ticket; secondly, that where dispensary buildings were fairly far away from certain areas the doctor should see patients in his own house and he would, of course, be remunerated for that; thirdly that the dispensary doctors should be empowered to authorise the admission of dispensary patients to district and county hospitals.
The association did not want to abolish the red ticket because, it was said, that people might pass out of the public assistance classes during the year and they would then be using the white card for the remainder of the year when they should not be using it at all. Secondly, they would not agree to see patients in their own houses and, thirdly, they would not agree to undertake to send patients to the county or district hospitals; they said that was the function of the assistance officer and they would not do it.
I am sure that many individual doctors would do these things if they were asked but it is the Irish Medical Association that speaks for them and it is with that body that these negotiations were carried on. Is it not difficult to understand how any man could object to such reasonable proposals as those in an endeavour to improve the dispensary system and make things a bit easier for those who have to avail of that system? But those proposals were turned down.
A little over a year ago, when the Irish Medical Association came to me to consider their scheme with me, I put many questions. I wanted to have a clear understanding of their scheme and I can assure the House I was as sympathetic as any man could be, but I did see insuperable difficulties inworking out a scheme of the kind suggested by the association. Mention was made of a means test and I said there would be no means test as far as their scheme would be concerned. I said I was not objecting to a means test. I was merely seeking information. The spokesman said that the present form of means test could be dispensed with and he said that under the medical card system—I found on some further discussion that this was a white card instead of a red ticket— that would work all right for their own scheme but they rejected it in connection with the dispensary system.
There has been a great deal of propaganda about lack of consultation with the Irish Medical Association. There was any amount of consultation with that body. Deputies may say that I was prepared to listen to but not accept advice. I am afraid the same charge can be made against the Irish Medical Association: that body was prepared to talk to me only if I would agree to their way of looking at things. It is difficult to see how we could reach agreement in that position.
Various committees were set up to deal with different matters. The Child Health Council was set up in 1948-49 and two members of the executive committee of the Irish Medical Association were members of that council It was on the report of that council that the mother and child scheme introduced by my predecessor was largely based. From that it can be seen that the members of the Irish Medical Association played a big hand in drawing up that scheme. I need not remind the House of its subsequent reception.
Why did you drop it?
I will cover all these points in time. On behalf of the Government I issued a White Paper the purpose of which was to give all interests an opportunity of discussing with me any matter they might wish to discuss. The Irish Medical Association was given an opportunity of submitting its detailed views and recommendations. They came along on the 8th October, 1952, and they made it clear to me at the outset that they were notplenipotentiaries and that the council of the association was to have a meeting at the end of the month but, in the meantime, they wanted my views in regard to certain objections they advanced against the scheme. They asked for my views in writing and I sent them on to them. I suggested at that meeting that they might appoint some of their members to meet the officials of my Department to discuss the details of the White Paper. They refused to do that.
It must be remembered that this was the third successive Government that had proposed a scheme of that kind and surely the Irish Medical Association was adopting an unreasonable attitude in refusing to discuss the details. Since then I have not met them because they said they were against the scheme and they refused to discuss it, but on the advisory council there are members of the Irish Medical Association. I met them on 4th March and agreed to meet them again on the 11th March to discuss with them any amendments they might like to propose to the Bill. I met them on the 11th March and there are on the Green Paper some amendments as a result of that discussion. I want Deputies to note that because many of them have said in this debate that I did not agree to a single suggestion that was made. I agreed to a number of the suggestions made and tabled amendments to meet those suggestions.
I agreed to meet them again in the first week of May in connection with enlarging the scope of the council itself. I said I saw no difficulty whatsoever in having regular quarterly meetings. I said I saw no difficulty in making a rule that a certain number of the council could call a meeting, if they so desired, outside of the quarterly meetings. I promised to have all the regulations made under this Bill, or the main Act, submitted to that council for its consideration before the regulations were published but in a case of great urgency where some minor regulation was necessary I suggested it could be submitted to them subsequently.
I promised to consider two othermatters advanced by them with regard to the secretariat and the annual report. I do not see any great difficulty about the annual report and I only see difficulty from the point of view of detail in regard to the secretariat. The next meeting, as I have told the House, will take place early in May. As far as I am concerned, I am quite willing to meet the doctors at any time they want to talk to me, but, naturally, that will be for the purpose of discussing the Bill and not for the purpose of telling me they do not want it. It will not be necessary for them to tell me that.
I have agreed to many of their suggestions. I have agreed—Deputy Norton raised the point—to discuss with them in the first week of May the possibility of setting up local advisory councils attached to the various local authorities. I would, of course, prefer a voluntary scheme if that was feasible, such as the scheme put up by the doctors, but the big objection to that is that we cannot be sure that everybody will join it.
Many people will remain outside it. Then, when they get sick later, they must be looked after and some such scheme as this will be necessary as well as their scheme on that account. I do not want to go into all the other arguments in detail. On a previous occasion I went into some detail and in a leading article in theIrish Medical Journal,following that, they called me a corner boy.
Sack them off.
I cannot— and even if I could I would not.
They were the "bucket shop."
Deputies referred to acrimonious controversy. I do not know that there was anything acrimonious in it. They did not agree to the proposition put forward by this Government, by the last Government or by the Government before that. I do not think a Government should be intimidated by anything like that, or that it should be accused of being non-co-operative. I am quite prepared tomeet them as far as I can. Their editor accused me of departing from the principles of Pádraic Pearse. I am very proud to be able to say that I was the last medical man to be able to look after Pádraic Pearse. I am quite sure that if Mr. Doolin had been there he would have been able to do it much better, because he is a very competent man—but he was not there.
I come now to the matter of contributions from self-employed persons. I think Deputy McQuillan is right—that the fairest way is to get it from the rates. As Deputy McQuillan pointed out, the large ratepayer is paying more than the smaller ratepayer. If a man has a valuation of £40 then he pays more than the man with a £10 valuation. It is a contribution for this purpose and it is collected without any charge.
A painless extraction.
Deputy A. Byrne said the artisan would have to pay on his rates. Therefore, there is a contribution coming by way of rates from all these people and I think it is the best type of contributory scheme we could get.
These remarks bring me to the contribution of £1 for those in the higher income group for maternity services. It is offensively referred to by some Deputies here as a "fraudulent subterfuge."
And "the dog tax."
It is regarded by some well-meaning people as a token. It is not a token. Anybody can see the statistics which were issued recently. In theAbstract of Statisticsfor the most recent year—I think for the year 1951—there were 242,000 married women under 44 and in that year 63,000 babies were born so that you had an average of one baby born for every four women of child bearing age. Therefore, in the ordinary way, a woman would pay £4 before she would get benefit under this scheme. I do not know what the doctors will get under this scheme:Deputy Costello said that they would get £4 or £5 but I think it would be more than that. I was aiming at a bit more than 50 per cent of the contribution. I believe we are getting that. The position can be reviewed from time to time and based on experience. Let it be such a sum as would pay about half the cost.
At what ages are married women——
Up to 44.
Does the Minister think for one moment that a woman who has had babies up to the age of 30 will have none between that and 40 and that from 40 to 44 she will be paying £1?
The Deputy is going into probabilities. She would be foolish I would admit, but we cannot go into this problem now.
You cannot base your estimate on the assumption that women are fools.
I am prepared to base the figure on two years' experience.
You will be losing money, according to yourself.
The question of consultative councils was raised in detail by Deputies Norton, O'Higgins and MacBride. At my last meeting with the consultative council I told them that I was prepared to go a great deal of the way. I made it plain that it must be an advisory or consultative council and that it could not be executive in any way. Under our Constitution, the Minister must have the last word. In the beginning, they were looking for an executive council but they accepted the other in the end. A few points were left over—points which, I said, I would have to consider —and I said that I would meet them early in May. I think only two points were left outstanding—the actual report and secretariat and also the possibility of having these local councils attached to local authorities throughout the country.
The question of local councils will be decided whenthe Minister meets the association in May?
I promised to be able to give the association my view on the matter early in May.
The Report Stage will not be finished by then?
The Report Stage will not have anything to do with it.
The election will be over by that time.
Deputy MacBride spoke about the maternity hospital in Limerick. A certain amount of reconstruction and building was done in the county home and hospital in Limerick which provided a very nice maternity unit. When that was done we came to the conclusion—the local authority and, I think, the various professional experts, both architectural and medical—that it would be quite suitable and, of course, very much cheaper, to extend them and in that way to avoid the building of a regional maternity hospital in Limerick. I can assure the Deputy that the beds will be quite satisfactory.
Deputy MacEoin asked me whether I had got the approval of the Catholic Hierarchy. First of all, I should like to correct some of Deputy MacEoin's statements or misstatements. He gave the impression that the Hierarchy condemned the 1945 Bill. I must say that I am not aware of that, if they did. I do not think they did. I do not think they ever considered the 1945 Bill in any way and, therefore, neither condemned nor approved of it. He also gave the impression that they had condemned the 1947 Act when it was a Bill and that I knew their views while the Bill was under discussion. That is not true either. The Bill went through both Houses and was signed as an Act before any communication was received from the Hierarchy at that time.
When the White Paper was issued in connection with this Bill I sent a copy of it to the heads of all Churches, including all Bishops, both Catholic and Protestant. Subsequently, I met representatives of the Catholic Hierarchyand a representative of one other Christian Church. At one of these meetings with the Catholic Hierarchy the Taoiseach was present; at another, the Tánaiste was present; and at some others, I was alone, that is, as far as members of the Government are concerned. I need hardly add that I would have been very pleased to meet representatives of other Churches if they so desired. I do not want to give the impression that I refused to meet any of them. As a result of those meetings, I am endeavouring to meet the wishes of the Catholic Hierarchy in some of the amendments which I have already outlined. They have asked for the greatest possible freedom for the person availing of the provision of the Bill, that is, a choice of doctor, a choice of hospital, and they are naturally solicitous lest any person would be obliged to accept treatment contrary to his religious beliefs. To cover this point, I shall propose an amendment by way of addendum to Section 4, that is, the point that no person will be obliged to accept treatment contrary to his religious teaching.
They also place great importance on the provision of consultative councils, both centrally and locally. Whatever our religious beliefs may be, whatever Party we belong to, I feel we can all subscribe to their advice on these matters.
In conclusion, I ask the Dáil to agree to this Resolution. It would appear to me to be most inconsistent for the Dáil to approve the Bill on the Second Reading, which means that they agreed to the Bill in principle, to pass the £600,000 for the implementation of the Bill in the Estimate, and now to stultify themselves by saying: "Although you have the Bill and the money, we will not let the Minister for Finance hand you over the money" because that, in fact, is what a vote against this Resolution will now amount to.
Has the Minister for Finance the money?
- Aiken, Frank.
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