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Dáil Éireann debate -
Thursday, 11 Jun 1953

Vol. 139 No. 8

Health Bill, 1952—Committee (Resumed).

Debate resumed on the following amendment:—
Before Section 9 to insert a new section as follows:—
Every institution receiving moneys from a health authority shall be subject to inspection by persons appointed for the purpose by the health authority. —(Deputies Noel C. Browne, Peadar Cowan.)

It is some satisfaction to know that the Minister does not approve of this particular amendment. In the course of the arguments last night for the amendment, Deputy Dr. Browne and Deputy Cowan made some statements which I think should not have been made. However, this is a free Parliament and I presume that no matter how much a thing may be in bad taste Deputies have the right to make assertions.

Before I deal with that, I would like to point out that this amendment israther peculiarly worded. It asks for an inspection of the voluntary hospitals and the appointment of an inspector because tens of thousands of pounds have been pumped into the voluntary hospitals by the State. Up to the present, of course, the thousands of pounds pumped into the voluntary hospitals were pumped in by private subscribers and then at a later stage by the Hospitals' Trust Fund. The Hospitals' Sweepstake Bill was put through this House to assist the voluntary hospitals because the voluntary hospitals were then rendering, have since continued to render, and will go on rendering valuable service in the interests of suffering humanity whether run by a religious order or, as Deputy Dr. Browne said last night, by the Society of Friends or any other religious or charitable organisation.

Surely this House is not going to take the line that we should probe into and investigate the activities of the voluntary hospitals because we give some assistance by way of Vote or otherwise when everybody knows that their activities are of the highest order. It is an extraordinary situation that Deputies in this House would make the suggestion that there was something underhand. Mind you, Red China made an allegation that the good nuns who reared and assisted orphan children murdered them.

Who made that allegation here?

Allegations were made here that inspection should be made in regard to the conduct of the hospitals.

No one can misrepresent what Deputy Dr. Browne said at any rate.

Notice taken that 20 Deputies were not present; House counted and 20 Deputies being present,

As I was saying, a charge of that type has been made by people in Red China. That charge, of course, was not made here. But the inspection, the innuendo of it, the hint that there is something to be investigated and that it is only a short time until we will have it——

Supposing the Deputy's wrong foot was cut off——

I am not giving way to the Deputy under any circumstances. The Deputy made the case last night that, in a short time, this inspection will take place whether the Minister likes it or not—that force of circumstances will compel him.

I do not charge Deputy Cowan or Deputy Dr. Browne with being Red emissaries or anything like that. I know thoroughly well that they are every bit as good Catholics as I am but I submit that grave scandal could be given and grave damage could be done by certain public action. I do not know Deputy Cowan's reason for saying in this House that I am a Knight of Columbanus. I do not know what the innuendo is. However, I do resent its being put on a par with the Masonic Order.

It is a secret order.

Deputy Cowan might as well say that I am a member of a sodality or of some other religious body.

Sir, I want to object to this. Everybody knows——

Is this a point of order?

I submit that everybody knows that Deputy General MacEoin cannot discuss a secret organisation in this House. No Catholic can get into that organisation unless he is elected.

That is not a point of order. I do not know what order is being referred to.

On a point of order. May I draw the attention of the Chair to the fact that last night I bordered on suggesting that Deputy Cowan was adopting a privileged position in this House and acting as a kind of a clap to invite confusion and disturbance on the Government ranks in order to disturb and confuse discussion here? I would ask if Deputy Cowan is going to be allowed to butt in every second minute on an allegedpoint of order in order to disturb the trend of a very serious discussion on a very important matter?

No Deputy will be allowed to infringe the Rules of Order of this House.

Is it in order to discuss the Knights of Columbanus on this section?

I do not know what order is being discussed. Knights have been mentioned.

They are the knights.

Deputy Cowan and Deputy Dr. Browne both made the assertion last night on this section that the reason they want inspection is that in certain hospitals no person can be appointed unless he is a Knight of Columbanus or that the Knights of Columbanus make the appointments and that in other hospitals the Masonic Order make the appointments. I challenged that in a gentle way at the time. Deputy Cowan did not then raise a point of order on that assertion by Deputy Dr. Browne. Later on, Deputy Cowan himself informed the House that I was a member of that order. That is nobody's business.

The Deputy informed the House himself.

Deputy Cowan will cease interrupting. I warned him last night. I am not going to tolerate it any further.

Very well.

Deputy Cowan told the House last night that I was a member of that order. I do not deny that I am a member and, I told him, a very unworthy member. I wish I were better. I am an unworthy Catholic as well. But I do not see that that should be made a charge in this House—and that is what Deputy Cowan attempted to do here last night. He attempted to hold a Deputy of this House up to ridicule, up to public odium, and asserted that he was a member of an organisation thatwas equivalent to and that could be put on a par with the Masonic Order.

I made that suggestion.

I said Deputies made the assertion. If the Deputy will be as ready to keep his ears open as he is with his tongue we will get some result. That assertion was made. The grounds put forward for this amendment are that appointments are made in certain hospitals by the Masonic Order and in other hospitals by the Knights of Columbanus. I say that that is untrue as far as the Knights of Columbanus are concerned. The Knights of Columbanus never interfere in any appointment. It is contrary to the rules and to the regulations of the order.

Having controverted what was said in respect of the Deputy's membership of a certain order, could we not now pass on to the amendment?

I will pass from it but I want to controvert the grounds that were put forward for this amendment. The justification that was given for this amendment by Deputy Dr. Browne was that appointments were made to certain hospitals by the Knights of Columbanus and to other hospitals by the Masonic Order.

The Deputy may discuss it in association with the amendment but in connection with himself I think we had better pass from it.

Except to make this one comment. I do not know anything about the Masonic Order or as to what they do but I know a certain amount about the other people and it is untrue to say that they made appointments to any body. I want that categorically stated and beyond question. Therefore, the grounds on which Deputy Dr. Browne moved this amendment are incorrect, to say the least of it.

Let us come back again to the matter of inspection. I am glad the Minister has refused to acceptthe amendment. It is one of the things that I approve of, in all the things he is doing that I disapprove of. If I may say so in passing, this whole Bill is not being amended by us but we are exposing it for what it is. We want to get full discussion here upon it and we intend to get that, as far as we can. I am glad that the Minister does not make it worse by accepting an amendment such as this. Whatever the spirit behind it—whether it is just pure provocativeness or cussedness—I believe that neither of the Deputies mean what they are saying. I am glad that the Minister has taken the line that he will not accept the amendment.

I only want to say that the amendment is very simple. It provides that where a local authority provides money for a hospital, that hospital will be subject to inspection. That is a very simple amendment and I think it is an important amendment. Of course, as usual, Deputy MacEoin likes to drag religion—and his religion. particularly—into the very simplest amendment before this House.

Deputy MacEoin says he is a knight. Presumably he was a knight when he was a Minister. That is a matter for Deputy MacEoin's own conscience. I am not concerned with knights, freemasons or anybody else. What I am concerned with is simply that there should be a right of inspection of any hospital, no matter by whom it is run, if it is receiving public funds, and particularly substantial funds from the local authorities.

I interrupted Deputy MacEoin to ask what he would say if he went into a hospital and had the wrong foot cut off. That has happened in a hospital and it is only right that there should be some inspection in that regard. Every Deputy receives complaints from time to time from patients about the way they have been treated in hospitals, but when we bring the matter to the notice of the Minister, at the request of a constituent, we are told by the Minister that he has no function in the matter, that it is a voluntary hospital, that it can do what it likes and that he cannot do anything aboutit. It is all very well for Deputy MacEoin to throw the cloak of religion over him, to refer to Red China and what has happened over there. Those are very good Sadleir and Keogh tactics and he is welcome to them; but there could be hospitals that would not be run by religious orders and in which practices to which Deputy MacEoin might object could be carried on.

The Minister said he is not accepting the amendment and I understand that it would probably be wrong to accept it on this Bill. I think it would be necessary for the Minister to have some discussion with the voluntary hospitals, but I am perfectly certain that the voluntary hospitals would be glad to submit to the form of inspection referred to here. If our people are treated badly in the hospitals, if they go in to have the right foot cut off they do not want the left foot cut off, and there are 101 other things that can happen in a hospital. I have come across instances where the nurses in a hospital were scandalously and disgracefully treated— treated as sub-human beings and the Minister or the local authority can do nothing about it. That was the only purpose of the amendment and it was only on these grounds that I spoke to the amendment.

I understand the Minister's position with regard to it—it may require considerable discussion with the voluntary hospitals—but I am perfectly certain that the voluntary hospitals would be delighted to have an inspection by the local authorities. Who are the local authority? The local authority is constituted of the people elected by the citizens of the country to it. There are many Deputies here who are members of the Dublin Corporation and we have members of the Dublin Corporation as governors and members of the boards of nearly every hospital in Dublin. Nobody says that their membership of these boards in any way interferes with the proper running of the hospital. In fact, it has a completely opposite effect—it assists the more efficient organisation and running of the hospitals.

If we could get down to dealing withthis Bill in a practical way, if we could get away from this line taken up by Deputy MacEoin and other members of the Fine Gael Front Bench of seeking to prove themselves better Christians, better Irishmen and better Catholics than the rest of us, we will get somewhere. If this Sadleir and Keogh line is to be persisted in on every section it will be a long time before the Bill becomes law, and in that way the public will be deprived of the benefits provided for them in this Bill.

This amendment is another attempt to place the voluntary institutions under State control. I think it is quite fair to say that, because Deputy Dr. Browne stated, when referring to the Bill at the beginning, that they had their toe in the door and that they wished to push it further open. Let us refer briefly to the voluntary hospitals. The voluntary hospitals were founded originally by voluntary subscription and they have carried on on the basis of these voluntary subscriptions and have done good medical and teaching work over a great number of years. As voluntary institutions, they are not subject at the moment to direct inspection, other than that involved in any powers that lie in the State in that regard, but, thanks to the action of the Fianna Fáil Party, they are subject to a certain amount of financial control.

The Hospitals' Sweepstakes were originally founded by the voluntary hospitals, and the money was used for the purpose of financing these hospitals. Somewhere around 1934, the Fianna Fáil Government introduced legislation by which, to put it bluntly, they collared that money from the voluntary hospitals. That is the money the voluntary hospitals are getting from the Government about which Deputy Cowan talked last night. These are the simple facts. The voluntary hospitals founded the Hospitals' Sweepstakes as a means of raising money to finance themselves, and the money was collared by the Government. That does not satisfy Deputy Browne and Deputy Cowan—they want to be able to get inside these hospitals and to inspect them.

Let us review briefly the financial position of these hospitals in relation to the cost per bed of maintaining a patient. We have St. Mary's Hospital in the Phoenix Park, a T.B. hospital, run as a State or rate-aided institution, and we have St. Kevin's Hospital in Dublin also. It costs in these hospitals £15 per bed per week. If they cannot keep within that sum, they need not do so, because, if they are unable to manage within that amount, all they have to do is raise the rates. Do Deputy Dr. Browne and Deputy Cowan suggest that the rates should be raised further for the maintenance of these hospitals? I was under the impression that the rates were sufficiently high in Dublin already, and, I might add, in the country areas as well.

A voluntary hospital is run in a different way. It is a private institution. The authorities of these hospitals have to arrange beforehand what it is going to cost them to run that hospital. In other words, they have to meet their commitments, because they have not got the entire resources of the State to fall back on or power to raise the rates to finance their institution. It may interest Deputy Dr. Browne and Deputy Cowan to know that the cost per bed in a voluntary hospital is £9 a week. Where does the difference come in? Why does it cost a rate-aided or State controlled hospital £6 per week more to keep a patient than it costs a voluntary hospital? Administration costs is the answer and that is what the whole argument boils down to. Is it better to have voluntary hospitals under private or State control?

The amendment proposes that every institution receiving money from a health authority shall be subject to inspection by persons appointed for the purpose by the health authority. That means a gradual encroachment on the private rights of the voluntary hospital. I am very glad the Minister has refused this amendment. I do not think he could do anything else. I do not agree with the Minister's attitude with regard to many matters in this Health Bill—I am at variance with him on most points—but at leasthe is taking a step in the right direction in refusing this. If he were to accept it it would represent a gradual encroachment. That is what Deputy Dr. Browne wants. Is that not a fact? He wants State control of everything appertaining to medical treatment in this country. I think I have made a pretty fair case of the Deputy's attitude. If your State hospitals are costing £15 per week per patient and your voluntary hospitals are costing £9 per week per hospital, is it not reasonable to assume, if Deputy Dr. Browne gets his way and enforces full and complete State control of everything appertaining to hospitals and medicine in this country, in the final analysis the people of Ireland are going to pay for it? Are we satisfied, even though they will have to pay more for it, that they will get a better service? I am not satisfied that they will.

Deputy Cowan's argument appeared to be that if you went into a voluntary hospital there was a risk of having the wrong leg cut off.

The Minister's inspector would stop that.

I would like to know —perhaps his colleague, Deputy Dr. Browne, could tell us—how that is to be prevented by Government inspectors. Of course, it is fatuous nonsense. When Deputies come in here and introduce an amendment, let them have decent arguments to support their case. I have some respect for Deputy Dr. Browne in that he is quite frank. He says he wants complete State control of everything. Deputy Cowan comes in and argues that we must have this examination of hospitals because there are numerous complaints of people having the wrong leg cut off. I know he is only making a hypothetical case there.

On a point of order. Deputy Cowan did not make that statement.

That is a point of fact, not a point of order.

If he did not make it I apologise for saying so, but I understood—I was sitting here listening the same as the Deputy—that Deputies had received numerous complaints—

Not in regard to having feet cut off.

He repeated it several times, that there was a possibility of having the wrong leg cut off.

It is quite a different thing to say there were numerous complaints.

Deputy Dr. Browne can make his case afterwards.

He said there were complaints. The question is, are we going to permit the State to control everything? Is there sufficient justification for interfering in any way with the voluntary hospitals? The voluntary hospitals have to deal with specialised medicine; they have to deal with cases that nobody else in this country can deal with. While I am on this subject let me say that the doctors in the voluntary hospitals in Cork, in Dublin, in Limerick and in Belfast work long hours every day for which they do not get paid. That is the system which the voluntary hospitals have built up over the years in this country.

I have stated before in this House and I would like to state it again categorically and emphatically, that I have never known a case of anybody being refused treatment in a voluntary hospital because he was not able to pay for it. That statement has been verified by a colleague of mine on the Fianna Fáil Benches, Deputy Dr. Maguire, who made a similar statement. That is the system that prevails in the voluntary hospitals as they exist to-day. I do not see anything wrong with that system. I do not think these hospitals require any inspection. They are able to run their concerns economically and well and on sound Christian principles. They do not require any State interference whatsoever. I feel the Minister was right to refuse the amendment, and I am glad he did so.

One would be more impressed by the arguments that have been used here if those arguments were consistent. Deputy Dr. Esmonde last night tried to reach general conclusions from two particular instances when he referred to a case where cortisone could not be administered, and a case where streptomycin could not be administered in the early days when those drugs were being introduced to this country because a certain measure of control was exercised at that time over the institutions that were to use it. It is the general position that requires to be examined. First and foremost, we have the public institutions where the funds come completely from public sources, either from the rates or from the State. Then we have what may be considered semi-private voluntary hospitals where a corporation or a county council or both make a contribution, where there are subscriptions from people who, through the years, have been interested in those hospitals and where the amounts that are required are made up subsequently from the Hospitals' Trust Fund.

In both of these cases you have representatives who are appointed by the people on the boards of management and generally they have visiting committees of their own. They look after the interests of the hospitals generally, and when the public authorities are appointing representatives they do not confine themselves strictly to those who have been elected on the county councils or corporations; sometimes they appoint the members, say, of trade unions who would be interested— people outside public administration. Therefore, there is an admixture of control which is for the good of the hospital. When changes are made in the public representation you have new ideas coming along and the position is not static by any means. It changes according to the various views of those who may from time to time be elected on these boards.

As regards the purely voluntary hospitals run by communities or by organisations of various kinds, surely these hospitals are also open to examination because patients are admitted and their friends occasionallycome to see them. People move through these hospitals day after day in the normal way. A point has been made here about not being able to bring complaints to the Minister. Generally speaking, if people come to public representatives with any complaints, those public representatives take them up directly with the governors of the hospitals or with the community concerned and the matter is usually adjusted locally without any great inconvenience to anybody.

Things have been read into amendments here that perhaps interference is meant when interference is not intended. As one who has been on these hospitals and has contact with the purely voluntary hospitals from time to time, I must pay a tribute to the work that is being done in them. Very few complaints ever come from them and, generally speaking, the hospitals are open to inspection, because you cannot have a better inspection than the inspection of public opinion. You will always have that public opinion while the doors of the hospital are open to the patients and to their relatives and friends.

I cannot allow certain things to pass because they might be taken as the truth if I did. Deputy Dr. Esmonde, in speaking of the Hospitals' Trust Fund, gave the impression that the Fianna Fáil Government collared all these funds for the local authority hospitals although they were meant for the voluntary hospitals. The Fianna Fáil Government was in power in 1933 when the amending Act was passed. I had occasion to look through the record of the discussion on that legislation quite recently because the same charge was made by others as was made by Deputy Dr. Esmonde.

I read through all the discussion in the Dáil and the Seanad and there was not a single dissentient voice raised against that Bill or the principle of the Bill. The Bill amended the previous Act that was passed in 1931 so as to enable the Minister for Local Government to devote a certain part of the funds to local authority hospitals.Not a single voice, as I say, was raised against it so that this type of political propaganda to try and saddle a charge like that on Fianna Fáil, to say the least of it is unfair because every Party agreed to it. No Party objected in the slightest, when that was being done. The Bill gave complete discretion to the Minister. It did not name any percentage one way or the other; it gave complete discretion to the Minister. What was the result? The Minister since that time, 1933, had complete discretion in the distribution of the fund. Deputies know that there was a programme mapped out by my predecessor in 1948. That programme is now in process of being completed and it is hoped to see it completed in a few years' time. When that programme is completed in three or four years' time, the voluntary hospitals will have received 75 per cent. of all the money that came from the sweepstakes into the hands of the Minister for Local Government or the Minister for Health. I made that statement in public.

Does that take into account the tax collected from the sweepstakes?

I say that all the sweepstakes' fund that came into the hands of the Minister for Local Government——

That is not what I am trying to get at. Is the Minister taking into account the tax that is levied on the sweepstakes?

I am not talking of the tax. I say that of the portion that was given to the Minister to distribute, 75 per cent. went to the voluntary hospitals and 25 per cent. to the local authority hospitals. The tax is taken from both if you like but that is a different matter. I want to say that I have made that statement three or four times in public in recent months. I do not expect that it will keep Deputy Dr. Esmonde or other members of Fine Gael from repeating the charges which they have made in this regard. They will make the statement again, I am sure, that Fianna Fáilcollared all this money and starved the voluntary hospitals. That is not true. At the moment there is one voluntary hospital being completed in Dublin costing £1,000,000. There are two others planned costing £1,500,000 each and yet another costing about another £1,000,000. These are four items I have mentioned costing approximately £6,000,000. Anyway, including those, on the completion of the programme, 75 per cent. of all the sweepstake funds that came into the hands of the Minister will have gone into the voluntary hospitals and 25 per cent. to the local authority hospitals. During all those years there was either a Fianna Fáil Minister or Deputy Dr. Browne who is now disowned, I believe, by the Coalition Government. Therefore the Coalition Government or the remnants of the Coalition Government who are present here cannot claim that the Coalition Government had any influence in making up that 75 per cent. It was done by a Fianna Fáil Government and afterwards by Deputy Dr. Browne although we were accused of collaring these funds from the voluntary hospitals.

I have noticed in recent times that Deputy Dr. Esmonde and the Irish Medical Association get their information from some common source. Whether Deputy Dr. Esmonde is taking his information from the Irish Medical Association, or they are taking their information from him, I do not know, but the information comes, as I say, from some common source. The statement that a bed in St. Mary's costs £15 and in St. Kevin's something about the same is absolutely fantastic. It is untrue. The average cost of a bed in St. Mary's is £7 and the average cost in St. Kevin's is somewhat less. Deputy Dr. Esmonde says that the cost is £15. Where he got his information I do not know. Whether he got it from the Irish Medical Association I do not know either, but, wherever he got it, it is not a very reliable source. I got the cost of a bed in various institutions not long ago, both for voluntary hospitals and local authority hospitals and you could not make the case in general terms that one was more costly than the other. Ithink that of all the figures, one voluntary hospital has the highest, if you take the whole country, and I think a local authority hospital has the lowest. I am glad to say, and I am sure Deputy Dr. Esmonde and Deputy Corish will be glad to know, that that is a local authority hospital in County Wexford. It is the lowest in the country, lower than any voluntary hospital. That is the position but, taking them altogether, you could not make the case that one is costing more than another. There is no use in making the case, first of all, that the money is being collared for the local authority hospitals and, secondly, that the voluntary hospitals are cheaper to run than the local authority hospitals. There is no great difference between them.

It is true that some voluntary hospitals are extremely economically run from every point of view, and, of course, as I have already said, from the medical point of view they are very well run too. It is true also, as Deputy Dr. Browne and Deputy Cowan said, that the amount of voluntary subscriptions coming into these voluntary hospitals is extremely small. I met the association and they said that the reason was that when they go to a person looking for a subscription that person says: "Oh, see all the money you are getting from the Hospitals' Sweepstakes." They said that attitude was responsible for drying up voluntary subscriptions. The amount of voluntary subscriptions received by the hospitals now, as compared with what they get from local authorities who are paying for their patients and, secondly, from the sweepstakes money in the payment of deficits, is extremely small.

That does not say that we should not encourage the voluntary hospitals to carry on because, first of all, they are run on different lines. We have a comparison of one with the other. There is a different system and there is voluntary effort there. There are the members of the board, the medical staffs, the other staffs and so on, but when I come to the next amendment there may be a change in that. There is that voluntary effort there. I have always said since I became Ministerfor Health that I shall do everything in my power to encourage voluntary effort.

I think arising out of this question of the voluntary hospitals, their position in the life of the community and the spirit they represent, it would be well to examine the position generally. The amendment put down by Deputy Dr. Browne rather suggested that it was the beginning of an approach to the control of the management of voluntary hospitals and the mention of what was done in regard to C.I.E. contains the suggestion probably that a statutory board might control the voluntary hospitals. Now, our reaction is entirely against that and there are certain aspects of the work of our institutions that are well worth examining and traditions that are well worth studying. Anybody who has been connected with any of the institutions in this State over the last 30 years must have been struck by the reaction he found amongst responsible visitors coming here in an inquiring frame of mind, teachers, doctors, politicans of different kinds and men interested in various aspects of social organisation. Anyone, as I say, connected with these institutions must have been gratified by the reaction he found on the part of these people to the atmosphere and the manner in which our institutions are carried on.

These responsible people coming here in an inquiring frame of mind have found in our schools, in our hospitals and in our institutions something that they lack in their own countries. That is the one outstanding impression one gets of the reaction of people visiting our institutions here. They find pervading the work and the very atmosphere of these institutions, be they schools, hospitals or establishments for the care of the poor, an appreciation springing from a Christian philosophy translated into the daily work of these institutions, a sense of man's dignity, a sense of his destiny and an understanding of how to do the work to the best advantage spiritually and materially.

I have met that myself and I regard it as one of the most hopeful indications we have and one of the most inspiring and gratifying and when we come to deal with the voluntary hospitals I do not differentiate in any desire to safeguard the voluntary hospitals as against State institutions. I do not differentiate as between what are described as Catholic hospitals and Protestant hospitals. I ask the House now to consider two of our principal voluntary hospitals, the Mater Misericordia and St. Vincent's. They happen to be Catholic hospitals. When one goes back to the traditions from which they sprung what does one find? One is driven back to the end of the eighteenth century and the beginning of the nineteenth century, to a period of intellectual resurgence, of an appreciation of the carrying on of national work and the moulding of our people's efforts towards a proper understanding of the need for the care of the diseased, the poor and the afflicted. All that formed a definite rhythm in our national life. I suggest to Deputies that they will find in the rise of religious orders, such as the Sisters of Mercy, the Sisters of Charity, the Christian Brothers and the Presentation Brothers, in the work of Catherine Macauley, Mary Aikenhead, Nano Nagle and Ignatius Rice the intellectual resurgence to which I have referred typified by the definite rhythm in our national life which succeeded in maintaining our people as a nation and gave them institutions through which they were able to express themselves, maintain themselves, develop their sense of nationhood in a voluntary way until we find ourselves to-day, as a result of their efforts, with complete control of our own country.

I mention these two hospitals because they are outstanding examples of voluntary hospitals. The roots from which they grew were fostered by the mutual co-operation and work of Catholic and Protestant alike. Mary Aikenhead, the founder of the Irish Sisters of Charity, had a Protestant father and a Catholic mother. Catherine Macauley, the founder of the Sisters of Mercy, was reared in a Protestant atmosphere, married a Protestant and for part of her life washerself a Protestant. Anybody who knows anything of the development of the Christian Brothers, the Presentation Brothers, the Irish Sisters of Charity or the Sisters of Mercy knows that these are national institutions founded by the willing and voluntary co-operation of both Catholics and Protestants.

Now I want to see the spirit of the voluntary hospitals as exemplified by these two hospitals fostered. To permit State interference in the way suggested by Deputy Dr. Browne or Deputy Cowan would be to give control contra our national traditions. It would be tantamount to going against our national traditions and would inevitably injure the potentialities of our people for making this country what we think it should be.

We have gone through a very difficult period of 30 years. Many problems have been left unattended. Many artificial influences have pervaded our people, creating difficulties of one kind or another, whether between Party and Party or between Catholic and Protestant, and these influences have been fostered by people for their own particular secular aims of one kind or another. I ask Deputies to consider the roots from which our voluntary hospitals have grown and to look back for a moment over the national rhythm of which the work of the lay people and the foundation of the religious orders to which I have referred at the end of the 18th century and the beginning of the 19th century all formed a part. James F. Kenney, Keeper of the National Archives in Canada, has published a volume which is available in the Library entitled Sources for the Early History of Ireland.In an introduction he epitomises Irish history in such a way as to bring out the background of thought, and the sequence of his writings shows that after the Viking invasion there was an uprising in the country characterised by the amalgamation of secular and religious learning. At page 10 he indicates that there were two dominating movements at that particular time; that the churches that survived the Viking storm in the 11th and 12th centuriesexperienced important religious secular developments. That development was both religious and nationalist in character. At page 12 he says:—

"The ultimate effect, however, seems to have been rather stimulating: the national revival which developed out of two centuries of alternate disaster and triumph showed itself in a rejuvenated literature and scholarship. Noteworthy features of this intellectual renaissance were that amalgamation of secular and religious interests to which reference has just been made."

On a point of order Can we get some ruling as to whether all this has anything to do with a discussion on the organisation of our voluntary hospitals?

It seems to be going very far back.

It is suggested here that the State should control our voluntary hospitals, to the extent perhaps of setting up statutory bodies, and I want to point to the sources from which these hospitals sprung. They came from the educational work of the Catherine Macauleys, the Mary Aikenheads, the Nano Nagles and the Ignatius Rices at the end of the 18th and the beginning of the 19th century, a period when democracy was getting its first chance of asserting itself. It had attempted to assert itself in arms in 1798. Following on that we had an intellectual resurgence.

The Deputy must see that he is travelling a very wide field in seeking to trace the development of these institutions down to the present day.

So be it. Let me say that there was after the Viking disaster a resurrection of which it could be said that the chief note of the intellectual life of that era was the amalgamation of secular and religious learning, and it was that that kept the nation alive. After the Normans, it could be said, on page 17, that "the triumph of Irish civilisation was greater than that of Irish arms."

The Deputy must see that if some other Deputy tries to put forward another aspect of Irish history, as opposed to his, we will find ourselves discussing Irish history and not the Health Bill.

I cannot see the voluntary hospitals, and what they mean in spirit and in tradition to this country, being attacked.

On that basis, the House might find itself discussing two or three philosophies of Irish history.

I want, respectfully, to suggest that when the voluntary hospitals, Catholic or Protestant, are being attacked and when an incipient attack is being developed against them here in an Irish Parliament, it behoves us, in the interests of our national future, of our people's strength, and of our being so secured in our minds as to what we are doing that we will be prepared for an emergency in the future, to take a short glance at what it was that helped to raise our people after dark days in the past—that helped them and prepared them to get through the very difficult days which they were faced with.

We are concerned to-day with the intellectual, the spiritual and the material development and strength of our people. When this is the only forum that is left to us to examine the details of a Bill of this kind, we can afford, in this forum, to convince ourselves that we have in what is left in our voluntary hospitals, as we have in what is in our schools to-day—the dominating control of our schools by the religious bodies, free and unimpeded for every religion in the country —that in our hospitals as in our schools we have the seeds, the legacy and the traditions that helped to raise our people after the debacle of 1798, that helped to give our people education and that helped to give them strength. Our medical schools, which affect life and health, are as vital to the education of our people, to their spirit of independence, their spiritual welfare and their material strength, as what they learn either in our primary or secondary schools.

I just want to show that there was that intellectual uprising after the Viking wave had passed so that it could be said that "Irish civilisation was stronger than Irish arms". After the Elizabethan crushing out, it is worth recording this from Kenney's book:

"Upon its having been observed by certain parties of the true order of St. Francis that the holiness and righteousness of their mother and nurse, Ireland, had perceptibly diminished, through not having the lives, wonders and miracles of her saints disseminated within her, nor yet made known in other kingdoms, the counsel they adopted was to send from them into Ireland a poor Friar Minor of their own, the Observantine Order, Micheál Ó Cléirigh (a chronicler by descent and education), in order to collect into one place all the books of authority in which he could discover anything that related to the sanctity of her saints, with their pedigrees and genealogies."

I must ask the Deputy to come more closely to what is before the House.

From the movement that was started after the Elizabethan crushing-out, we came along until we got the Mother Mary Aikenheads and the Catherine Macauleys who, with the co-operation of their Protestant neighbours and Protestant relatives, and in many cases their Protestant parents, laid the foundations of what we must characterise as the secular, the religious and intellectual development which took place at that time, and made it possible for our people to exist, to establish schools and provide for the treatment of the sick. All that helped to keep our people in the position in which they had the strength of a nation. It was these voluntary institutions which strengthened our people's fibre for the future. They strengthened not only our people's national fibre but their educational fibre as well.

I want to say that, before any of the influences from the receding tide of futility, disagreement and disorder which are the result of the unhappyexperiences since 1914—before the remnants of that time are allowed either to muddy our discussions or dictate our actions or policy—we ought to look at our traditions and our institutions. We ought to determine whether our voluntary local institutions and State organisations in the past were the ones that saved and strengthened our people when the central institutions broke down and that, when we have been enabled by Providence to set up our own Parliament here and our own central institutions, we ought not now, through our central institution, trample down the small local voluntary bodies through which the real calm and constructive spirit of our people breathed. Therefore, when we are discussing and deciding that the State is not going to put its heavy hand on our voluntary hospitals, or on any of our voluntary institutions, it is worth while looking at what it is advisable for us not to do. It is advisable for us not to do this because this State would not be here to-day if it were not for the spirit which breathed itself into our people through the education, the hospitals and the charitable institutions that were founded in these days and arose out of the debacle of 1798.

That is my answer to those who say that they want to squander and to spend money building up stone edifices of one kind or another and think that the State, because it is paying for the maintenance of these stone edifices into which the hospitals' funds are being put, can take over the spirit that lies behind the foundation of those institutions—the spirit of those who founded those hospitals and charitable institutions and which have since been carried on in that spirit. Let me say to them that we have got something here that other people have not got. Let us hold on to what other people have not got, because it is the thing which enabled us as a nation to live after one crushing defeat and another.

It is a pity that some members of Deputy Mulcahy's Party were not present to hear him give them that lecture, and saying that national records are dying or are dead.

If they were here they would not understand it.

I think that Deputy Mulcahy has been wasting the time of the House by his long contribution. I do not think many could understand what he was talking about. His idea was to delay the passage of the legislation. I do not propose to press the amendment this morning or later, but I intend to press the intention behind it as long as I am here in the Dáil—for five or ten years or whatever it may be. I would say to Deputy Esmonde that I was very careful to choose my words meticulously in moving the amendment, pointing out that I did not want to upset in any radical way the existing voluntary system. In reply to Deputy Mulcahy, I was particularly careful to say that I did not intend that there should be established statutory boards on the lines of C.I.E. or the G.N.R. I mentioned them merely to show that it is the accepted practice when you are giving a lot of money to a company to see that the representatives of the people have some say in the spending of it and know where it goes. That is perfectly reasonable if we accept our responsibilities as Deputies in a democratic Parliament.

As to the extension of State control, I did not suggest we should have State control of the voluntary hospitals. I suggested that we should have an increase in the democratic control. I was very pleased to hear Deputy McGrath say it exists in the City of Cork, where many Deputies, either as members of local this House or as members of local authorities, have right of access to these boards. The City of Cork seems to be in advance of us here in Dublin in that regard.

I do not think any of the orders who run hospitals in Cork or any of the doctors there are in any way encroached upon by the State—I have had no complaints to that effect—by virtue of these public representatives being on the boards of those institutions. I honestly do not think the average voluntary board in Dublin—lay board, at any rate—would resent very much the inclusion of a public representative, a nominee of the Minister, whether he is a Deputy or a county councillor, possibly because he is anexpert in some particular aspect of public administration. One very prominent member of a voluntary board recently suggested that it would be a good idea if the Government did send along someone to see how the work was done and what work was done. I do not wish to press it on this occasion. I was anxious that a certain view should be made known, I had the right to express my views and did not expect everyone to agree with them enthusiastically. They were reviewed on their merits and I was prepared to hear reasonable arguments made against the case I put up.

The Minister replied most effectively, I thought, to the suggestion that the sweepstake moneys have been misappropriated. This charge has been made elsewhere against myself as well as the Fianna Fáil Government. I think that the refutation, to the effect that 75 per cent. of the money spent has gone to the voluntary hospitals rather than to the State hospitals, was an adequate one. In relation to the stamp money, 25 per cent., I might say I objected to that going to the Department of Finance. Formerly, when I was Minister, I suggested that it was unfair. I may be wrong in that, but that was my view. I felt that it should go to the hospitals—whether voluntary or State did not matter, as it was the sick people we are trying to cure that I was primarily interested in. That suggestion was turned down by Deputy McGilligan as Minister for Finance and in consequence the money continued to flow to the Department of Finance.

Deputy Esmonde referred to the cost of sickness. I am afraid we all differ on the force of that particular argument and on what sickness costs. Personally, I do not know of a limit that I would put, either for myself, for my own family, as a Deputy, as a public representative, or as a Minister, to the money that I would make available or wish was made available to any citizen of the State, rich or poor, adult or child, for the restoration of his health or the saving of his life. I concede to Deputy Esmonde that money shouldnot be misused or misspent, that maladministration should be reduced to the minimum; but it is not a good argument to place on one side the hospitals that spend much money and on the other side those that do not spend so much. The Minister replied even more effectively by showing, as was my own experience, that the most expensively run hospital in Dublin is a voluntary one. I do not know whether the cheapest is a State hospital, but the Minister says it is and I accept that. I would not be terribly impressed by the expenditure argument in relation to health costs.

I was asked if I would be in favour of raising the rates to increase the expenditure in St. Kevin's or St. Mary's. If it were necessary in order to improve the health of people or to save life, I would be quite prepared to stand over the raising of the rates or an increase in taxation. My attitude to these matters is that the community is responsible to the weaker sections, the poor, the aged and the sick; that from the community purse funds should be made available to the extent required, no matter how heavy that burden may be, and that we should readily accept that burden, reducing to the minimum the unnecessary expenditure and administrative costs. The community is responsible for health services for the aged and so on and the dominating practice should be that whatever resources the community has will be redistributed so as to give every boy and girl, every young man and woman, exactly the same opportunities in this aspect of the social life of the community.

I repeat that I would not wish to interfere with the truly magnificent work which religious orders have done for so long in voluntary and State hospitals, particularly, as I said last night, in our very ill-equipped county homes, where they do probably the best work. My main point is that I would like representatives of the public to be on these boards.

At the moment, certainly in the non-community or the non-religious hospitals, the tradition of appointment on these boards has led to the appointment,in the City of Dublin at any rate, of people who belong to a particular section of society. I have no objection whatever to these people being members of boards or governors of boards of hospitals but I do not see why we also, the public representatives, the public patients in the ward, the patient in the public bed in the hospital, should not have right of access in so far as he may want to make a formal complaint and see that something is done about a particular matter.

When I was Minister for Health there were occasions when I was written to to inquire about matters where people were dissatisfied, whether it was in regard to service, bad food, bad treatment, ill manners—whatever it may be. I am not suggesting that these complaints were very frequent. I am merely suggesting that these complaints were there and, although as Deputy Cowan pointed out last night, I, as a representative of the people for the time being, was paying a lot of money for the running of these hospitals, I had absolutely no functions whatever, I had no right of inquiry beyond the right of a private citizen. Many of the voluntary hospitals to whom I wrote at that time making inquiries replied in a most courteous and a most helpful way. Some of them saw fit to point out in an abrupt way that I had no functions in the matter and that there was nothing I could do in relation to a particular incident that occurred.

However, we will have an opportunity again of raising this matter, I hope, on another occasion. Gradually I think we will be able to persuade people that we are not seeking anything which is outrageous or revolutionary and that we are not asking to have any really fundamental change in the organisation and running of these institutions, that we are merely asking that there should be a greater degree of democratic control—democratic in the real sense of the word.

I can understand Deputy Mulcahy's attitude. He has grown up and lived with these institutions and has become particularly attached to them, I haveno doubt, over the years, but he must accept that our generation are now gradually beginning to impose ourselves and to be anxious to impose our will and our wish on the form which our society will take. He must also understand that no society can remain static or fossilised or ossified—such a society would be a dead society—and that anything that these institutions, for which we have all great regard and great respect, can do in order to increase their efficiency—efficiency can be the only consideration that must weigh with us—and to increase their value to our patients, the people for whom we are paying, the sick people for whom we are providing these services, and to give better service to our people is just fine as long as it does not conflict with any of the fundamentals, the natural law or the moral law.

A point has been made by Deputy MacCarthy and Deputy McGrath. I do not wish Deputy MacCarthy to feel that I am bringing him into my rather more advanced views, possibly, than his, but he did mention the fact that these practices are accepted in the City of Cork. In consequence I do not think there can be any suggestion that they are as advanced or as dangerous as Deputy Mulcahy seems to imply.

I do not think that Deputy Dr. Esmonde was serious when he suggested that Deputy Cowan thought the inspector could protect the patient from getting a wrong operation. Deputy Cowan's suggestion was that, if there was an operation carried out which the patient thought was a wrong operation, the inspector would have the right of inquiry and the question could be pursued to the patient's satisfaction.

The points which I wish to raise in relation to it, I hope to raise again on as many occasions as present themselves. Eventually I hope to be able to persuade the House that I am not proposing anything which is unduly revolutionary or which will conflict with the best interests of these fine institutions but something which will merely increase their efficiency and therebyincrease the already high prestige in which they stand with the citizens.

I do not presume to have any knowledge of how the hospitals in Cork are operated or how the boards are appointed or manned, but I do not think that Deputy Dr. Browne can use the position that exists in Cork to support what he is trying to do. Whatever has been entered into in Cork, I think I would be right in saying that it has been entered into on a purely voluntary basis, the result of voluntary agreement between those who are responsible for operating the hospitals in Cork. In other words, whatever the position is there at the moment, however the boards may be constituted, it was not as a result of any dictation or direction or anything in the law that imposed it on them.

It was as a result of the law.

I am only looking for information. I do not know. I take it from Deputy McGrath that, in so far as the representatives of public authorities in Cork have anything to do with voluntary hospitals there, it is because that is there by law and they are put there legally?

Under the charter, yes.

The Deputy wants that extended all over Ireland. Is that under the charter of the voluntary hospital?

The charter of the North and South Infirmaries in Cork. By law, the county council and the corporation are represented on them.

That is a completely different matter. I am thankful for the information. It proves the point I set out to make that Deputy Dr. Browne was trying to use a situation to support his views that has no relation whatever to what he is trying to do and what he would like to do.

Deputy Dr. Browne said that he was very scrupulous in his use of languagein moving and supporting and speaking to this amendment. He undoubtedly was. He was so scrupulous that his speeches were completely different, of course, from his intentions—completely different. The Deputy spoke for quite a time on this, covered quite a number of points but he only came down to the real reasons at the conclusion of his speech. He showed us that this desire of his is based on the fact that he found he could not interfere in the running of a voluntary hospital during the time he was Minister and that he could not dictate to them as to how the voluntary hospitals should be run. He has admitted that he tried to do so and was rather peremptorily—or his interference in the matter was—rejected. I think we got the Deputy's mind towards the end of the speech when he told us of his belief in his right to impose his will on society. That is where he and those who think like him differ from the rest of us, but, according to the Deputy, we are getting old in our ways as well as in years and becoming almost fossilised.

I do not think it would be unfair to say that the type of speech which Deputy Dr. Browne has just delivered, coolly and calmly giving his real mind, is the type of speech that was made some years ago in Germany and in Italy. The system is wrong; it must be changed. Under the present system certain people have not the right to impose their wills on certain organisations or on society. But Deputy Dr. Browne thinks he ought to have the right to impose his will on certain organisations and societies in this country. I do not believe for a moment that either side of this House will agree with that. Perhaps it is just as well that the Deputy this morning coldly and calmly announced in such clear language his real mind on these matters.

The Deputy does not believe in the voluntary hospitals. The Deputy believes that the Minister should have a right to impose his will on the voluntary hospitals. The Deputy says that when he became Minister he found he could not do it. He tried to do it, and he resented it when he would not be allowed to do it. He said that he foundas Minister that he was paying over money to these hospitals. Might I remind the Deputy that his predecessors for nearly 20 years were in a similar position, that the present Government for a period of 16 years were handling the Hospital Sweepstakes money and during that 16 years I do not think any Minister for Health, or Minister for Local Government and Public Health as it was before, ever sought, in Deputy Dr. Browne's words, to impose his will on any of the voluntary hospitals, and I do not think any Fianna Fáil Minister would ever try to do it? I was very glad to see that the Minister made it quite clear that he was not prepared to accept the amendment.

Let us be clear on this matter. The Hospitals' Sweepstakes were originated and run in this country for the voluntary hospitals. The first Bill dealing with the sweepstakes was passed in this House for that purpose. Subsequently changes were made, changes that, in my opinion, were not for the better and were unfair. With one statement which Deputy Dr. Browne made I find myself in absolute agreement, that it was wrong for the State to take out of the Hospitals' Trust Fund very large sums of money over a long period in the form of stamp duty.

Surely that does not arise on the amendment.

With respect, Sir, Deputy Dr. Browne was allowed to speak about it before he sat down.

This amendment deals with the inspection of institutions.

The amendment was put down because Deputy Dr. Browne says that when voluntory hospitals are in receipt of State money the State or the local authority should have some say in the running of them. The Deputy spoke for some time and gave his views clearly and fully on this question of the 25 per cent. stamp duty. All I am saying is that I find myself in entire agreement with the Deputy on that matter. I am not ina position to question his statement as to what he is supposed to have put up to Deputy McGilligan on this matter when he was Minister for Finance. All I can say is that I never heard it put up by Deputy Dr. Browne or anyone else. I am not saying that the Deputy did not put that to Deputy McGilligan, but I do not know anything about it.

None of us, not even Deputy Dr. Browne, can have other than a very limited personal knowledge of how the voluntary hospitals are operating. But, so far as I can gather from people in this city and in the country who had occasion to avail of the services of these hospitals, I think that on the whole they have been very satisfied with them. We know quite well that, whether it is a voluntary or a local authority hospital, there will always be patients and the relatives of patients who will make complaints, well-founded or otherwise. Any Deputy who has served even for six months on a local authority knows that that is quite true. But I have always heard that our voluntary hospitals, both from the point of view of their committees of management and from the point of view of their staffs, are at least as good, and some of them are supposed to be better, than those in other countries.

There is no use in Deputy Dr. Browne saying that he does not want to cast any reflection on the hospitals or on those responsible for their management and for the medical and surgical services given when in fact he does. The Deputy's statement was very disturbing. It must cause concern on all sides of the House. The Deputy showed his real mind on the matter, and that is his right, according to himself, to impose his will and his power. That is something which will cause a bit of a shock. It may be because we are old-fashioned, but I do not think we are as old-fashioned as all that.

I do not want to repeat what may have been already said by other Deputies in connection with this amendment but I am in favour of its being inserted in the Billand I will give my reasons for supporting it. With regard to what Deputy Morrissey has just said, I say it is not an attempt by Deputy Dr. Browne or any other Deputy to impose his will on the voluntary hospitals.

He said that.

It is not a question of Deputy Dr. Browne's will, but the will of the people, the democratic right of the people. The first thing I should like to comment upon is the association between these voluntary hospitals and the Local Appointments Commission. From now on large sums of money will be made available to these voluntary hospitals by the taxpayers and the ratepayers.

I think it is a serious thing if the general public realised that they are now going to pay large sums into these hospitals while at the same time there is no guarantee whatever that the sons and daughters of the taxpayers who become professional men and women, in other words, doctors, will have a chance of appointment to these voluntary institutions. There is no doubt whatever that in many of these institutions the appointments to the medical staff are made in a manner which must cause grave doubts in the minds of the public as to whether the best candidates are appointed.

The amendment does not cover these appointments.

Perhaps the amendment itself is not embracing enough as far as that is concerned.

This is the only amendment before the House.

It is only the beginning.

The opportunity of appointment to the staff of a voluntary hospital is not available to the sons and daughters of the taxpayers of this country. In the Local Appointments Commission there is an equal chance for every doctor who goes before it and the best horse jumps the ditch. In the voluntary hospitals I know perfectly well that influence can beused and that the question of the best qualified doctor does not always meet with the approval of those who make the appointment.

The appointment of doctors cannot be discussed on this amendment.

I heard it discussed last night.

The amendment deals with inspection by persons appointed by health authorities.

That is the first point I wanted to make. I want to make a second point in connection with these voluntary hospitals. I do not for one moment suggest that these voluntary hospitals are not giving good service. I would be the last to suggest that our religious communities, who run many of these institutions, do not do excellent work but that is not the point at issue. In no other sphere where State money is allocated does the State give up the right to ensure that that money is utilised to the best advantage of the community as a whole. Where any State institution or any semi-State body is given money by the House for some particular important purpose this House has a right, every 12 months, to discuss the manner in which that money was spent and to offer criticism in respect of the manner in which it was spent. Wherever public money is given, we, as the representatives of those who pay, should at least have the right to ensure that the highest possible standard of efficiency is available in these voluntary hospitals and there is no higher standard than that in our local authority hospitals. I am speaking now as one who knows the local authority hospitals in my own constituency and I can say without any doubt that if every other hospital in the country was as good we would have little criticism in respect of that type of hospital to-day.

It cannot be suggested that the Deputies in this House are trying to act as dictators so far as the voluntary hospitals are concerned. I could notfor one moment accept that the board in these voluntary hospitals had a terrible dislike to public men. At the present time there are many public men on these boards, not in their capacity as public representatives but they are on the board. I cannot see why members of local authorities and the members of Dáil Éireann, who are members of local authorities, should not have the right, on behalf of the taxpayer, to inspect these institutions from time to time and satisfy themselves that the money given by the public is put to the best possible use.

I was rather surprised, especially at the attitude of the Fine Gael members in regard to this section and their talk about everything being all right with the voluntary hospitals. I do not believe that everything is all right with the voluntary hospitals in Dublin. Take a case where it is impossible to have a Catholic appointed as master.

I do not hear any outcry from the defenders of the Faith on the opposite side of the House about that. I think they have an opportunity of giving expression to their views now.

There was an appointment to one of those hospitals in Dublin during the year. I know a man who was interested in the appointment and he was told that he would not have a chance in the world.

The question of appointments to these hospitals does not arise.

It was discussed by every member.

It was not discussed by every member.

It was discussed by several members at any rate.

That matter cannot be discussed.

Where over 90 per cent. of the patients in a hospital are Catholics, I do not think that Catholics should be deprived of having a mastership in the hospital. I am surprisedthat the Knights of Columbanus on the other side passed no remark about that.

From a personal viewpoint, I do not see anything drastic about this amendment. I think it is very desirable. I cannot see how it will interfere in any way with the working of a voluntary hospital if there is a system of inspection. We have that system in regard to the local authority hospitals and it gives very good results. I think we should have it in the voluntary hospitals just as well.

Much has been made about complaints coming from time to time from voluntary hospitals but if you had some system of inspection it would be easier for the people on the visiting committee to see whether complaints were well founded or not. Taking this amendment at its face value, I say it is exceptionally commendable. I am speaking as a member of a visiting committee and I cannot see why the Minister should refuse to accept it. From what Deputy McGrath stated and from what other Deputies sitting behind him stated, they appeared to be in favour of it. I cannot see why they could not enforce their opinion on the Minister.

I do not understand Deputy Morrissey's objection to this measure, that the State would be imposing its will on the voluntary hospitals. I think it is not intended that this amendment should be in any way as drastic as that but that it would give to patients and relatives of theirs an assurance that either the State or the local authority would appoint some properly qualified persons who would at regular intervals visit these hospitals and see that everything was going well.

Every hospital in the State has a visiting committee and that visiting committee undoubtedly performs very useful work. In the first place, the members, who are usually members of the local authority, go round to see the conditions obtaining so far as bedding, food, clothing, and the general health of the patient are concerned. Theyhave an opportunity of conversing with the patients and of finding out if they have any complaints. In the same way, district hospitals throughout the country are generally visited to find out the conditions obtaining in the hospitals.

While the voluntary hospitals are giving great service, I do not see how the management board of any voluntary hospital could object to a visiting committee, let it be a person appointed by the Department or a number of persons or let it be some person appointed by a local authority. I think it would be most desirable, because any complaints that would be made to public representatives of patients in these hospitals as regards the conduct of any particular member of the staff, or otherwise, could more easily be dealt with if there were a visiting committee to ascertain whether or not the complaint was justifiable. I think it would be an advantage to the voluntary hospitals themselves because such a committee would provide a better chance of having the work being done in these hospitals publicised as well as the undoubted benefits which many of these voluntary hospitals are conferring on the people.

I think there is nothing objectionable in this amendment. It is seldom that I have occasion to agree with the former Minister for Health. However, he has had three years' experience as Minister for Health and he must have had experience of hospitals. He mentioned that he received complaints— some of which, probably, are unjustifiable—but that, even in his capacity as head of the Department of Health in this State, he had no function to enable him to inquire whether or not the complaints were justifiable. That is a deplorable state of affairs. Coming from a former Minister, I accept the statement as being true. If a complaint is made to the Minister for Health in the morning by a patient in a voluntary hospital or by a relative of that patient the Minister has no function to ascertain whether or not the complaint is justifiable. Surely, in this year of 1953, such a position should not exist. Voluntary hospitals or anyother hospitals for the maintenance of which public money is being contributed should definitely have some type of visiting committee which will visit them periodically and see how they are being operated.

Deputy McGrath raises the question whether, in a voluntary hospital which is controlled, say, by a Protestant committee—a Protestant hospital as distinct from a Catholic hospital—the hospital authorities should be overruled and powers should be taken to see that in the matter of appointments, Catholic doctors would get preference as against Protestant doctors.

I said when over 90 per cent. of the patients are Catholics.

The Deputy asks us to interfere with the committee of a voluntary hospital. Under the Constitution, there is the same freedom for the various religions. If the Deputy thinks that the State should make regulations which would enable the State to interfere in the running of a Protestant hospital in a way in which it would not dream of interfering with a Catholic hospital then I would not agree to it.

It was done in the case of the Meath Hospital.

The Deputy does not suggest that the Act which was passed in relation to the Meath Hospital was not generally agreed to and was not accepted by the Meath Hospital authorities and was not welcomed by them? Does he? We have heard both Deputy McGrath and Deputy Dr. Browne—one no doubt of the old tradition and the other advancing himself here as the new generation, the advanced generation: one for some particular purpose of alleged fair play and the other for some particular purpose of getting away from the old traditions and being new and advanced and efficient. They want to sweep away our vital traditions in matters very much affecting the faith and the strength of our people.

They are not the onlytraditions that were swept away—and more will be.

People who ignore the strength of Irish tradition want to sweep away the Irish tradition of organising their work and charity and education in a spirit of freedom and advancement.

With the help of public funds.

With the help of public funds. If the Deputy thinks that the voluntary and free spirit of our Irish people in their general local associations will yield that spirit of freedom and that spirit of free will in exchange for a few State pence or a few State millions, then the Deputy misunderstands the Ireland in which he is living and the Ireland from which he sprang.

The Deputy is going to see, as far as he can, that the Catholic and the Protestant will get fair play but that one crowd will not be boycotted.

I do not know what the Deputy is referring to.

Of course he does. Deputy Mulcahy has been living long enough in Dublin to know.

I marvel that Deputy Dr. Browne, on the one hand, can pay a tribute to the prestige of our voluntary hospitals, while on the other hand, Deputy Cowan, whose name is also down to the amendment, can talk about the necessity for supervision in order to avoid having the wrong leg cut off. I marvel also that Deputy Dr. Browne, who is in touch with the general run of hospitals and institutions throughout the country, can cast aspersions on the voluntary hospitals when comparing them with local hospitals. I am very glad to hear that the local hospital in Roscommon is of the highest possible standard—so much so that Deputy McQuillan is prepared to recommend it. Anybody with practical experience will appreciate the positionin which we found this country 30 years ago when we took it in hands and the good-will and effcrt that went to improve our local institutions and hospitals throughout the country and how slow and difficult the progress has been.

I suggest that those who have the responsibility of assisting local authorities to bring their institutions into a proper order have plenty on hands without abusing the spirit in which our most successful and our teaching hospitals were founded and are being run. The position to-day is that their dispensary doors are crowded out—in Dublin City, at any rate—by people who normally ought to be dealt with by dispensaries run under the local authority. Why are they so overcrowded? Is it because the people are met in these dispensaries with bad manners? Is it because they are met by nurses who are underpaid? Is it because they are given treatment which is not up to the best standard of treatment that they can get?

Deputy Dr. Browne says that this is just a beginning and Deputy McQuillan thinks that this amendment is not sufficiently embracing. It is not. However, you will never be able to get anything that would be embracing enough to curb the spirit of our Irish national voluntary institutions whether they be in regard to medicine, education, or any other field of activity. Our strength lies there. The tradition of our people lies there. The fact that they have been messed up in the way they have been messed up since 1913 is no reason why their minds will not rise above the difficulties and disorganisation that exist in many directions at present. If Deputy Dr. Browne, like a new mind appearing on the scene, feels that there is a lot of confusion and inefficiency and graft and preference of all kinds, it is perhaps good that the young minds in Ireland can feel something of that but, gradually, they will come to realise the kind of problem they are dealing with here and the traditional way in which it has to be dealt with. However, they will not, in their youthful excitement, haste or enthusiasm, tear up the roots of our strength here.

Amendment, by leave, withdrawn.

I move amendment No. 5:—

To delete sub-section (1) and substitute the following sub-sections:—

(1) A health authority may, with the consent of the Minister make and carry out an arrangement for the giving of institutional services to any person or to persons of any class, being a person or persons who is or are entitled to receive institutional services from such authority otherwise than under Section 24 of this Act, in an institution not managed by such authority or another health authority.

(2) Payments shall be made by the health authority for institutional services provided pursuant to an arrangement under sub-section (1) of this section and the payments shall be in accordance with such scale as may be approved of or directed by the Minister.

Amendment No. 6 is consequential.

Amendments Nos. 5 and 6 go together. Amendment No. 6 is part of the amendment.

Perhaps we will leave amendment No. 6 to be taken separately.

Very well. The effect of this amendment is to make it absolutely sure that a local authority, in making an agreement with a voluntary hospital or other institution to take their patients, will include payment for the staff. I am advised that the section as it stands does that, but representatives of the Irish Medical Association who are members of the Health Council have pressed this point very much, and I do not want to be accused by some of the members opposite, as I suppose they would like to accuse me, of interfering further with the voluntary hospitals in the way of encouraging that their staff should be paid. I had no intention of interfering with them in that way; it was the members of the Irish Medical Association who are members of the Health Council whoinsisted on this amendment being put in, to make it doubly sure that, when local authorities are making agreements with the voluntary hospitals, the hospitals may insist that they will pay also for treatment so as to enable them to pay their staffs for looking after these patients.

That, I admit, is going to introduce quite a new principle. The voluntary hospitals, as we know and as has been pointed out here already, are now getting very few subscriptions from the public. They are being maintained practically entirely, first, by payments from local authorities for the patients being sent to them and, secondly, by payments from the Hospitals' Trust Fund by way of deficits. If there is added now the requirement that the staffs in these hospitals be paid, I am sure that some members will wonder what will be the voluntary content of these hospitals; but I am not taking responsibility for that, or at least I am not taking responsibility for being the originator of this idea.

The idea was pushed very strongly on me by the Irish Medical Association who are anxious that nothing in the Act should prevent their being paid. I do not think it is proposed by them that they should be paid now or in the very near future, but they want the Bill framed in such a way that, when they make their agreements with the voluntary hospitals for payment, the voluntary hospitals cannot claim inability to do it under the Health Bill. That is why these amendments are put in.

The amendment being inserted mentions institutional services and we had a great deal of discussion here yesterday on the meaning of institutional services, but at any rate it includes diagnosis and treatment. The amendment, I am assured by my legal advisers, gives the necessary power to enable voluntary hospitals to pay their staffs, and, in making their arrangements with the local authorities, to get a sufficient amount from them for that purpose. The journal of the Irish Medical Association in an editorial comment on this amendment said:—

"Provision had been made for the maintenance or treatment of anypatient referred by a health authority to a voluntary hospital. Under the Minister's amendment No. 5, maintenance and treatment becomes the giving of institutional services. The amendment, however, carries no hope that the staffs of the voluntary hospitals will be paid for the services given. There is no change."

In case Deputies might have any doubt, that shows that the Irish Medical Association are anxious that the staffs in the voluntary hospitals should be paid. The editorial comment in the Irish Medical Journalexpresses the fear that I have not covered it properly in this amendment, but I can assure the Irish Medical Association and theIrish Medical Journalthat the position is now quite clear legally, if the amendment is adopted, and the voluntary hospitals will be in a position, in making arrangements with the local authorities, to insist on payments being made in such a way as to enable them to pay their staffs.

I thought it better that the members of the Dáil should be perfectly aware of what is being done in this amendment, that they should know that we are departing to some extent from the voluntary nature of these hospitals, but if we are, I am asking the Dáil to agree to this at the request of the Irish Medical Association, and if the Irish Medical Association feels that it will be difficult or impossible to get staffs to work in voluntary hospitals in future without payment, the position has to be faced.

Are we to take it that in relation to the honorary physicians and surgeons who, Deputy O'Higgins told us, were giving their time free in the voluntary hospitals, the Irish Medical Association, the association representing a section of the doctors at any rate, is anxious to have provision made to enable these doctors in future to be paid by the voluntary hospitals? The voluntary hospitals at the moment deal with many local authority patients and I cannot understand this proposal, in view of the attacks made on mein Cork by doctors who said they never charged a penny in the public wards of these hospitals. Some said they were there for 30 years and had never charged. Am I to take it now that the Irish Medical Association want to make sure that there will be provision to enable the voluntary hospitals to pay these doctors in future and that these doctors will not in future be appointed on an honorary basis but on some kind of salary or fee per head basis?

I do not want to have any confusion about this. I should mention that everybody realises that the staff, other than the medical staff, are always paid in voluntary hospitals. Some of the medical staffs, such as specialists who give their full time, are also sometimes paid in these hospitals. With regard to existing staffs, any of the senior staffs with whom I have discussed this matter are very definite that they are not going to accept payment, but they are thinking more of the future and they say it may be impossible to get junior staffs to continue—that is their opinion—unless some payment is made to them.

I am sure the Minister is aware of the competition for any vacancy that occurs in these voluntary hospitals whether extern or intern, and Deputy Murphy or any other Deputy on the board of a local authority hospital is aware of the amount of canvassing done to secure these positions. Why should there be any anxiety that there will be a lesser demand in the future when it is the only opening for a doctor to get beds in a hospital?

Could the Minister say if it was not a fact that, when a local authority sent a patient to a voluntary hospital previously, they always paid for the treatment?

They did.

They included a money payment for treatment in the amount they paid to the voluntary hospitals.

That is true.

And that all that is being done in this amendment is that the Minister is making that position clear?

Yes. As I said, the members of the Irish Medical Association on the Health Council were afraid that it was not clear. This amendment makes it clear.

The amendment provides for nothing but the type of inclusive payment that the local authority has been making up to this; in other words, it is an amendment to remove doubt?

Yes, it is an amendment to remove doubt. However, I do want to make it clear that the anxiety of the Irish Medical Association in requiring this amendment comes from the fact that they believe the junior staff may have to be paid.

The period in regard to medical education has been so extended that very few people entering on study for the profession know where they are going to be by the end of their period of training, and now they have to spend a year in a hospital before they can practise as a doctor except in the hospital. Can the Minister say whether some other considerations in regard to the entrance to the medical staffs in hospitals, are not the provision that would have to be made for the students that are carrying out their post-graduate year?

The house surgeons were always paid.

May I ask the Minister a question? It is my recollection of the National Health Council meeting—if I may discuss it—and of my own negotiations with the Medical Association, that they were anxious to have the higher staff paid for work carried out on institutional services, diagnosis, advice and treatment, by radiologists, surgeons, physicians and so on, the whole way through. Does this amendment empower the Minister to fix a range of fees or to come to some arrangement on some sessional or salary basis for all the medical staff,the visiting voluntary physicians and the junior staffs who are not paid at the moment?

No. That is not the idea. As a result of this amendment—I agree with Deputy Mulcahy that I had the power already but they were not satisfied; anyway the power will be given now—if the local authority pays, at the present time, let us say, £5 12s. per week per patient, and the voluntary hospitals were to say: "We must get something for our staffs as well." Suppose they increase that by 10/-; then it is for the voluntary hospitals to make their own arrangements with their staffs. As far as this is concerned it only means that the local authority is to pay the hospital for both maintenance and treatment. The hospital will then be in a position to put so much aside for maintenance and so much for treatment but they will make their own arrangements with their own staffs.

May I make it quite clear that I am in complete agreement in regard to the payment for work by the visiting physicians, surgeons and so on? I think that the present position is completely wrong and it should be rectified. I do not think it is a great evil but it is much more reasonable that the physician or surgeon who gives his time should be paid for that time. He has spent many years perfecting his particular speciality, whatever it may be, and has deprived himself of many things he would have liked at particular times in his life in order to become highly qualified. He should be paid and well paid. That was my attitude as Minister in fixing salary scales whenever the occasion arose. I would hate it to be thought that I expected the medical profession to work for nothing. The question of payment of the medical staff of the hospital is a most important one and I wish it could be clarified.

It does seem to me by this amendment—I hope it is true—that the Medical Association as a trade union, may come to the Minister and say: "We have received the authority of our voluntary boards to negotiate with you in relation to fixing of fees for institutional services"—for diagnosis,laboratory work, investigations of all kinds, for advice, consultations, and for any time they may spend on work in the hospital on treatment relating to operations and diagnostic procedures of different kinds. It would be reasonable for the Minister to come to a satisfactory arrangement agreeable to both himself and the Medical Association for payment for each of these different procedures involved in the provision of institutional facilities in connection with our health services for which we are now trying to lay the foundations in this Bill.

May I ask the Minister is it so, that by virtue of this amendment—and I would say again, I hope so—the Medical Association, if they receive the authority of the separate or collective boards of the voluntary hospitals, can come forward to the Minister and say: "We have received this authority, first of all, to negotiate on the amount of money that will be paid for the institutional care or maintenance of our patients, and, secondly, for the institutional services which will be made available to you by the members of our union, of our association"?

Can they negotiate in the ordinary way as worker and employer for the best possible conditions they can get for their members? It may appear a little bit odd to find me advocating the case of the Medical Association but I do feel in this particular instance they have a perfect right to go and negotiate and get the best possible bargain they can for their members, if it is now decided that the community will seek to avail of the expert advice, treatment and diagnostic facilities which will be put at their disposal and which we hope will be put at their disposal by the various voluntary general hospitals in the different cities.

It seems to me that Deputy Dr. Browne, Deputy McGrath and, to a certain extent, the Minister, are anxious to emphasise that whatever is going to be done will be done by virtue of this amendment. They are going out of their way to hang this right around the necks of the Medical Association. I do not intend to argue the merits one way or the other but Iwant to remind Deputy Dr. Browne and the House that the Minister himself in moving this amendment said that he is advised that it was not necessary, because anything this amendment purports to do is already covered in the section. He said he only introduced the amendment, although it really made no difference—it did not do anything or enable him to do anything that the section itself did not enable him to do—in order to remove any doubts that might be in the minds of the Medical Association or anybody else. It was not his own amendment. It was an amendment that was forced on him.

By whom?

I did not want to use the word but the Minister did say it was not his idea. It was put over on him by certain people. The Minister also said that, in his opinion and according to advice given to him, the amendment was not necessary, as anything the amendment empowered him to do was already in the section itself.

Deputy Morrissey is quite right. What happened was this. Before Deputy Dr. Browne became a member of the Health Council, there was a session of the Health Council at which amendments were suggested. I should say that, roughly speaking, nearly every meeting dealt with this point that the voluntary hospitals should have power to pay their staffs. I argued that they have that power already. They argued that they had not. The Medical Association complained afterwards that they had come to me and that I had given them no satisfaction. I said several times during the discussion that I was not against the hospitals paying their staffs but what I was arguing was that the power was there already. They misunderstood me; they never grasped the point. They always said the Minister would not agree to do that. Therefore I had to do my best to make it plain that I am not against the principle of the hospitals paying their staffs. It is made perfectly plain now that the power is there. Coming to the point raised by Deputy Dr. Browne, I do not come into the matter of fixingthe salaries, as Deputies know. I have no function in any discussion between the voluntary hospitals and their staffs but it may happen that when the staffs apply to the voluntary hospitals to have their salaries fixed the voluntary hospitals may say: "We shall have to go to the Minister to see if he will make up the amount in meeting the deficit or in the payments made for patients by local authorities." If the Irish Medical Association come to me on that issue, all I can say is that I approve of the principle but that there should be some reservation with regard to the amount.

That is the point I want to make clear.

Amendment agreed to.

I move amendment No. 6 which is consequential:—

In sub-section (2), line 48, to delete "maintenance or treatment of patients" and substitute "giving of institutional services".

Amendment agreed to.

I move amendment No. 7:—

To add to the section a new sub-section as follows:—

(4) Notwithstanding any enactment contained in any other Act of the Oireachtas the determination of any charge or charges to be made for any service provided under this Act shall be a reserved function in accordance with the provisions of the County Management Act, 1940.

Right through this Bill discretion is given to county managers and city managers to make certain charges for maintenance and for certain types of treatment. The manager is not specifically mentioned but inasmuch as there is no clause to say that the making of such charges shall be a reserved function we thought it was necessary that this amendment should be moved. I think a case can be made for giving this power to the elected representatives of the people and that the discretion as to what charge orcharges might be made should not be left entirely to one man. I am sure that if most managers were given this power they would not abuse it but there is the possibility that if one particular individual has the right to determine what particular charge should be made, or whether any charge should be made at all, such power might be open to wide abuse. I submit further that the public representatives would, in the majority of cases, be in a better position to say whether a particular family or a particular patient could afford to pay a certain charge or not. Because the matter is not specifically mentioned in the Bill and because the local authority in all cases means the county manager, I believe that this amendment is necessary to give the power of fixing charges to the elected representatives.

I do not know that the Deputy is right in saying that all these charges are at present in the hands of the county managers. The fixing of individual charges is definitely, but if the Deputy is speaking about the contract between the local authorities and the hospitals taking patients in Dublin, I do not know that that is a function of the county manager. However, I suggest it should be regulated by the County Managers Act and there is a Bill coming forward which will deal with that point. I do not mind at all except in regard to one point. I would certainly insist that the fixing of individual charges should be in the hands of the county managers. This amendment says "under this Act"; it does not say "under this section". "Under this Act" means that the charges made to individuals who come into a county hospital must be determined at a certain figure, whether £2 2s. per week or some other figure. I do not think it would be advisable that the county council should discuss whether a man should pay or not. I think it should be left to one individual; that it should be inquired into and discussed confidentially. I do not think that any patient would like to have his case discussed publicly by the county council. In the Bill which was before the House, but which was not proceeded with,dealing with county managers' functions, etc., the Coalition Government agreed that the question of individual health charges should remain with the county managers. That is all I am asking for. I do not think this is the appropriate place for an amendment of this kind. It could more appropriately be dealt with in the County Managers Bill when it comes before the House.

Amendment, by leave, withdrawn.
Section 9, as amended, agreed to.
SECTION 10.

I move amendment No. 8:—

To delete sub-section (1) and substitute the following sub-section:

(1) Where a health institution is discontinued under sub-section (1) or an Order under sub-section (2) of Section 11 of the Principal Act and—

(a) a person who held an office under a health authority in the discontinued institution is offered a similar office in another health institution managed by that health authority or by a joint board some of whose members are appointed by that health authority, or

(b) a person who held an office under a joint board in the discontinued institution is offered a similar office in another health institution managed by that joint board or by one of the health authorities who appointed the members of that joint board,

the office held by the person in the discontinued institution shall, for the purposes of any enactment relating to superannuation, be deemed not to have been abolished.

As Section 10 stands it provides for the transfer of officers from a discontinued health institution to another health institution of the same authority or to a joint board whose members are appointed by the authority, but it does not cover the converse case where the health institution of a joint board is discontinued and it is desired that the staff be taken over by one of the constituent health authorities. The purposeof the amendment is to make the converse apply. There will probably in certain cases be a handing over of an institution by a joint board to a board that is at present one of the constituents of this joint board and it is to cover that particular point that the amendment is introduced.

Does this amendment contemplate that a person who is working under certain circumstances in one institution may be transferred to another institution to work under different circumstances there?

He might be transferred to a similar office but he has an appeal to the Minister if he thinks he is being unfairly treated by being transferred from one place to another some distance away. I think that is not likely to happen. It is only likely to be applied in the same town or district

Could it mean from one institution to a new position in another institution?

As the Bill stands, yes. There is the safeguard that a person can appeal to the Minister if he is unfairly treated.

I see the difficulty of providing for any hardship that may arise but it is quite conceivable that a person covered by this section or amendment, a married man with a family growing up, who might have employment in an institution situated where there are educational facilities and other facilities available which would be of very great value to that particular officer; and he might, under this section, and even under the amendment suggested, be transferred to an institution located in an area where it would be either impossible for him to have the same educational facilities available for his children or, alternatively, he could only get the same educational facilities at a greatly increased cost to himself. I do not know whether that is a matter that, even on appeal, the Minister would or could take into consideration. As we know, it is the sort of case that frequently occurs in the transfer ofofficers, particularly officers of the State.

I am trying to visualise the case of an officer, a married man with a family of school-going age, who is employed in an institution or near a centre where very good educational facilities are available for his family. If he is transferred, as he can be under the section or under the amendment, to another institution remote from first-class educational facilities that will undoubtedly constitute a definite hardship on that officer and, in particular, on his children because they will be deprived of the educational facilities available in that officer's former position, so to speak; either that, or alternatively, equally good educational facilities can only be provided by him at very considerably increased cost. I mention that as a type of case that not merely can happen but has happened quite frequently in so far as officers of the State are concerned.

Mr. A. Byrne

I support the points made by Deputy Morrissey. Is it possible under this section for a medical officer or an officer in an institution to be transferred from a very good post in the City of Dublin to some post in a remote or backward area? Can that occur? I would appeal to the Minister to give the individual concerned an opportunity of appealing against such transfer. I have in mind the case of the transfer of an officer from a station —I use the word "station" because that is what the office is called. Some opportunity should be given for appealing against such a transfer.

It is extremely difficult, as I said, to put in reservations that such officers would not be transferred more than ten miles, or something like that. Take, for instance, Mallow sanatorium. That will be closed eventually and all the patients will be transferred to the regional sanatorium at Sarsfield Court: Generally speaking, no nurse will have a grievance as a result of that transfer. The door-man or the hall porter, on the other hand, will have a grievance if any effort is made to transfer him because he will have a wife and family living in the vicinityof his present employment. However, the institution in question will be used for some other purpose and I am sure a job will be found for him.

There might be difficulty if a full-time surgeon with school-going children was transferred to an area where the same educational facilities would not be available to him for his children as they enjoyed before that transfer took place. As Deputy Morrissey pointed out, we would, I admit, have some difficulty there. I suppose we will have to deal with such cases as best we can by compensating the officer by sending his children to school, or something like that.

Another example would be if Crooksling closed down and the patients there were transferred to the regional sanatorium here. The same difficulties would arise. Deputies will appreciate that it is very hard to the legislate for individual cases. On the whole the fairest thing is to do what it says can be done in Section 10: if any particular officer thinks he has a grievance under this section he can appeal to the Minister.

Mr. A. Byrne

Can he appeal to the Minister?

Yes. Deputies know how to get to the Minister here if there is anything wrong.

I agree it is not merely difficult but sometimes impossible to provide for every case that may arise. I think the Minister appreciates that it is possible, and even probable, that cases of hardship will arise. The Minister says it may be possible to allow some measure of compensation for the loss of valuable facilities or amenities. I noticed that the Minister, when talking about transfers, talked about a transfer within a particular region or county. Is it not possible to have a transfer from an institution in Dublin to an institution in Mayo?

No. It could only be to the adjoining county.

I had not adverted to that. Take Galway now: there maybe an officer working in an institution there with a school-going family. He has secondary schools and a university available for his children. The saving in board and lodgings, so far as the cost of the university is concerned, is enormous. If he is transferred to another institution 50 miles away that may impose a very heavy burden on him in trying to continue the education he had started to give his children. If he has a daughter in her second year at the university, such a transfer will be tantamount to a reduction in his salary of perhaps a couple of hundred pounds a year.

I know that, even on appeal, it will be very difficult for the Minister to take all these things into consideration. What I am trying to urge and, if you like, put on record here, is that where a man's position is considerably worsened from the point of view of facilities and amenities—under the section he must be offered a similar post to the one he occupies—something should be done. Putting additional expenses on him might be tantamount to reducing his salary by anything up to £200 per year.

I think it would be better to deal with these matters as they arise.

Does the Minister think that he has the power to compensate a person?

I think so.

If the Minister is satisfied that he has the power, and if it is done in a way that meets the equity of a particular case, it will satisfy me.

I suggest to the Minister that he ought to make inquiries into that. If there are any doubts about it, then I think he should remove the doubts by moving an amendment later.

Very well.

Amendment agreed to.
Section 10, as amended, agreed to.
Section 11 agreed to.
SECTION 12.
Question proposed: "That Section 12 stand part of the Bill."

Will the Minister tell us what this section is about?

I think I might interpret it in this way, that the Minister is not entitled to have any addition or alteration made to a dispensary without first holding a public inquiry. The purpose of the section is merely to remove the necessity for holding the inquiry in minor matters only.

I would ask the Minister to have a look at Sections 10 and 11 of the 1947 Act. Sub-section (2) of Section 10 of that Act provides:—

"The Minister, after having caused a local inquiry to be held into the desirability of so doing, may by Order direct a health authority to:—

(a) provide and maintain at a specified place an institution of a specified character and size, or

(b) restore, enlarge or otherwise alter in a specified manner any institution maintained by them pursuant to this section;

and such health authority shall comply with such Order."

That is with regard to maintaining, providing, enlarging or restoring any institution following a local inquiry. The Minister, in that case, may make an Order which shall be complied with by the health authority. That is Section 10. Now, sub-section (2) of Section 11 says:—

"The Minister, after having caused a local inquiry to be held in relation to the desirability of so doing may by Order direct a health authority to discontinue, as from a specified date, a health institution maintained by them or any department of such an institution."

The section further provides that the health authority shall comply with every Order made in relation to them under the section. The Minister is proposing to take power to discontinue an institution which has been established or a service which has been made available in an area and which formspart of the local life. He is taking power, without holding a local inquiry and, if necessary, over the heads of the local authority in the matter, to close a dispensary, a clinic, a health centre, a first-aid station or any similar institution. I suggest that he is taking too drastic a power for the shutting down of a service that has already been established, and that he should not do that without holding a local inquiry.

The power to hold the inquiry is there, but I think myself it is ridiculous that we should have to go through all the formality of the holding of a local inquiry when dealing with small matters such as a dispensary, clinic, a health centre, first-aid station, or any similar institution. The purpose of the section is to remove the necessity for the holding of an inquiry in relation to matters of that kind.

The only point about it is that the closing of a dispensary in one case may not be a matter of very great importance, while in another case it might be of considerable importance, particularly to the people living in the area where it was proposed to close it down. If we are going to err at all, I would prefer that we should do so on the lines that we have been doing up to the present. It is with considerable hesitation that I venture to talk about clinics. I understand, however, that nowadays, and to a greater extent in the future, these clinics are likely to become very important centres, much more so than the dispensaries.

One is, naturally, always a bit nervous when one finds a proposal in a Bill to discontinue a service such as a dispensary or a health centre. The words in the section "or any similar institution" may be capable of a very wide interpretation indeed. I cannot speak with any authority on that, but I do submit that the Minister would need to make a stronger case than he has so far made for this section before asking the House to pass it.

Deputies are, no doubt, aware that a big effort has been madein the Department during the last few years, in fact since the Department was set up, to get local authorities to improve existing dispensaries or build new ones. Local authorities have made a very good response in that direction, in recent months particularly since a grant was offered for the purpose by the Department of Health. There will undoubtedly be cases where local authorities will be very slow to carry out a direction, and so it may be necessary in the end for the Minister to make an Order, and say that they must either close the existing dispensary or build a new one. It is only in the case of dispensaries where I think it may be necessary to do that.

A first-aid station is a smaller thing than a dispensary. A health centre would also be smaller. I cannot promise what it may develop into, but at present it is not of any great importance. I agree with Deputy Morrissey that clinics are much more important places than dispensaries. The county clinics that we are putting up at present will cost perhaps 20 times as much as a dispensary. The words "or any similar institution" is the phrase which, I think, is usually found in a section of this kind. Dispensaries, as I say, are the only things I have in mind. The others are mentioned in the section because work of a more or less similar kind is carried on in them.

We are all anxious that the very many unsuitable—to use a charitable word—dispensary buildings should be destroyed and replaced at the earliest possible moment. The only point the Minister has made in support of this amendment is that where a local authority is not taking steps to demolish unsuitable buildings which are being used as dispensaries and to replace them, he should have power to do that himself. With all respect, I think that is the old story of the steam hammer and the fly. The Minister does not need such wide powers as this section would give. He has other and more effective ways of getting the local authority to carry out their obvious duty as quickly as possible to replace the many disgraceful dispensary buildings and provideproper well-equipped buildings in their place. This section is far too wide to give the Minister what he wants to secure in this instance. I would appeal to the Minister to consider it.

I will look up the points made and will have them examined before the Report Stage.

Question put and agreed to.
SECTION 13.

I move amendment No. 9:—

In sub-section (1), page 5, line 32, after "appliances" to add "including optical and aural appliances".

I think the amendment is self-explanatory. It is a proposal to make certain that the two essential services are included in the rights of a group whom this Bill was primarily intended to cover. Perhaps the Minister could assure us that that right is preserved in some other section or that he is willing to preserve that right to these particular benefits. If that is so we will be very pleased to withdraw the amendment.

I am assured that "medical appliances" includes both optical and aural appliances and has always been interpreted as such.

Even though dental appliances are specifically mentioned there is no necessity to mention optical?

No, it has always been interpreted to include that.

Amendment, by leave, withdrawn.

I move amendment No. 10:—

To add to the section a new sub-section as follows:—

(3) The regulations to be made under sub-section (1) of this section shall require that as far as practicable the general practitioner service to be provided under this section may be obtained by any person entitled to suchservice from any doctor of his choice who is a participant in a prescribed scheme and who is willing to accept such person as a patient.

I think the Minister indicated in his Second Reading speech that he was prepared to accept this amendment or introduce a similar one. Even at present there is a big demand for choice of doctor. Under the present system the person who gets this particular service must go to one particular doctor. I know very many cases of poor people who have the service of a dispensary doctor available to them but because they have not confidence in that particular man they go to another who is not a dispensary doctor and have to pay him a fee. They are also required to pay for medicines, pills or appliances. Every one of us knows that is the case in our own constituencies and home towns. I humbly submit to the Minister that the people catered for under Section 13 should also have a choice of medical practitioner. I do not know if the Minister stated specifically in his Second Reading speech that he would accept this particular amendment but I would try to impress on him now the necessity to give that choice of practitioner to those people in the lower income group.

I may not have been very specific but what I had in mind was amendment No. 22, choice of doctor in the case of maternity. The Deputy's amendment would mean that the ordinary dispensary patient would have a choice of doctor. That would be departing entirely from the dispensary system. I do not think we can face that. It is a thing that might come some time and it would be only right it should, but it is going to be a very big matter when it comes. First of all, it would be very hard to give the choice in the ordinary dispensary district. In the country districts there is usually only one doctor and the lower income group, as we call them now, will go to that doctor. Acceptance of this amendment would not be of very much use to them, though it may give them some choice.

It is not that that troubles me so much. Whenever we face this issue— we may have to, some time—we will have a very big job on hands in dealing with the existing dispensary doctors. They will naturally claim compensation, they will claim to be continued as they are till the end of their days or almost so. In addition, other doctors must come in, as you cannot give a choice otherwise. The system will become suddenly a very much more costly one. That would be a big problem in dealing with this matter.

If this amendment were accepted, we would have virtually the panel system they had in Great Britain, where a person could go to any doctor he wished and someone would have to pay that doctor for his services, whether through the local authority or otherwise. It is not contemplated at all in the present legislation that that should be done. The furthest we are going in that direction is choice of doctor in the case of maternity. It is the first step, if you like, but it is an easier one to take, at the moment, administratively.

While saying to the Deputy that I must ask the Dáil to reject the amendment, it is not because I am against it in principle. I would like very much to accept it if I were able, and I think it will come in time.

Our intention was partly to go that further step the Minister suggests will likely come. With regard to the point that that would be a big step, could we get an assurance or is there anything the Minister can say? It is not so much the fee charged by the doctor who is the choice of the patient—he may be prepared to pay that fee—but it is the cost of the medicines prescribed. That is the snag. Very often an ordinary working fellow in a particular income group will manage to pick the doctor his wife, son or daughter has confidence in. We all realise that confidence in a physician is an important thing. He will get the money to pay him. However, when that doctor prescribes certain treatment, could there be any assurance from the Minister that the cost of the treatment would be met inthe same way as if that treatment were prescribed by a dispensary doctor? At the present time the local authority or health authority has no power to compensate for that. Is there anything the Minister could say? Does he think there is a case being made for him to suggest that he would include a section to deal with them? If we got that assurance we would be prepared to say that he has met us reasonably.

I would like very much to accept this, to give everybody freedom of choice, if it could be done. I am afraid even to permit another doctor to write a prescription which would be looked after by the local authority would be a big step. Even that would be a big step at the moment. I can see all sorts of difficulties.

Of course it is impossible. It could not be done in our existing circumstances. It might be done in a certain sense.

I am talking of the prescription part of it.

Even that could only be done to a limited extent.

I would like to explain this clearly to Deputy Morrissey. I move to report progress

Progress reported; Committee to sit again.
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