Dáil Éireann debate -
Thursday, 9 Jul 1953

Vol. 140 No. 6

Health Bill, 1952—Committee (Resumed).

Debate resumed on amendment No. 66.

Dr. Esmonde

When I reported progress yesterday evening I had been stressing the point that the fact that sub-section (6) of Section 44 lays it down that every meeting of the consultative health committee shall be held in private would defeat the ends for which the committee is being created. I had discussed also the question as to whether the medical officer of health should be a member of the consultative committee and I had suggested that, as he more or less would be acting in advising the council relating to decisionshe might have taken on behalf of the health authority, it would not be suitable for him to be on this consultative committee. Then I had reached the stage where I discussed the position of the county surgeon who, it was suggested, should also be on the consultative committee. I had concluded on that by saying that in my opinion the county surgeon would be a good person to be on this consultative committee because in many cases a question, which we had been discussing a few weeks ago as to the venue of treatment of patients, would arise. In many instances the matter would have been referred to the county surgeon—that was the Minister's intention as far as I could gather. When it was a question of transferring a patient to a particular hospital for a particular type of treatment the matter would be referred to the county surgeon.

The Minister may remember that when we were discussing the particular section dealing with that, I was not very keen on the matter being referred to the local surgeon concerned or the local physician as the case might be because he would be in opposition in practice to local practitioners and therefore it would place them in an awkward position in so far as it would be necessary for them to answer his questions if they were actually treating the patient. It would be awkward also from the point of view of the patient who might have gone direct to the local practitioners rather than to the person who would be actually carrying out the treatment later. The Minister apparently did not agree with that but, in any case, I think it would be a good thing for the local surgeon to be on this consultative committee because any safeguards that would be necessary are provided by the clause which says that two other registered practitioners who will be members of the local medical association will also be on the committee.

The suggestion has been made by some other Deputy—I think it was Deputy MacBride—that it was possible that there might be two separate medical associations in the country. Ido not think that contingency will arise at all because the position with regard to medical associations, as I know it, is that there is only one medical association as a rule of which the parent body is the Irish Medical Association. In some cases members of the local medical body are not members of the Irish Medical Association but as I explained are members of the local association. I think, however, an adequate safeguard is provided by the provision which states that the consultative health committee shall include two other registered medical practitioners residing in the county, each of whom is nominated by a body which in the opinion of the council of the county is representative of registered medical practitioners practising in the county. I, therefore, am of the opinion that the county surgeon is a satisfactory person to put on this council because, even if he might be practising in opposition to the medical practitioners concerned in particular cases covered by this Bill, they have adequate safeguards in the clause introduced by the Minister.

In connection with clause (a) of sub-section (3), which provides that the membership of the committee shall include not less than four members of the council of the county, the suggestion was made by some Deputy that these four members could be nominated by the county council much in the same way as nominations are made to ancillary bodies such as vocational bodies, agricultural committees and so forth— that they need not be members of the county council, but that they could be nominated by the democratically elected representatives on the county council. I think there is a good deal to be said for that suggestion. It is very often the case that you might have somebody who was unsuccessful in the elections to the county council itself but who might be considered by the members of the county council as a suitable person to place on this committee. I think the Minister would not be giving a lot away if he met that particular point. It is not a very big point.

Then there is the question of how often the consultative health committeeshall meet. That is met fairly by the Minister in sub-section (5) of the proposed amendment which says that where meetings of a consultative committee have been held on six or more days in any year, no further meeting shall be held in that year save at the request by resolution of the council of the county or at the request of, or with the consent of, the county manager. It might seem to meet the case pretty fairly to say that they shall have six meetings in the year—that they shall meet once every two months. I am not a member of a county council or of a local authority of any sort myself but it seems to me that a county council meets once a month. The agricultural committees and other ancillary bodies may also meet once a month and it therefore seems reasonable that the consultative health committee should be in a position to meet once a month if they so desire or consider it necessary. It is rather arbitrary to provide that they shall meet only six times a year.

I can quite see that the Minister has probably introduced that as a safeguard against a lot of unnecessary meetings. There may be people who would want to hold meetings very often and that would lead to a lot of unnecessary work and unnecessary discussion about things generally. I think, however, we have to accept the fact that there has been a considerable amount of controversy in relation to the proposed improved health services. This controversy has ranged far and wide. We, on the Fine Gael Benches, stress the importance of these consultative committees in that we believe that they will act as a brake in respect of the particular alignment of health services to which we object. We feel that we are handing over the rights of families and individuals to unnecessary State control. I am accepting the fact that the Minister has met us to a certain extent with regard to the consultative health committees he is introducing. We, as I say, place great stress on these health committees inasmuch as they can act as a medium of control or a brake against any arbitrary decisions on the part of the health authority. In spite of the extensive discussions we have had here, we feelthat this authority is more or less in the hands of one man. We must accept the fact that in so far as any local authority has any say in any matter relating to the suggested improved health services, the final decision rests with the county manager. The county manager has the final decision in everything. It is in the hands of one man except in so far as the democratically elected representatives of the people have the right to refuse the money. I think it was Deputy Allen who when speaking yesterday tried to stress the point that the democratically elected representatives, viz., the county council, had the right to oppose anything in that they could refuse the money.

In particular things that come up for discussion, such as whether or not patient A should go to such and such a hospital, it is unreasonable to suggest that the democratically elected representatives themselves, the county council, would have the power to veto that by saying: "We will not vote the money to permit such and such a person to go to such and such a hospital." It is not reasonable to suggest that they would have the power to stop the county manager from doing a certain act in relation to the health services. We accept that they have the control of the finances but they have not really any executive authority whatsoever.

We place a lot of stress on the importance of this consultative council. We feel that unless that council is in a position to discuss in an open field any decision that is taken by the manager or by the health authority, to put it that way, they really will not be serving a function. I would ask the Minister to reconsider the amendment of sub-section (6) of Section 44, which reads: "Every meeting of a consultative health committee shall be held in private." That really nullifies straight away the importance of the authority that may lie behind the consultative council. It defeats its own end. I accept that the Minister is trying to meet the force of public opinion in this State.

Public opinion in this country isagainst handing over the rights of the family to State control. This consultative health council be it a general one or a local one, such as we are discussing, is important in safeguarding that matter. The Minister has met us to a certain extent but he is entirely nullifying it by sub-section (6). I would ask him to change it. It is very easy to change it. It will not affect the issue one way or another. All he has to do is to change it from "shall be held in private" to "may be held in private". There are certain things that must be discussed in private. If you are going to get down to brass tacks, if you are going to discuss health matters, certain things must be private and must be discussed in committee around the table. The function of this consultative health council is to act as a brake on any arbitrary decision taken by any one individual relating to the health of the people—and it is entirely nullified by sub-section (6) of Section 44. I appeal to the Minister to consider that aspect of the matter very carefully.

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

Dr. Browne

Deputy Dr. Esmonde is quite correct in suggesting that we have ranged very wide in the discussion on this amendment, particularly Deputy Mulcahy. I consider that such remarks could not help very much because the Bill is being administered under the existing County Management Act. As Deputy Allen pointed out, there is no change whatsoever in principle to the state of affairs that exists at the moment and has existed for a number of years. Therefore, I do not think that Deputy Mulcahy's contribution helped in any way at all. It merely prolonged the debate which, probably, was the intention, in his regard at any rate.

One has a certain sympathy with the Minister due to the fact that this section appears to be put into the Bill in order to satisfy, I suppose, the Medical Association in particular. Yet, it seems that there is still objection by Fine Gael. I am not awfully clear as to whether they object to thesection or whether their objection is to the County Management Act and that they want to try to amend it on this Health Bill.

The odd points made by Deputy Dr. Esmonde could be boiled down to the question of publicity—publicity for the committee's activities Deputy Kyne also made the same remark. He is a member of a local authority and I would attach a lot of importance to his objection to the possibility of secrecy which would in any way hinder the activities of public representatives in bringing up points that they might want to air or put right for their constituents or the people whom they represent on the local authority. I wonder if Deputy Kyne's point has not been met by the suggestion that this committee will meet in private and that members of the local authority will still have their full rights to raise any point that may be worrying them in the local authority. I wonder if this further consideration has occurred to Deputy Kyne and to Deputy Dr. Esmonde? Deputy Kyne was worried about the question of a complaint against a doctor, a hospital, a health institution or a local authority. I wonder if Deputy Esmonde would agree to that point being aired in public and getting full publicity.

My own attitude to the question of publicity in health matters is, I think, the attitude of the medical profession, that we must at all costs maintain to the maximum the secrecy, the privacy of the doctor-patient relationship. Secrecy with regard to any illness or sickness which any person, no matter who he is, rich or poor, which has been confided to a medical practitioner must be safeguarded to the maximum and anything which would jeopardise that relationship should be shunned at all costs. I would probably go a very long way with Deputy Kyne in regard to malpractice, bad medicine, bad hospital treatment or anything of that kind not being suppressed but being open to public exploration, but I think his worry is covered by the Minister's point that he still has the right to goto a member of the local authority or to the Deputy.

I want to put this other point to Deputies who may not feel as strongly about it as I do, that matters of health are not matters of roads, engineering or drains. There is that tremendously important fundamental principle of medical practice that all matters relating to the health of the individual are the personal and private property of the doctor and patient and should be so maintained. Consequently, I am very strongly opposed to public sessions of this consultative council. Again, taking the case of the voluntary hospitals, most of these voluntary hospitals have consultative councils—they call them boards—to advise them and I think they would consider it unthinkable that any of the meetings they hold should be held in public or that any private matters discussed, even matters of policy, should be discussed in public. The average doctor and member of a voluntary hospital board would be very surprised if it were suggested that any of their meetings, whether dealing with pure administration or, more particularly, with the personal and private matters of patients receiving treatment in the institution should be dealt with in public.

In passing, I would say that it is regrettable that, in relation to these consultative committees, we should have all this talk about bureaucracy, State interference and State control. The State comes out of this whole argument extraordinarily well. Here we have the delegation of responsibility to a paid official of the State, and, in order to guard ourselves even further, we have control of that man, because we pay him and make the laws under which he carries on his activities. If we do not like him, we change him and if we do not do so, we are fools and must blame ourselves. We cannot blame the manager.

To get back to the point of control, we are accepting the fact that we appoint advisory councils to supervise the activities of these people, the manager and his executives. These councils, the Minister tells us, are not to be accepted by the voluntary hospitals which are also to be part of ourhealth organisation. They are to be health institutions and they are to spend considerable sums of money— something in the region of £750,000 a year, provided by this House—but with no functions whatever in relation to the voluntary hospitals. In this matter, the State is being particularly careful to observe all the best points of democratic Government, in seeing that the services are well organised, that the money is well and properly spent and in accordance with the rules and regulations with which we bind ourselves, but which we are not going to apply to the voluntary hospitals at all. Apparently, they will not accept any of these, while we accept these things for our nominees on the local health authorities. I feel that publicity would be very bad—it would only lead to abuses and would do damage to medical practice generally and health services altogether.

Listening to the debate with regard to the personnel of the advisory council, it struck me that it was like overhearing a conversation in some exclusive mid-Victorian club as to whether amateurs and players should mix, whether they could have tea or dinner together—in the suggestion that paid officials should not have the same functions or responsibilities on the advisory council. What is the difference between a paid employee of a local authority and an unpaid member in relation to his functions? What difference does it make to the advice that would be given by the county physician or county surgeon that he is an employee of and paid by the local authority? The amendment says that this advisory council need not necessarily be one which will offer criticism, although it should and can offer criticism, but the suggestion that these paid officials should be different from the people who are elected or nominated, because of their public work or some other reason, and should not have the same status on the council is silly. It is an old fashioned and out-dated argument—the relationship between servant and master.

In the case of the voluntary hospitalsystem, they have paid doctors who are very often nominated to the boards of the hospitals because they can give useful information about the practical running of the hospitals, from the medical and surgical point of view. It may be said that they are not paid. Of course, they are, but I do not propose to go into that long subject. Even if they are not paid, I still do not think it makes any difference to their merit or value as advisers, co-equal advisers, on a council. The voluntary hospital system has been in existence for a long time and has done its job and I do not think it has suffered any particular damage by having employees, surgeons and physicians as members of the boards.

At the other extreme, take the modern approach to the management of industry. Surely Deputy Kyne will accept that the trade union movement would insist on the employer, if possible, having the workers in his factory sitting on his councils and committees.

Mr. Kyne

I do not think it was I who made that point.

Dr. Browne

I am sorry. I am sure the Deputy will agree with me, however, that it is desirable that we should get away from this 19th century attitude towards employees and all the rest of it. A man should be considered on his intrinsic merit as an adviser and not from the point of view as to whether he is an employee or a master. I do not think that would be tolerated in this country. There is no reason why a man should not be criticised and why he should not be asked to defend himself. There is no reason why he should lose face or caste because he is not consulted by the manager. That seems to be an utterly childish approach.

Consultation is an accepted part of the control and management of industry, factories and institutions for the past 20 years, even in backward countries. Even the United States, backward and all as it is in social matters, has accepted as a principle control of industry by the worker. I see no reason why these county physiciansand surgeons should not be accepted as members of these councils. They can be very helpful. I do not know anyone who would be of more assistance in helping a county manager to decide than would be the legal practitioners, the employees of the local authorities and the elected representatives.

I appreciate that the proposition is that the committee should be merely a consultative one. I do not think there would be any great danger of serious decisions being taken. Deputy Corish is worried about the question as to whether votes would be taken from democratic non-elected members of the council which might have the result of swaying the decision of the council. I think that is attaching probably too much importance to the part these consultative councils will play in health services. They will be purely advisory. I think they will have no great function at all but if it satisfies the medical association to have them I see no reason why they should not be put in. They can do no harm. They may do a certain amount of good.

On the point of the number of meetings to be held, I think the Minister's answer is a good and effective one and should meet Deputies' difficulties. I would have no objection to these bodies meeting 12 times a year instead of six times a year. I would be strongly opposed to undue publicity in relation to health matters. I have no great fear at all of the further development of bureaucracy as a result of the expansion of our health services just as I have no great fear of final decisions being handed over to one man.

This is a fundamental argument on the whole question of the expansion of State services as between health and social services and so on. I do not see that we should be afraid of this at all. We are all nominated in open election for a term here to enact legislation and to carry out certain functions under that legislation or appoint certain executives to implement our will. So long as those executives implement our will I can see nothing immoral orwrong in anything they will do because theirs will be a delegated responsibility from this House and we will have a continuous check on their activities.

We have no check on and we have no rights at all in relation to the voluntary hospitals even though we pay out a tremendous amount of money to them. I see no reason why we should be worried about the activities of men whom we appoint by statute and whose activities will be governed by regulations made by the Minister and whose activities can be curbed at any time by a decision of this House. The State machine is not something to be feared. People are nominated here to govern the country and the activities of this House are an expression of our opinion in relation to particular matters relevant to health and social welfare and so on. So long as we have active Ministers in Government and articulate Deputies there is no danger at all of any growth of bureaucracy. I am very anxious to see this Bill passed into legislation as soon as possible.

Mr. Kyne

I want to reply to a few points made by Deputy Dr. Browne. I made an appeal in relation to the freedom of the Press. The Minister in his reply partly indicated where the criticism that I saw could be made public. I think Deputy Dr. Browne, however, has put his finger on the actual point that is worrying us. This is a new consultative council. That is all we know about it. We do not know what the functions of the council will be. We do not know what will be discussed by the council. I think no one does at the moment. We are afraid that it will be used as a council to which all matters relating to health will be referred by the county council or by other public representatives. One may be told that if one has a grievance the grievance should be dealt with by the consultative council. In that way one will be choked off, as it were, from raising one's complaint. The chairman will refer one to the consultative council. The case made before that council will not be publicised.

Now Deputy Dr. Browne knows what happened during his period in office as a Minister; a particular doctor did not give the services required by law to a patient. Now, supposing that patient's people do not notify the Minister but the matter comes to the knowledge of a conscientious councillor who happens to be a member of the consultative council and he brings it before the committee, what will the position be? Remember, there will be at least four doctors on that committee, all members of an association. The charge will be against one of them. Is it not natural to assume that they will play down the complaint? Publicity is the only instrument that will focus attention on the wrong done and cause it to be put right. Publicity is the only instrument to put fear into people, thereby ensuring they will pay more attention to their work and give the services they are bound to give. One cannot raise a complaint again if the council has already dealt with it because one will be told that the matter has already been discussed and the council has decided against one. We know what it is to find the council arraigned against the few who may be described as "extremists", the few who are not afraid to stand up and fight the Irish Medical Association, or any other association, if they think they are thereby doing the right thing for the working people. Remember, it is the working people who will be the patients or the guinea pigs under this. I think it would be a generous gesture on the part of the Minister if he would leave it to the council to decide as to whether or not they will have the Press present.

As regards Deputy Dr. Browne's point in regard to confidence between patients and doctors, sub-section (1) of this section clearly indicates that there will be no individual cases to discuss. No member of any board would wish to make a health matter between a doctor and a patient public in order to satisfy the curiosity of the public. I do not think anyone would do it, and no reputable newspaper would publish it. Even if some member made reference to it no reputable newspaper would publish it. I have never seen it happenand I have a pretty wide experience in regard to local authority business. If there is a secret the patients themselves will feel that the matter is being smothered. I cannot at the moment see what function we are going to have.

On the point made by Deputy Corish in connection with the doctors, I do not think that he had any intention of conveying that the ordinary member would in any way resent a doctor, because he is paid by the county council, co-operating with the council. We welcome co-operation between the officials and the members. The point was that the doctor, who is a paid official, might very often be subject to a charge and it would be unfair to have a colleague of his acting as judge and jury in such a case. I think you are taking from the council that which I, as a Labour member and as a member of similar councils, value most and found to be most effective. It is true that if you had a T.D. on the council he could take the matter up in the Dáil. But on every council there is not a member of the Dáil. Again, it is not easy to get a question like that satisfactorily answered in the Dáil, as the Minister will point out that it is the county manager and not he who has authority over those people. Under the Managerial Act, the county manager has the right to take references out of the minutes. The matter is not as simple as Deputy Dr. Browne seems to think. It may not be very important but, in my opinion, this is a matter the principle of which the Minister could concede.

Mr. MacBride

Possibly I would not have risen again to discuss this amendment were it not for references by some Deputies this morning. The Minister, I think, dealt very frankly with the various matters I mentioned yesterday and admitted the difficulties that I put to him. On this question of secret meetings, I think the Minister should leave it optional in the way in which Deputy Dr. Esmonde suggested. It is always unwise and of doubtful constitutionality as a matter of fact to provide that any meeting be held in secret because the whole purpose of democratic institutions and democratic government is to have publicity sothat the people would be aware of what was going on. The matters mentioned by Deputy Kyne are very real. Let us examine the kind of matters that will probably come before these committees. Before doing so, however, let me say that I am quite prepared to concede immediately to the Minister that probably 75 per cent. of the work of the committee would be carried out in private and that the Press would not be present. We will leave that to the committee to decide.

Let us examine the kind of cases that are likely to reach a committee of this kind. There will be complaints, for instance, as to the inadequacy or quality of food supplied to hospitals or all the institutions in the area of the committee. There will probably be complaints in regard to the dispensary doctors and the doctors administering the scheme that they are not fulfilling their duties properly, that they are not as readily available as they should be when required. There will be complaints against some of the officials of the council.

I think it is no harm to have these complaints dealt with publicly. It would be healthier. If there is any kind of a scandal, for instance, in some institution the whole neighbourhood will probably hear stories about it. Would it not be just as well to have the matter dealt with publicly at that stage? I fully understand the Minister's purpose in putting in this provision. I concede immediately that probably 75 per cent. of the work of a committee of this kind will be done privately but I think the committee should be left a certain discretion in the matter so that it could, in certain circumstances, decide whether a particular matter was one which they had better have investigated publicly and let the public know what the answer is to the charges that have been levelled against a given institution or doctor.

Quite apart from that, I do not like any provision in a statute which provides that meetings be held in secret and that the Press should be debarred from attending. That goes very close to a denial of the right of freedom ofexpression. I know it is not the Minister's desire to infringe upon those rights. I fully understand the purpose of this provision. By and large I think it would be better if the Minister altered that particular paragraph and allowed the committee a certain latitude and discretion as to whether it should hold its meetings publicly or privately.

One matter that I mentioned to the Minister yesterday was in regard to the number of meetings. The Minister quite properly pointed out in reply that the county manager could always organise additional meetings. That is so. If the Minister thinks of the actual practical working of a committee of that kind, he will visualise many circumstances in which the committee will have to meet much more often than six times a year. I put this instance to him. Suppose a complaint made by a patient or a member of the public against a dispensary doctor or against a hospital comes to the committee. That complaint comes before the committee at one meeting. The committee will have no information in regard to it and all it can do at that first meeting is to ask for a full report on the doctor or hospital concerned so as to get their answer. Straight away you will have two meetings. You can assume that there will be at least two meetings before any progress will be made to investigate any complaint that comes before the committee. In regard to the second meeting, it is quite probable that further information will be required from the person making the complaint.

It is not a matter of very grave import, but I think it is unwise to put in a proviso that limits the number of meetings to six in the year. I would imagine that committees of this kind would not want to meet more often than is necessary, and that is why I think they should be left a discretion.

Deputy Dr. Browne thought it necessary to have a tilt at some of the things I said yesterday in regard to the membership of these committees— the inclusion of the county surgeon and of the county medical officer of health. I pointed out yesterday that these two officials should be available toattend meetings, and that they should be in a position to supply information to the committee, but I think it is creating an extremely bad precedent to put on the committee officials whose conduct is likely to be investigated— to be appointing them, so to speak, judge and jury over themselves.

I pointed out that some of the functions of the committee will certainly be to investigate complaints as to the administration of the medical services and as to the adequacy of the services provided, complaints as to the quality of the food or as to the quality or adequacy of the treatment, and complaints with regard to the conduct of doctors. Deputies should bear in mind that, straight off, these committees will consist of four doctors and four members of the county councils. Far be it from me to start attacking the medical profession, but it seems to me that, when a complaint comes in against doctors or against the county surgeon or the county medical officer of health, the best tribunal to determine that complaint is not the county medical officer of health or the county surgeon or the other doctors on the committee. I would rather see that the committee was not loaded with doctors for the purpose of investigating complaints of that kind.

Dr. Browne

You are too much of a judge and jury yourself.

Mr. MacBride

I have a good deal of experience of life, and I also appreciate that Deputy Dr. Browne is very unrealistic in these matters. I have no desire to set up a hierarchy of doctors in control of our social services.

Dr. Browne

Why, then, did the Deputy back up the medical association in the Custom House?

Mr. MacBride

The Deputy is now quite willing to agree to have the nominees of the medical association on these consultative committees, a matter which he would not listen to before.

Dr. Browne

With no executive functions.

Mr. MacBride

The Deputy has changed his views in order to remain here. He is now supporting a proposal which will put four doctors on a committee of eight to act as a consultative committee for local authorities.

Dr. Browne

But not to draw up health services.

Mr. MacBride

The Deputy is prepared to give control to a committee consisting of four doctors and four nominees of the county council.

Dr. Browne

But we here decide the question of health services.

Dr. Ryan

And two others.

Mr. MacBride

Four doctors and four members of the county council and, as the Minister says, two others. The Medical Association will be adequately represented on the committee when it has four members on the committee of every local authority to advise on health services. I am not saying that is a bad thing, but I want to put in some safeguards to ensure that the members of the medical profession will not be the judge and jury of their own efficiency or inefficiency. I think it is quite obvious that, if complaints are made as to the efficiency of the county medical officer of health or the county surgeon, or if there are complaints as to the efficiency of dispensary doctors or as to the quality of the food supplied to the patients in hospital, it would be much more desirable to have these complaints investigated by persons other than those who are directly responsible themselves.

Let me take an example. We have an extremely efficient Clerk of the Dáil and an extremely efficient staff. I have no doubt that they are far more efficient than many members of the House, and that they could very often make much more valuable contributions than many of us make, but we would not dream of such a completely new concept of democracy as automatically to make the officials members of the House. The officials are there to help and to advise the House and to provide information, but we would not dream of giving them the same rights as members of the House.Therefore, I think we should be slow to do that in the case of local authorities.

We are, in fact, appointing two officials on these committees. It is certainly a new departure in democratic Government. I listened to the Minister yesterday, and I understand fully the reasons which prompted him to do this. I think it is extremely desirable that these two doctors, the county medical officer of health and the county surgeon, should be available at meetings of these health committees, but I still have grave doubts as to whether it is wise to make them actual members of the committee because undoubtedly they will, very often, be placed in the position of having to consider complaints against themselves, either against themselves personally, or against their administration or against people working under them. I think that is bound to put them in a very invidious position when matters of that kind arise.

As I said yesterday, it is inevitable that there will be a number of disputes and a conflict of views between the county manager and members of a committee of this kind. Again, I think that the paid officials of the council. on a committee of this kind, will be placed in an invidious position whenever such disputes arise. They will be there under the direct control of the county manager and will be placed in a certain amount of difficulty if they have to take sides in disputes in which their own chief is involved.

There is one other matter that I did not mention before. It is in regard to the regulations which are provided for in sub-section (8) of the amendment. I should like to know if the Minister will agree to have these regulations tabled in the House in the ordinary way by making the usual arrangements for the annulment of the Orders by the House. That is not provided for in the sub-section. It is probably due to an oversight that it was not. I think that, as a general rule, it is well to provide for that.

Dr. Ryan

All regulations will be laid on the Table of the House. That is provided for in the Principal Act.

Mr. MacBride

It is covered generally by the 1947 Act?

Dr. Ryan

Yes. Deputy MacBride made a point against the inclusion of the county surgeon and the county medical officer of health on the advisory committee from two points of view, firstly because it is not feasible to have paid officials as members of a committee like this along with members of the county council and others. I do not see any great objection to that because it is an advisory committee. If they are sitting at the table it makes very little difference whether they are members of the committee or not because they are purely advising.

The only thing I would say in favour of having them members of the committee is that they would have a better right to speak. If they were not members they might feel bound not to speak unless they were asked for their opinion. If they were members of the committee they would speak if they thought they could add to the conversation or contribute to what was going on. From that point of view I think it would be better if they were members. In a purely advisory committee like this there is scarcely ever such a thing as division or a vote. I was 15 years in the Department of Agriculture. I had about a dozen advisory councils there meeting occasionally. In all the time that those advisory councils met there was never such a thing as a division or vote. The considered opinion is taken and conveyed.

Another point made by Deputy MacBride was that the advisory committee would be overloaded with doctors. There might be something in that. If the Dáil agreed with Deputy MacBride from that point of view, I would be prepared to alter the constitution so that they would not have as high a proportion of the representation as this amendment provides. It must be remembered, of course, that the Irish Medical Association were pressing for this and made very much of the point that they were the best people to advise on health services. As this is an advisory committee I thoughtthey should get a good representation, but, as I say, if the Dáil thinks otherwise I am not going to press it.

Mr. MacBride

I merely made the point in regard to the county surgeon and the county medical officer of health. I pointed out that it was four out of ten.

Dr. Ryan

I thought the Deputy made the point that it was overloaded with doctors.

Mr. MacBride

Only in that connection.

Dr. Ryan

The point was made by Deputy MacBride and, I think, Deputy Kyne that a complaint against a doctor might be the subject of discussion. I cannot imagine that coming up at this advisory committee. If a man has a complaint against a doctor, he is not looking for advice. He will make the complaint and that complaint may be made at the county council meeting as it has always been made, where it will get whatever publicity it deserves. If a complaint is made at a county council meeting it is usually conveyed to the Minister for Health, and even if it is not made at the county council meeting it is made by letter, as I frequently get complaints. If there is any substantiation at all for a complaint it is investigated. Deputies will understand that we sometimes get very frivolous complaints and a very cursory examination shows that they are not worth pursuing. If there is any substantiation for a complaint it is fully investigated. I do not see at all what function this advisory committee would have with a complaint against a doctor. They are an advisory committee. Certainly they will criticise the system. That is a different matter. Deputy MacBride gave the example of, let us say, poor food in an institution. The advisory committee might advise that the food should be varied or improved and notice would have to be taken of such a matter.

Mr. MacBride

Does that not illustrate the kind of difficulty there is bound to be between the countymedical officer of health and the county surgeon and the manager? Would not the county surgeon or the county medical officer of health be slow to make a finding which might reflect on the county manager's capabilities in providing decent food?

Dr. Ryan

I do not see what difference it makes whether the medical officer of health is a member of the advisory committee or not. I think Deputies should keep this in mind. We have heard speeches of Deputies who have experience of health authority work and the general opinion amongst these Deputies is that things go smoothly, that the county manager and the officers concerned are anxious to consult with local authority representatives and discuss matters with them. That being the case, we should provide for the great majority of cases. What we should have in mind is a group that is out really to improve matters if improvement is necessary, and I suppose it is necessary everywhere. They have no other object in view but to improve matters.

I come now to the question of publicity. You are very much more likely to get good work without the Press being present. First of all the members who are present may be friends of the county surgeon or of the county manager. They would like to make some criticism of what is going on but they might say: "I have a criticism to make, but, seeing that the Press is here, I will wait until the meeting is over." If the Press is absent they will refer to the matter and the county manager and the county medical officer of health will discuss it in a friendly manner. If there is any justification for the complaint it will be remedied, or if there is a good case made for the advice tendered, that advice will be accepted.

It would be a great mistake to hold these meetings in the presence of the Press. What I have in mind is a number of people who are friendly disposed to one another and anxious to get things improved, if improvement is necessary. I had not in mind at all hostile groups coming together and looking for the Press to be present inorder to publish their grievances, whatever they may be. Therefore, I would certainly drop this amendment completely rather than allow any such sub-section because any good that is in the amendment would be destroyed if the Press were present.

Deputy Kyne's point was a very good one. He was afraid that if a man on the county council has a complaint against an official, whether it is the county manager, the dispensary doctor, or anyone else, on the health side, of course, the county council would be inclined to say: "Raise that at the advisory health committee." In the first place, he may not be a member of that committee, there being only four of the county council members represented. Even if he is he can well say: "I do not want to give advice at all: I want to make a complaint." I do not see how it can be ruled out if he wants to make it. It is a separate matter and it should be done at the county council meeting as it was always done. Here we are dealing with a committee which is there to advise and, if you like, to advise in a friendly way without hostile elements being brought together. Therefore, I am entirely in favour of the meeting being held in camera,that is, in the absence of the Press.

Some of the members opposite, Deputy General Mulcahy and Deputy MacBride, were members of a Government. I am sure that at some of those Government meetings they had differences of opinion and they may have criticised one another. It happens with all Governments. When they come in here and the Press is present they do not criticise one another. If the Press were present at a Cabinet meeting it would be very hard to carry on.

Mr. MacBride

Agreed.

Dr. Ryan

The only way in which you can get good work done where you have a team who are friendly disposed to one another but who at the same time wish to criticise one another, is to exclude the Press. It is much better to have the Press absent. I want to state again that I see Deputy Kyne's point. It is quite a point.

Mr. S. Collins

The Minister is not seriously suggesting an analogy between a Cabinet and the health advisory committee?

Dr. Ryan

It is not a very good analogy but it is no harm to mention it.

Mr. S. Collins

It is rather attenuated.

Dr. Ryan

Take a meeting of an executive committee of even a sports club. If the Press is present, probably, they will not talk out their minds as they would if the Press were absent. Take any body of people that meet. Take Fine Gael executive. Would they talk out as openly if the Press were present? Take the Fianna Fáil executive. Is not it obvious that you will get better work done if the Press is absent?

I can understand the mentality of Deputy Esmonde and Deputy Mulcahy because they cannot get away from the mentality of making political capital every time they can and you cannot make political capital unless the Press is present. Therefore, as far as they are concerned, a private meeting of any kind is no use to them and they would always advocate that the Press should be present. Let them try to put their minds down to this for once in their lives, that we want work done, not publicity, not political capital. We want advice, and the best advice, given. If they could look at it from that point of view, they would not press to have the meetings held publicly.

Mr. MacBride

It seems to me that there are two main functions that these committees will discharge. One will be to do the planning work, the private type of work that the Minister has just referred to. Quite apart from that function, will these committees not also have the function of investigating complaints? It is in regard to the investigation of complaints that I think they should be permitted to hold their meetings publicly. I would leave that discretion to them.

Dr. Ryan

I would like the House to be clear on this. Suppose the members say: "We hear that the foodin a particular institution is bad, that there is no variety and that it could be improved without increasing the cost", the manager or the county surgeon may say: "Investigate it for yourselves. I have no objections". That is the type of investigation they might do. In other words it would be a sort of visiting committee. It would not be a formal investigation. I do not see that they will ever come to the point of making a formal investigation. For instance, if there is a serious complaint against a doctor they would never investigate that.

Mr. L.J. Walsh

In my opinion the introduction of this section will be a definite improvement to the Bill. I would draw the Minister's attention to sub-section (5):—

"Where meetings of a consultative health committee have been held on six or more days in any year, no further meeting shall be held in that year save at the request by resolution of the council of the county or at the request of, or with the consent of, the county manager."

I respectfully suggest to the Minister that he should make that obligatory and have definite meetings primarily, leaving to the council the discretion as to the dates, which could coincide with meetings of the county council. This is leaving a rather wide gate and giving rather more power to the consultative council, or the majority of them, than they would really be entitled to, if it is intended that this consultative council as constituted is to be effective.

I can see in the administration of this Health Bill problems and difficulties arising such as we have in connection with the administration of the ordinary health services. I am not a bit perturbed with regard to the powers we are getting under this Bill. I believe it will work out satisfactorily. There should be a definite date fixed for these meetings. I would like the Minister to explain, having regard to the inclusion in the sub-section of the words: "... six or more days in any year, no further meeting shall be held in that year ..." how we are todecide what other meetings shall be held in addition to the six referred to. I think the Minister would be well advised in making that specific.

Mr. S. Collins

I am afraid that the Minister for Health, in being as naïve as he is to-day, instinctively arouses suspicion in my mind. His arguments in support of his contention, even on his own admission, are, to put it mildly, more than attenuated. To discuss on an analogous basis executive functions and advisory functions is slightly unworthy of the Minister at this stage of the debate. The issues involved in this amendment are clearly knit. The Minister says in a noncommittal way that it does not make any difference whether the county medical officer or the county surgeon is a member of the board or not when he is sitting with the board. That argument is typical of the suspicious type of naïveté that the Minister is cloaking himself with to-day.

The fact remains that you are putting on an advisory council the chief executive officers for the discharge of the health services of the county. I cannot see that they would not be more effective in their executive capacity to advise and help such a council rather than as members of it, particularly when one adverts to the point already raised by Deputy Kyne and Deputy Corish that it is more than likely in the normal circumstances of meeting of this council, that the officials would be the regular attenders and, in many cases, under the quorum laid down for the council, would be making the decisions. It is to protect against that kind of extended officialdom that most people argue against the inclusion of permanent officials of the county council on the advisory committee. The Minister would want to weigh that rather deliberately instead of looking upon it as something of no consequence.

Having regard to our experience of county council administration, there is no doubt that with the establishment of this body there will be a tendency to divert more and more of the problems arising from the administration ofhealth services in the county to this consultative council for investigation and decision.

I, myself, would not accept at its face value the suggestion from the Minister that they would not deal with complaints. I feel that the natural tendency will be with their specialised type of terms of reference to refer matters even by way of complaint to this body for advice on. It is true that the Minister may argue that they are purely advisory, but in the ultimate analysis the decision of this council by way of advice or otherwise will be implemented and in this case may have to be implemented by the very members of the advisory council itself. Let us be reasonable in our argument on the issue. The Minister very quietly and seemingly innocuously tried to draw an analogy between a Government meeting and a meeting of this advisory committee and then he goes on to a beautiful extension of the argument to suggest that these meetings may be a body of friends meeting and if the Press were present they would not be inclined to say: "Well, so-and-so, you have done wrong". I do not think that that argument in fact is a real argument at all. I do not think that where there is a question of complaint by somebody who is friendly, as suggested by the Minister, with the county manager or the county surgeon he could raise it at that committee in a public way. He would inevitably have resort to the type of after-meeting discussion that the Minister himself adverted to in his argument.

The Minister tries to justify exclusion of the Press on the basis of people seeking political advantage or political gain by virtue of these meetings. If the advisory council, in fact, as envisaged by the Minister is to be effective at all the Press may be the the best medium by which to achieve that object, for the simple reason that there in a dispassionate way on purely factual statement and on purely factual investigation you will have a collective objective mind brought to a problem and it might well be that the service the Press would give to that body would ultimately enhance its prospects of success because thingsdiscussed by them could readily be effectively observed if they were running in any way contra to the wishes of the county manager or of his principal officials. If the Press is there as the custodian of the public opinion and there to deliberate in the forum of its circulation the type of discussion that was carried on by this advisory body it might prove a very effective weapon to break down walls of red tape and the effective cloak that officialdom can put on difficult problems or on unpleasant remedies.

I am not at all convinced in any way by the Minister's argument. I think we are not approaching this whole problem in the best interests of either the health service itself or efficiency in its administration. The theory and concept of an advisory council is an excellent one, but let us take a more reasonable line of argument than, should I say, the uncorrelated analogies attempted by the Minister. If this advisory council is, in fact, going to have paid officials of the council itself as part of the advisory body, who will it advise? Their function is to advise the county manager, and in the delegated powers that the county manager delegates, to advise the county medical officer and the county surgeon as to what would be best to do.

Dr. Browne

Is not the county manager a paid official?

Mr. S. Collins

Agreed, but I am dealing with the people who will in fact be exercising his delegated powers, and when it comes to a question of administration in either any branch of the health service or any of its institutions the responsibility does not directly fall in the accepted sense on the county manager. The person who in the real issue is going to be the person in the dock or the person in jeopardy is in many cases the medical officer who we might argue in another place was not the authority at all. There is the situation in logical argument that even if it is nominally to the county manager the advice is tendered, in fact nobody would know better than Deputy Dr. Browne himself that the implementation and ultimatecarrying out of the advice and directive will be in the hands of either the medical officer or the county surgeon or maybe some other medical officer of the county delegated by him to perform specific functions. You have that kind of double-headed penny where these paid officials of the council in their professional capacity will be advisers to themselves in their administrative professional capacity within the council. I do not think that that is a happy state of conception for any such council. I do not think it is going to leave them free to do the best work possible. I think from the point of view of the county surgeon and the county medical officer himself they would be better off to come in as people in command of the facts and the knowledge of what is going on in their county, to lay facts and figures before the advisory council for their objective analysis as distinct from becoming participants themselves in the particular deliberations. They will achieve, I would say, a better and a more useful function in that way than they would by actual membership of the council.

It goes a little further than that when the Minister deals with the exclusion of the Press. I think he is not dealing with it on a realistic basis. There is an instinctive suspicion created around that type of body, whether you call it an advisory consultative council or a commission of investigation or anything else, where it becomes something behind sealed doors having a more or less furtive type of gathering, it creates not the best possible atmosphere for the development of any suggested scheme or the improvements that may be suggested by such consultative body.

There are circumstances in which one could conceive that it would be necessary to exclude the Press, but surely it would be wiser for the Minister to allow that function to be operated by the council itself as distinct from laying down as a direction to them the necessity for completely excluding the Press. I think the Minister would be well advised to consider possibly vesting in the consultative council itself the rightto decide on any issue whether or not the Press will be present, and to put the onus of exclusion on them rather than, as I have suggested, making it a condition precedent to their meetings that the Press must be excluded.

I move to report progress.

Progress reported; Committee to sit again.