Dáil Éireann debate -
Tuesday, 14 Jul 1953

Vol. 140 No. 7

Health Bill, 1952—Committee (Resumed).

Debate resumed on amendment No. 66:—

Mr. S. Collins

When I reported progress on this particular amendment on the last day, I was summarising, in the main, the circumstances that should operate to compel the Minister to desist from certain, at least, questionable facets in relation to proposals for this consultative committee. I do not intend to weary the House by extending the arguments but I would impress upon the Minister that he may be embarking by secrecy on a dangerous course. The one particular facet of the public service that I think is best served by the searchlight of public criticism and, indeed, by the informed investigation sometimes pursued by the Press, is in relation to complaints that can be made in connection with food, services or attention given in health institutions.

The Minister would be well advised to consider carefully whether it is of practical value to a consultative body to have the paid officials of the county, namely, the county medical officer and the county surgeon, as de factomembers of any consultative body that may in fact be investigating some of the actions of these people.

General Mulcahy

The discussion that has taken place on this amendment is very revealing over a fairly wide range of country. From my particular point of view, however, it helps to throw into perspective the seriousness of the main point upon which additional light is thrown by the Minister's amendment. Various questions have been introduced into the discussion here both by Deputy Allen on the one hand, and by the Minister on the other. In order to avoid facing up to the questions that are being put by some of us here and the details that are required with regard to the Minister's approach to the administration of this Bill, all kinds of innuendoes and red herrings have been dragged across the trail.

Deputy Allen, supported by the Minister, sneered at people from these benches on the grounds that we were showing a great interest in the position of the county manager in relation to the administration of this Act while we had shut our eyes to the position of the county manager in relation to general health administration for the last 12 or 15 years, or whatever the length of time it was. The fact is, however, that from the time of the disclosure of the Fianna Fáil attitude towards health services, from the time of the introduction of the 1945 Act, our whole approach and our whole concern has been radically changed.

The Minister knows that their approach to health administration in the 1945 Bill was such that the Bill collapsed in their hands but only after substantial and lengthy discussion here. The 1947 Act, in which they enshrined their principles and plan and their machine of administration, as the Minister is quite aware, was challenged on constitutional grounds as well as on other grounds. From the time the Fianna Fáil approach to health plans and health administration was fully shown, from 1945 on, naturally we were concerned very much with the position that the county manager was to occupy in the administration of these services.

For purposes of red herring manufacture, the Minister suggests that the amendment before us has not beenread by Deputies. Deputy MacBride read sub-section (1) and in sub-section (1) it is made plain and clear that the making of any service available to any individual is a matter that neither the elected body nor the advisory council that is contemplated in this amendment will have anything to do with. One man will be responsible for deciding any question relating to the making of any service available to an individual, that is the county manager.

We are not concerned with attacking here in this Bill the county manager, either as an individual or an institution. We are concerned with being clear as to what powers this Bill could put into the hands of an individual as county manager. Take this particular reservation—it would be a reservation in any case as far as the power of the county manager is concerned—no person under the County Management Act as it stands, apart altogether from anything that may be mentioned in this amendment, would have any power to interfere in any way with the manager's decision in the making of any service available to an individual under this Health Bill if it is passed in the way in which the Minister contemplates, except in so far as Section 29 of the County Management Act might be brought into play and a couple of meetings of the county council might be held to issue an order to the manager to provide a certain service for a particular individual. Even then we might have the Minister in the position of standing behind the manager in the matter and annulling the local authority's attitude. However, as I see it, Section 29 is just a way of calling in elephants to do something that ought to be done by ordinary systematic administration.

The Minister is well aware by this time that this Bill divides the people who are likely to be affected by it into three different sections, three different millions, the lower income group, the middle income group and the higher income group. If we take only one of the problems that are being made the responsibility of the one individual, the county manager, in this case, he will have the personal responsibility of deciding in respect of people who areto some small extent at one side or the other of the line dividing the 1,000,000 lower income group from the 1,000,000 middle income group. He is the person who will have sole authority to decide whether a person at one side or the other of that particular line will have a certain service, whether it is a service by way of payment or by way of medical attention or by way of institutional attention, given to him or not.

The same applies to people who are on both sides of the other dividing line between the second 1,000,000 of the middle income group and the third 1,000,000 of the higher income group.

Deputy Dr. Browne declares:—

"... I have no great fear of final decisions being handed over to one man."

He declares that in relation to the whole of the administration and the entire provisions of this Bill. He says:—

"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."

That is at column 921, Volume 140 of the Official Debates.

It is quite satisfactory to have a clear definition of Deputy Dr. Browne's attitude in this matter but we want to be equally clear. I have no desire in any way to misrepresent Deputy Dr. Browne's attitude in this matter. I do not think that any interest that he or any other Deputy, including the Minister, may have will be served in any way by misrepresenting our attitude.

Deputy Dr. Browne, at column 922, declares:—

"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."

"The activities of this House are an expression of our opinion." Deputy Dr. Browne uses that in relation to his attitude in regard to one-man rule once the man is subjected to this Department and to his approach to thereview or the supervision of voluntary hospitals, on the other hand.

One of the most remarkable activities in this House as an expression of our opinion was the passing of the Public Charitable Hospitals (Temporary Provisions) Act, 1930. That was an Act which expressed our opinion in relation to the value of the work and the value of the tradition enshrined in our voluntary hospitals. The body that came into being as a result of that Act, subsequently confirmed in the Public Hospitals Act, 1933, or superseded by that Act, that is the Hospitals' Trust Limited, is the most remarkable piece of voluntary and private enterprise work I think we can boast of. At any rate, it is one of the most outstanding pieces of private enterprise we can boast of and the work done in collecting moneys to assist the public hospitals was done by a most remarkable piece of private enterprise.

An Ceann Comhairle

I am trying to relate what the Deputy is saying to the amendment.

General Mulcahy

I am relating this to the amendment. The amendment here is for the purpose of setting up a consultative or at least an advisory body to advise the county manager, and every possible attempt has been made here by the Minister and by others to obscure the function of the manager for which this advisory body is being set up, and to a very remarkable extent, and I am making use of the discussion on this amendment to bring out in the clearest possible way that the county manager, the one-man rule that Deputy Dr. Browne states in column 921 that he has no fear of a final decision being handed over to one man—that that is the fundamental part of the legislation that we are passing through here. When we set up a special body here, a consultative health committee for the purpose of advising the county manager I feel it is an obligation here in the House that we should clear away the obscurities that have been gathering upon the machinery for the administration——

Dr. Ryan

You have a good method of clearing away obscurities.

General Mulcahy

Clearing away that particular type of obscurity. I am clearing the obscurity that Deputy Allen speaks of here, the attempt to convey that in our discussion and our criticism of this particular aspect of the proposed administration of this Bill we are now for political reasons interested in particular classes. We are interested in seeing that every section of the people, particularly the people in the lower income group, will have the administration of their health service in the hands of something other than a mere State official entirely in certain circumstances under the Minister's direction.

Dr. Ryan

Interested for the first time.

General Mulcahy

Yes, interested for the first time; I again want to suggest that remarks of that particular kind are just for the purpose of trying to obscure the issue. We had to be interested in very serious aspects of health proposals and health administration from the time the 1945 Bill was first introduced here; the Minister himself who brought the 1947 Act through this Dáil knows more than anybody else what constitutional and other aspects of social policy were involved and were challengeable in relation to the 1947 Act.

Mr. Allen

Not in relation to the amendment.

General Mulcahy

When you get proposals that are questionable from the constitutional point of view or are questionable from the moral point of view then you are particularly involved with the fact that the machinery that it is proposed to administer these proposals through is the County Management Act which in respect of these particular proposals gave the county manager complete and sole direction of them subject to the local authority's power to strike a rate.

Mr. Allen

On a point of order, a Cheann Comhairle, I want to make a point of order. On this amendment is the principle whether this Bill should be administered by the county manager or the county council or byany other authority? Is that the issue in this amendment?

An Ceann Comhairle

I am afraid that that is not a point of order.

Mr. Allen

I would like to know have you to determine whether Deputy Mulcahy is in order in discussing the merits of the county manager on this Bill here or not?

An Ceann Comhairle

Yes, I have to determine that.

General Mulcahy

I am trying to make it clear——

Mr. Allen

As mud.

General Mulcahy

——that a health Bill is being passed here with vital and important provisions in it affecting closely not only the health life but the personal life of many individuals in the country and this Bill does not show in any single clear way how it is proposed to administer that when it does say that it will be administered by the local authority.

An Ceann Comhairle

Surely the Deputy is travelling very far from the amendment.

Dr. Browne

It got a unanimous Second Reading, Deputy.

General Mulcahy

It did not. The amendment sets up an advisory council for the purpose of advising the county manager——

An Ceann Comhairle

We cannot travel over the whole Bill on the strength of this amendment. We must confine ourselves to the particular matters concerned in the amendment.

General Mulcahy

I am concerned with the functions of the man in respect of whom this amendment proposes to set up an advisory council.

An Ceann Comhairle

Certain matters have been decided already on the Second Reading of this Bill and the main principle of the Bill has been decided. Now we are asked by this amendment to set up a consultative council. We must confine ourselves to the setting up of that council and the composition of that council, whetherthat council should be set up and so on.

General Mulcahy

I submit that we are concerned with the functions and the work of that council.

An Ceann Comhairle

Quite so.

General Mulcahy

And the function and the work of that council. It has been stated here by the Minister that the local authority will have authority to set up a council, that the council will advise the manager and that the manager will have whatever powers he has. Now surely when we set up a council to advise a particular person we are concerned with his power, and surely when we in this particular amendment make specific mention let us say that there are certain powers of the manager which would not be interfered with—surely we are entitled to discuss those powers which are mentioned in this amendment if we want to do so. I want just more or less in a passing way to make a reference to the fact that this consultative council will not have any power to interfere with the manager in relation to the making of any service available to any individual, and in connection with that I point out the extraordinary problem that exists if the population of this country is taken and divided by two dividing lines between them with 1,000,000 at one side, 1,000,000 in the middle and 1,000,000 at the other and here by this amendment the consultative council is expressly forbidden to have anything to do with whether people immediately on one side of the line or immediately on the other are going to be treated in a particular kind of way. I am pointing out that not for the purpose of arguing that their powers should be of a particular kind but for the purpose of showing the fantastic approach to administration that is fundamental to the whole Bill, because this Bill gives no idea in the world as to what kind of local authority ought to administer the Bill. A Health Bill ought to be administered by some kind of local authority, and the local authority that is provided for here is the one man who has been appointed as county manager and who has all the responsibilities and allthe duties of a local authority other than those prescribed and defined by Section 15 of the County Management Act.

An Ceann Comhairle

We cannot go into that. It is obvious that we can only go into the power given to the county manager and the local authority by this amendment. We cannot go back and travel over all the powers the manager has and has not in respect of those other matters.

General Mulcahy

It does no harm to set up this consultative committee, but when you propose the provision and administration of services so closely affecting in a personal way the health of the people and when you put these powers into the hands of one man, then—even though Deputy Dr. Browne may feel that because we have the statutory machinery here for appointing this man we can control him—the more people you have looking in over his shoulder the better it will be. Indeed, a lot of supervision and of "looking over the shoulder" will be necessary if these powers are ever put into the hands of one man locally.

Dr. Browne

I am often asked why I do my best to obstruct the return of Fine Gael to power. Anyone listening to the Health Bill debate has an answer to that question as there has been the most transparent filibuster over the last fortnight. Deputy Mulcahy pointed out that the county manager is an official who will carry out the will of this House through the local authority. It is only right that my attitude to that should be clear. Deputy Mulcahy quoted from my remarks in the debate here on the last day, column 921. My remarks were:—

"... I have no great fear of final decisions being handed over to one man."

Deputy Mulcahy did not continue to read:—

"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."

General Mulcahy

I read as far as that.

Dr. Browne

I continued:—

"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 or wrong 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."

It is quite a different thing to hand over our decisions in relation to legislation to any group, as was done by Deputy Mulcahy's colleague, Deputy Costello, as Minister for Health, when he handed over his powers to the Medical Association, which was not a democratically elected body.

An Ceann Comhairle

The Deputy should keep to the amendment.

Dr. Browne

Deputy Collins suggested, in furtherance of the argument, that the official salaried officer had no right at this committee beyond being called in. I deprecated the arguments put forward by Deputy Esmonde and by Deputy Mulcahy, I think, suggesting that these salaried officers could not consort with the nominated members of the committee. I did not see anything wrong in it. If these salaried officers are not to appear on the consultative committee, I would ask Fine Gael members what would they do with the county manager. He is a paid official of the local authority. Do they suggest he should not be on the consultative committee either? If that is so, who is to be on it and who is to convey the wishes of the consultative committee to the local authority or to the manager?

I do not see any objection to the paid officials being members. It does not make a ha'porth of difference whether a man is a paid official or not; the question is whether he is of any value on the consultative or advisory committee. He should be prepared totake any criticism coming to him, he should answer to the best of his ability if he can and, if he cannot, he should accept whatever censure is imposed upon him.

I would urge strongly on the nonprofessional and non-medical members of the Dáil that it is terribly important that professional secrecy should be maintained. The doctor-patient relationship is important. All the higher medical men in England agree— and I am completely at one with them —that anything that would jeopardise the doctor-patient relationship should be deprecated. Some of the lay members might not appreciate that, but if they do a little thinking they will realise that it would be very wrong if any of a person's personal worries, or the details of medical histories, were at the disposal of anybody. On the local authorities, 99 per cent. of the people are intelligent and sensitive in understanding but you might get a person who would not appreciate the significance of blurting out details in such a council and do irrevocable damage to our State health services. It is one of the pitfalls which must remain, one of the pitfalls pointed out by the Medical Association and greatly exaggerated in their suggestion that the State health service could add very grave dangers to the secrecy of the doctor-patient relationship. I think they should be denied the satisfaction of anything like that happening.

Normally, so long as there is the possibility of a local representative being able to air his grievances, that is terribly important. I completely agree with Deputy Kyne that as long as a member is in a position to air his grievances at a local authority meeting, or to air the patient's grievances, with the patient's authority, one cannot see that anything is in danger by having these meetings held privately. I look on these committees as advisory or consultative committees. That should be their primary or main function. I do not see any grave reason why the meetings should not be held in private, with the local authority carrying on its own functions as it does at present.

I do not want again to remind Deputy Mulcahy that this Billin its fundamental principles got a unanimous Second Reading.

General Mulcahy

That is not so.

Dr. Browne

It got a unanimous Second Reading.

General Mulcahy

It did not.

Dr. Browne

It did, of course.

An Ceann Comhairle

That does not arise on this amendment.

Dr. Browne

Nobody voted against it.

General Mulcahy

It was negatived from these benches.

Dr. Ryan

The Deputy and his colleagues must have negatived it.

An Ceann Comhairle

It does not arise.

Dr. Browne

Deputy Mulcahy and Deputy McGilligan both said they agreed with the health legislation.

General Mulcahy

The Deputy should read that in its context.

Dr. Browne

I do not propose to pursue that. It is quite obvious that on the Second Reading there were ample opportunities for all the points brought out now.

General Mulcahy

The Deputy had ample opportunity to speak then and did not open his mouth.

Dr. Browne

Now those opposite are trying to take every opportunity on every section to obstruct this social legislation.

General Mulcahy

The Deputy is more vocal now than he was on the Second Reading.

Dr. Browne

It is typical of their attitude since 1922, "kicking and screaming into the 20th century."

General Mulcahy

The Deputy should get another phrase.

Mr. Kyne

I would like to suggest to the Minister for Health, on thissection, something that is very close to what Deputy Browne has just been discussing, that is, the question of the two extra medical doctors that it is proposed should be nominated to the consultative body. I suggest that the Minister should put in a proviso, if this section is to be left as it is, that these two doctors be not dispensary doctors or officials of the local authority. There would be on the consultative committee a medical officer of health and a county surgeon. If you add to them two doctors nominated by the Medical Association or by some other authority, and leave it at that, you could quite possibly get two dispensary doctors as well. You will then have on the consultative committee three subordinates of the medical officer of health in so far as they are immediately under his control and, to a certain extent, can be subject to disciplinary measures if they either irritate or aggravate him. I do not suggest that any dispensary doctor so appointed would allow that to interfere with him, but it would be an unpleasant thing and it would at least prevent him from having complete freedom of thought and expression of opinion.

I understand that amongst the things which may be discussed is whether steps should or should not be taken in regard to the immunisation of people in the county. If the medical officer of health expresses the opinion that it should be done it will be difficult for the dispensary doctors to say other than that they agree with him. I suggest that the Minister should put in a provision that the two doctors should not be paid officials of the local authority.

Mr. Allen

They will be.

Mr. Kyne

At the present moment they are not. I suggest that these two doctors should not be paid officials of the local authority in the sense of being dispensary doctors or holding any other official post, but should be private practitioners. You will then have doctors who will not be under disciplinary control to the same extent as dispensary doctors and who will view things from the private patient'spoint of view. Very often the private patient's point of view is not considered and the matter is looked at from the State point of view. I think the suggestion has merits in as much as you will have a variety of opinions, if it is absolutely necessary that we should have four medical men on the committee.

I am aware that in present circumstances in this House there is very littIe hope of defeating any amendment the Minister brings in, but I appeal to him to consider that suggestion and, if he feels there is wisdom in it, he could bring in a further amendment to alter the position and provide that the two doctors to be nominated should be in private practice.

Mr. Allen

They would be paid fees.

Mr. Kyne

Are we to take it that this is only a Fianna Fáil ruse? Every doctor in the country, I suppose, will be in that position, but there is a very big difference between taking fees to work the scheme and being a dispensary doctor or a medical officer of health or a county surgeon with a fixed salary.

Brendán Mac Fheórais

There is one important factor that we may have missed so far. I must confess I missed it up to now. I suppose the reason it has been missed is because we have not yet dealt with Section 63. Section 63 says: "Nothing in this Act or any instrument thereunder shall operate to enable the Minister to direct the giving of any service or benefit to any individual person." I may be wrong, but I read that in this way, that there is no appeal to the Minister following a decision which the county manager might come to, say, as regards the making of a service available to an individual. That is a departure, especially as far as health matters are concerned, because at present if a county manager refuses the granting of an allowance to a tubercular person there is an appeal to the Minister. But, if Section 63 is passed, it will mean that the county manager will have the final say.

I appreciate that there must be some one person within the local authority to make decisions and to take responsibility for them. I suggest, however, that there ought to be an appeal to such a person as the Minister, or at least a person who has been elected to this House by the people of a particular constituency and who has responsibilities to these people and therefore responsibilities to the House. I think we ought to follow the usual practice, especially in respect of the granting of a health service or an allowance under the health services, of an appeal to the Minister where there is disagreement with the decision of the county manager in respect of this particular amendment, which is in effect a new section.

There is a provision in the first sub-section that the consultative committee shall not have any say in the making of any service available to an individual. I am not advocating that the consultative committee should take these decisions themselves. But, inasmuch as they will be representative of the elected representatives of the functional areas and will have on them as representatives the county medical officer of health, the county surgeon, and two other medical practitioners, the Minister ought to make a further change and allow the county manager to discuss any difficult or borderline cases with them. I think there will be a lot of dissatisfaction, to say the least of it, in many cases relating to health services on the part of individuals who will believe that they have got a raw deal from the county manager. I think the county managers themselves would welcome the idea of an appeal to some other authority, if not to the Minister, then to the consultative committees proposed here, because in very many cases local committees such as these will be able to give additional information and probably a type of advice which will be of benefit to the county managers in individual cases.

I supported Deputy Kyne's plea on the last occasion that the meetings of these committees should be held in public, with this reservation, that the committees themselves should decide whether or not certain meetings shouldbe public or private. Everybody is in agreement that we do not want to disturb the doctor-patient relationship. But there is another type of relationship which exists in this country— whether it is peculiar to this country or not I do not know—and that is the constituent-public representative relationship. I will not say it is the same type of relationship as that to which Deputy Dr. Browne referred, but it is a relationship which is very secret and very guarded. Again, as Deputy Dr. Browne stated, the vast majority of our public representatives on the county councils and other public bodies are people who will not divulge a confidence and who get the confidence of the people whom they interview from time to time. Possibly in some respects they can give public representatives much more information than they can give a doctor on family matters. For one example, I do not think that this section would be upset to any great extent if the Minister gave power to the manager, or, if you like, to the local council, to consult with the manager on such a thing as the making of any particular service available to an individual. If the Minister or the House does not agree that this amendment should be further amended in that way I would suggest in respect of Section 63, that the Minister provide for an appeal to him in the event of dissatisfaction by an individual.

Dr. Esmonde

When Deputy Dr. Browne was speaking just now—perhaps I misunderstood him—I took him to state that the county manager would be a member of this advisory or consultative body. I do not think that is the intention of the Minister. Perhaps the Minister might clarify that later on. He also stressed the point that it would be natural for the officials to be there as they would be administering the scheme. I understand Deputy Dr. Browne's point of view. It is consistent. It is simply this: that the State should take complete control and maintain this control. That viewpoint is quite consistent. We object to State control only in so far as it is absolutely necessary and this consultative or advisory council as I said before seemsto be a step in the right direction because it is a council set up of democratically-elected representatives, and public representatives of different opinions to consult or advise on matters appertaining to health, a local council and a most desirable thing. Our opposition to it is this. We have made several objections and we are not alone in this. These objections have been made by other speakers, by other Opposition Deputies as well as the Fine Gael Party. Whether they make them or not Fine Gael intends to state its case and maintain its principles. and is surely entitled to do that. First of all, we maintain that the county medical officer of health is ipso factoan official with delegated powers from the county manager. This council is set up for the purpose of giving advice or considering actions taken by the county manager in his function as health authority. Is it not the height of nonsense to suggest that the medical officer of health who in the majority of cases will be acting in the person of the county manager with powers delegated to him should be a member of this council? Surely that nullifies the whole thing straight away? I cannot see any argument against that one way or the other. It is quite the usual thing on local authorities at meetings to have the permanent officials there acting in their capacities ready to give their views if they are required. If the county medical officer of health should be present as an official it is quite possibly conceivable that some action he has taken may be under discussion or consultation. It surely is going to be embarrassing to this advisory council if they are going to carry out their full functions, if they have to criticise one of their own members. I think they are handicapped from the word “go”.

The other point we object to is Section 6 and it is very easy for the Minister to meet that point. I know Deputy Dr. Browne cannot agree with this point and he is consistent with his principle in that he believes in complete State control. Sub-section (6) of amendment 66 states:—

"Every meeting of a consultativehealth committee shall be held in private."

The Minister has produced all sorts of arguments as to why consultative bodies' meetings should not be held in public. I freely admit there are occasions when they should not be held in public and that sometimes it might be desirable that they take place in private but Section 6 says they "shall be held in private." In other words, this is a secretive committee and that is where it defeats its own ends. It is put there for a purpose, a democratically-constituted body, for the purpose of defending the rights of citizens, or the local people concerned who are deriving benefits from these improved health services administered by one man who is the centre of the local authority, the one man who controls the whole thing. That is admitted now. He is the county manager and this body is for the purpose of advising him and if they are going to meet in secret, does it not nullify their functions straight away? The Minister is giving with one hand and taking away with the other. This consultative body is no good provided the proviso remains that they shall meet in private.

The Minister says that the publicity derived will be sufficient to nullify the effect of the solo control but it is no argument when you keep the clause that they shall meet in private. The Minister could quite easily alter the case by saying they may meet in private.

Deputy Dr. Browne was worried that there might be possibly some interference with the doctor-patient relationship but when this advisory council meets I do not think they will discuss the particular ailments of people or particular treatments. They may discuss the facts as to why a certain person should have been sent to a hospital and was not sent to that hospital but that does not reveal anything in particular.

Mr. Kyne

That is an individual case. They cannot even discuss that.

Dr. Esmonde

Perhaps Deputy Dr.Browne will explain how he feared the doctor-patient relations will be interfered with? I think it is a great pity the Minister does not try to meet us on this. It is no use purporting to offer something. Obviously the consultative council is a new idea. It comes in before Section 44. The principle is good but the way the Minister is tying the hands of this council would nullify its functions altogether. It would be very easy for him to meet us on this point.

There is no need to stress the point made by Deputy Kyne in regard to dispensary doctors. There is a certain amount to be said for it, provided there would be any other doctors than State or dispensary doctors if the intentions of Deputy Dr. Browne and those who support the Fianna Fáil Government are put into effect. It seems to me we are going to have whole-time doctors and State officials, and as far as the private practitioner goes, you will not find him anywhere unless you go to a foreign country. I think Deputy Kyne can forget that, although if we had private doctors I think they would be the best people to sit on this council.

I think the Minister could very easily change that sub-section (6) from "shall" to "may". I do not say that we will agree with it then or that we would be any more in love with this state of affairs that exists in regard to health than we are now, but it would be a slight improvement.

Dr. Ryan

I do not think it would be worth while for me to waste time trying to argue with Deputy Dr. Esmonde because he apparently believes that they will not do good work unless the Press is present to hear them speaking. I think people do good work when the Press is not there— even, in fact, better work. Men of the type of Deputy Dr. Esmonde forget about the publicity part of it and settle down and do good work. That is my point about not having the Press present. I think Deputy Dr. Esmonde should try and forget about propagandist opportunities for these committees and try and settle down and do good work. It is a most extraordinarything that we spent two hours on the Second Reading and we are spending four days on a comparatively minor amendment. It goes to prove the rumour that is around that Fine Gael are boasting that they will not let this Bill through. We will see whether they will or not. That is their boast at any rate. Evidently they are making a good attempt, spending four hours on a minor amendment of this kind that I think would not matter whether it was put in or left out. But they have spent four days discussing it and Deputy Mulcahy is trying to bring into it the county manager. I know Deputy Mulcahy a long time but I can never make up my mind whether he is stupid or dishonest. I think it is a combination of both. It is difficult enough to deal with a dishonest person who is not stupid, because he is sometimes amusing but when you get a dishonest person who is stupid as well as dishonest it is very hard to put up with him.

I have not tried to obscure the position as Deputy Mulcahy alleges. I have pointed out over and over again that the local authority will adopt the scheme, give a general direction as to the Way in which it will be administered and then the county manager has his functions in carrying out the administration of the scheme. There is nothing obscure about that. Maybe there is in Deputy Mulcahy's mind but to the ordinary Deputy there should be nothing obscure about it. If the local authority adopts the scheme it will give general directions how it is to be administered and then the county manager takes over the administration of the scheme. This committee then comes in to advise the county manager. It would be ridiculous to suggest that you should have the committee to advise the county council. You might as well suggest that you should have a committee to advise the Dáil. Nobody would attempt to set up a committee to advise the county council. It was simply because some people thought that the county manager in the secrecy of his own office might do certain things that should be open to review that this advisory committee was suggested and is being set up toadvise the county manager. I wonder am I being obscure to anybody when I put it that way? Despite the fact that all this has been clearly explained before Deputy Mulcahy comes in here and starts the discussion all over again. He has been at this amendment now for four days—I suppose under orders of his Party that this Bill will not be allowed to pass. He is doing his job well so far but we shall see who will win in the end. It is very amusing to hear Deputy Mulcahy talk about the freedom of the individual.

So far as I can see the only matter we have to decide here is whether the amendment should be inserted in the Bill or not. That issue could be decided long before now. If it is rejected well and good but if it goes in, all these refinements as to whether doctors or the county medical officers should be members of the committee or not, could be dealt with on the next stage by suitable amendment. Apparently Deputy Dr. Esmonde has been forbidden to put down an amendment by a Party decision but some other Party could put in an amendment to deal with these matters. All we have to decide at the moment is whether this amendment should go into the Bill or not.

One point raised by Deputy Kyne or by Deputy Corish had reference to the question of individual benefits. I am strongly of opinion that the county manager or somebody must decide who is to get benefit and who should not get it. Again I say the county council should not be called upon to make that decision. I do not think any person who applies for benefit would like to have his case discussed in all its details at the county council meeting. He would not like to have everything about the family circumstances made public at a county council meeting. I think the individual concerned would prefer to have his case decided without publicity. It is a matter that should be decided by an officer of some sort. As the law stands at present under the County Management Act and other Acts that decision rests with the county manager and he has been deciding cases of that type for the last 12 years. As Deputy Allen has already pointedout, when it was a question of deciding whether a member of the lower income group should get benefit or not, Fine Gael did not take any interest in that matter but now when it is a case of a person belonging to the middle income group Fine Gael has become very anxious about the whole thing, about the county manager's powers and so on. I think the county manager is as well able to deal with cases arising from the middle income group as he dealt with cases from the lower income group in the past.

It is provided that the members of the advisory committee cannot raise an individual case and I think rightly so because if they could raise such a case it would follow that they would have power to ask the county manager to produce the evidence or the facts about the case which caused him to decide it one way or the other. That would be wrong I think because if an individual gives information about his means and perhaps even about his ailment, whatever it might be, the details of that information should not be passed round and discussed in such a way that every person present can hear them. On the other hand I am quite sure that if any member asked the county manager why so-and-so was refused treatment, the county manager would at least give the advisory committee the general principles upon which he acted and say that in his opinion the person concerned according to these general principles was not entitled to benefit. It would then be a matter for the advisory committee to make up their minds as to whether that was a fair decision or not.

It is true, as Deputy Corish pointed out, that under Section 63 a person will not be entitled to appeal from the county manager's decision to the Minister. Persons affected by a decision of the county manager have such an appeal at the present time in connection with the infectious diseases maintenance allowance but I do not think it has done very much good. A few cases come along occasionally but I do not think the Minister has ever given an order turning down the county manager. I cannot speak for my predecessorbut so far as I am concerned when such an appeal came before me, I wrote to the county manager stating that I got such a letter and asked him what were the facts of the case. I think on one or two occasions I wrote back to the county manager and said that I thought it was a case into which he might look again. That was as far as ever I had to go. I suppose that any Minister who is there can go over the facts without any right of appeal to him and I think it is better that this right of appeal should be withdrawn. However, that is a question that can be discussed on Section 63; it does not arise on this amendment.

I do not know whether it is very much use appealing to the House; I suppose it is not very much use appealing to Fine Gael. They have made up their minds that they will not allow the Bill through as far as they are concerned. I suppose they have got to keep on talking as stupidly as they have been talking and keep away from the Bill as far as possible but I would appeal to members of the House, other than those of Fine Gael, to be a little more considerate. As I have pointed out, we have now spent four days on this amendment which is an ameadment of a rather minor type.

Dr. Esmonde

I am sorry that I have to intervene again but the Minister did not deal with the question which I raised in regard to the county medical officer being retained as a member of the committee. Another point upon which I should like some information is this. If in the event of this consultative committee wishing to ventilate a grievance, can the Minister indicate what avenue they have for ventilating that grievance? So far as I can read the sub-section they have no right to ventilate a grievance. The meetings are held in secret and if they object to anything that the county manager as the health authority does, what redress have they got? So far as I can see none whatever. The Minister has not clarified that point.

Mr. Larkin

I think it is a pity that the Minister should have tried to decry his own amendment by describingit as one of minor importance. Frankly, I do not think it is because the principle embodied in it is one which the Labour Party tried to have embodied in an earlier amendment. We have no very great objection to the amendment as it stands, because we accept the position that the committee is intended to give advice in general matters to the county manager and that machinery will have to be provided for that purpose.

It seems to me that the Minister is stressing too much the role of the consultative committee in advising the county manager on the purely technical aspect of giving effect to the policies decided by the council, and too little the role that can be played by the consultative committee in helping the council and the county manager to get a wider and more general acceptance of the services that will be made available to the citizens. It is from that point of view that I would suggest that the Minister should permit the consultative committee to decide themselves when they should have private meetings. It seems to me that the point made by Deputy Dr. Esmonde that they should have the power of utilising the Press as a means of defence against a county manager is not very effective. If they have any difference with him, their recourse is to the county council and they can very readily invoke that power. There may be occasions on which both the county manager and the committee want to discuss some new service. To the extent that it is envisaged by the amendment, the committee can, in fact, be composed of a number of persons who are not members of a local health authority, who are not doctors but who are men and women interested in public health generally and prepared to devote their time to it. To the extent that they would associate themselves with, say, a manager at a meeting of the committee, in discussing and supporting the introduction of a new service and examining in detail its value to the citizens and generally indicating the value of that service, it should be possible for them on such an occasion to invoke the assistance of the Press.

All the argument about bringing individual cases before the committee and having a person's intimate affairs discussed at the meeting, in front of the Press, and weakening the doctor-patient relationship, and so forth, is cod. That does not happen at all. The Minister is putting up arguments and knocking them down again. At least this amendment provides a connection between the full-time officer and the public-spirited people who, for a long time, have been interested in public welfare and public health and are prepared to associate themselves with a committee such as this and desire to assist the health authority and the full-time officers in making such a service not merely effective but accepted as well. From the history of vaccination, we know that it takes a good deal of time, sometimes, to get the public to accept a service. The fact that the Department of Health are carrying out a campaign of advertisement in relation to immunisation against diphtheria proves that advertisement has an effect on public opinion. I know of no more effective way than of a committee like this, constituted not only of medical experts but also of those directly engaged in the administration of the service plus a number of men and women who carry weight generally in the county, meeting in public, with the Press present, to consider and deliberate, in consultation with the county manager, new services proposed to be provided, and explaining in detail the benefits of these services. If they meet behind closed doors, the Press will eventually get the report on the service but it will not carry with it the support of the members of such a committee. It will be a cold statement from the manager and, in many cases, it will be accepted with great reserve. I think it would be better from the Minister's point of view if he permitted the committee to decide, in their own good sense, whether or not they will have the Press.

My second point is in connection with the number of meetings to be held per year. Why should a committee of responsible men and women be confined to six meetings a year unless they get permission from thehealth authority or the county manager to hold more than that number? Surely they are not children. If they feel it is necessary to meet oftener than six times in the one year then I think it should be possible for them to do so. The less restriction that is placed on this committee the better. They should be put in the position of being invited not only to advise the manager on general matters but to give him that advice as sensible men and women, with a sense of their responsibility, and these restrictions both in regard to the number of meetings and the exclusion of the Press are not, I think, in character with the whole of the Minister's amendment.

Mr. MacBride

I appeal to the Minister to consider the points made just now by Deputy Larkin. He has made them reasonably. I do not think that these matters are important from the Minister's point of view but they are regarded as important by this side of the House.

General Mulcahy

The Minister is quite welcome to discuss my stupidity and my dishonesty if he thinks that it will help him in any way to make himself clear in this House. I should like to assure the Minister that if he would appreciate our approach to this Bill he might save himself from wandering into these directions and he might get through his business, such as it is, a bit quicker.

I am not concerned with delaying this Bill so much as I am concerned with bringing out with clarity what the Minister's proposals are. I am not concerned with amending or improving in any way the Minister's proposals because the Minister's proposals are made on such an unsound basis that I do not think that any attempt to improve them or to rectify any minor details in them would be of any use at all. They are based upon a flat-footed attitude by the Minister. He is introducing proposals that are in flagrant disregard of the desire of the medical profession of the country to be consulted and to have their opinions taken and their experience understood.

At column 920 of the Official Report of the 9th inst., Deputy Dr. Browne is reported as saying:—

"Consultation is an accepted part of the control and management of industries, factories and institutions for the past 20 years, even in backward countries."

Here we are introducing a health scheme in face of a statement published by the medical fraternity as recently as the 18th March last. The following resolutions were passed unanimously at a meeting of the Irish Medical Association held in the Royal College of Surgeons in regard to their attitude to the Health Bill of 1952.

Parliamentary Secretary to the Minister for Social Welfare (Mr. Kennedy)

The Deputy is making a Second Reading speech.

General Mulcahy

It probably is. I will not mind reading out the declaration but I will state the fact. I want to tell the Minister again, so as to be clear in regard to our attitude and so as to help him to speed up his work, if he wants it speeded up, that we are concerned with bringing out the facts by such question and discussion as we can have in this House. If the Minister would give the House the clearest possible information as to his proposals then there would not be so much time wasted. However, when we have Deputy Allen, on the one hand, and the Minister, on the other hand, pretending that the local authority have powers in respect of health administration which they have not then, naturally, there is persistence on our part in putting questions and in pointing to facts which, in the interests of the Minister's proposal itself and particularly in the interests of the public, we must do. Deputy Dr. Browne declares that because this House gives, through a statute, power to one man to carry out a certain scheme of administration, it makes it all right—that we have power to remove the man at any time and, therefore, it is not only pure and perfect democracy but a complete safeguard of anything that democracy would look for in connection with the freedom of the individual and the services he may require. That is allnonsense and so much is it nonsense that Deputy Dr. Browne is driven to take up the attitude that not only does he stand four-square with the Minister on this Bill and on the 1947 Bill but he has to go back to 1922 to say that he stands with the Minister.

An Leas-Cheann Comhairle

Is the Deputy discussing amendment No. 66?

General Mulcahy

I am, Sir.

An Leas-Cheann Comhairle

That is the only question before the House.

General Mulcahy

That is the only question before the House and we have endeavoured in every possible way to bring out the facts with regard to this amendment and its implications. So far has Deputy Dr. Browne, who professes in a superior kind of way to criticise our approach to this matter, slithered from the point of view of being able to put forward any argument or justification for his attitude that he has now to go back and say he stands with the Minister in regard to 1922. It is an indication of how far we can travel in looking for sticks and stones and mud, as it were, to obscure the situation. Whatever Deputy Dr. Browne may say with regard to any aspect of Irish history to bedevil or obscure his attitude with regard to this Bill——

An Leas-Cheann Comhairle

The Deputy is discussing the Bill. The only question before the House, as I have pointed out, is amendment No. 66 which deals with consultative councils.

General Mulcahy

I am helping the work of the House by pointing out that so long as the Minister wants to talk about our stupidity and our dishonesty and so long as Deputy Dr. Browne wants to travel back 30 years to 1922, so long will we be driven all the more to take up time in bringing the House back to the actualities of this proposal. This proposal is that the consultative council shall be set up with the restrictions imposed on it here for the sole purpose of advising a man who is the only man with any power to administer the Bill, subject only to the normal power of the local authority to strike the rate.

I could traverse some of the statements made by Deputy Allen to show how necessary it is to clear up the misunderstandings that Deputy Allen would like to create and go back to the position in which the Minister, who is handing over these powers to what he calls frum time to time the local authority, told the House a couple of days ago that he did not know what the reserved functions were, whether they applied to a county manager or county council. These are the circumstances in which we are trying, not to improve a measure conceived in an absurd frame of mind and which cannot get into operation, but to get clear for the House the facts of the situation so that we may be clear in our discussions.

Amendment put and declared carried.

Question proposed: "That Section 44 stand part of the Bill."

Dr. Esmonde

Could we have an explanation of this section?

Dr. Ryan

It could not be clearer than it is.

Mr. MacBride

It really is not a bit clear.

Dr. Esmonde

We are very stupid over here and cannot see these things. We would like an explanation.

Dr. Ryan

I know you are, but try to get over it.

Mr. MacBride

What are the types of requirements visualised in the section? Are they to be laid down in bylaws or Orders, or is it to be purely a matter of discussion with the Minister?

Dr. Ryan

The section sets out:—

"A health authority, when making an agreement with any person for the provision by such person of any service which the health authority are authorised to provide, shall comply with any requirements specified by the Minister."

Mr. MacBride

What type of requirements?

Dr. Ryan

For any service—if they make an agreement with a hospital or a doctor.

Mr. MacBride

Will they be prescribed by Order?

Dr. Ryan

By regulation.

Mr. MacBride

Would the Minister not say so in the section?

Dr. Ryan

"Requirements specified by the Minister" implies that it is done by regulation.

Mr. MacBride

Is it not open to the Minister to write a letter saying: "I require you to do so and so"? If the Minister is correct with regard to the intention of the section, would it not be better to provide some such words as "comply with any regulations made by the Minister"?

Dr. Esmonde

Could this possibly be construed as giving the Minister power to override any decision made by a local authority? As we know, the services are to be administered by the local health authority, but does the section mean that the Minister can intervene and override any services the authority may establish or put into effect? I am not clear on that.

General Mulcahy

The Minister has been talking about our stupidity and our dishonesty, but surely when the Minister puts a particular clause in a Bill, that clause has a purpose. If the Minister has any function in relation to the measure, he has the function and the responsibility of putting before the House the circumstances in which he thinks it necessary to embody such a clause in the Bill, of stating what is the purpose of the section and what is it intended to deal with and giving us, if we require it, an idea of what procedure will be adopted to put the section into operation.

Dr. Ryan

Surely nothing could be clearer than the section. If the local authority propose to make an agreement with any person or body for the provision of services, they will be subject to any requirements specified by the Minister. There would, in the first instance, be general regulations laid down. It is usual to stipulate that certain things must have the approval ofthe Minister. Certain agreements made under the regulations shall be, I take it, subject to approval. I do not know that this section requires any particular explanation. In my experience, after four days' explanation Deputies opposite seem to be as wise now as they were in the beginning and I do not see why I should waste four more days explaining this section.

Mr. MacBride

The only question I have asked the Minister is whether the requirements of the Minister which are referred to in the section are to be set out by way of Order or regulation? Surely we are entitled to an answer to that? I am not being difficult. Will these things be done by regulation, by an ordinary letter written by the Minister or through the medium of the telephone?

Dr. Ryan

Perhaps the Deputy has not had much experience of local authorities. General regulations will cover a good deal, as they always do, but it may be that certain things will require the approval of the Minister. I could not at the moment state any particular type of agreement that would need such approval. Local authorities making agreements with doctors in connection with maternity services would certainly be covered by the general regulations laid down and the same agreement would be entered into with every individual doctor. That will apply, too, so far as I can see to agreements with voluntary hospitals. But there may be very special cases where the regulations will not cover specific instances; a local authority may need the specialist service of some particular doctor in a specific case in which the existing regulations would not cover the doctor in question and in that connection the Minister then will lay down certain regulations by letter or by circular.

Mr. MacBride

I am afraid the Minister has not yet answered the question I asked. This section provides that the local authority shall in certain circumstances comply with the requirements specified by the Minister. Now, are those requirements to be specified by way of regulation, by Wayof letter, by way of telephone communication or what? A regulation made by the Minister must be laid on the Table of the House and, because of that, the House will have some opportunity of expressing its views as to the desirability, or otherwise, of any regulation made by the Minister. On the other hand, if this section enables the Minister to compel a local authority to adopt a certain course by letter or by telephone communication, the House is thereby deprived of the one safeguard there is in relation to the powers of the Minister to order local authorities to pursue a certain course.

Dr. Ryan

I do not think I can explain it any more than I have explained it already. Generally speaking, regulations will cover most matters, but I cannot at the moment say that regulations will cover all cases that may arise. Specific cases may arise which will not be covered by regulations and in such cases the local authority might be or could be directed by the Minister to observe certain conditions in making a certain agreement.

Dr. Esmonde

This section then gives the Minister power to make a ministerial Order without reference to the Oireachtas. Is that not the position? There will be certain regulations in certain districts. The bulk of the regulations governing the administration of these envisaged health services will be universal, but in certain areas there will be differences in the regulations. I take it what the Minister has in mind is that—I may be wrong in this—he may consider a certain type of service should be given in a certain district or something carried out by the local authority which is not already included in regulations: this section then gives the Minister power by ministerial Order to compel the local authority to put something into effect forthwith without reference to the Oireachtas.

Dr. Ryan

Without reference to the Dáil or Seanad—that is quite right. I might say that in every appointment made by local authorities at the moment the Minister lays down the conditions of appointment. That has been the rule all the time.

Mr. MacBride

Is that not done by regulation?

Dr. Ryan

Not necessarily.

Mr. MacBride

I think the Minister will find that all these things are done by regulation specifying the conditions of appointment and so on.

Dr. Esmonde

This section really covers the whole Bill from beginning to end. It gives the Minister complete control over the health services.

Dr. Ryan

Every amendment and every section so far, according to the Deputy, gives me that power.

Dr. Esmonde

But under this the Minister can ignore the Administration.

Dr. Ryan

The Deputy has said that in relation to every section up to this.

Dr. Esmonde

But this covers every section and every amendment. The Minister has said that he is in a position to make a ministerial Order. This section empowers him to do that with regard to any appointment. It legalises the position for him.

Mr. Kennedy

That is a power every Minister has under statute.

Dr. Ryan

I have that power at the moment.

Dr. Esmonde

Then what is the object of the section? It is giving the Minister power to make regulations without reference to the democratically elected representatives in relation to health services. I cannot find any other interpretation for it.

Question put and agreed to.

SECTION 45.

Amendments Nos. 67 and 68 not moved.

Question proposed: "That Section 45 stand part of the Bill."

Dr. Esmonde

Would the Minister like to tell us something about Section 45? This is a long section about the training of disabled persons. Does the Minister intend to have these persons trained locally? Is there anymachinery already in existence to deal with these people?

Dr. Ryan

This is a new power being conferred on the local authority; indeed, it is a new obligation. This section will be operated by regulation; and under regulations made by the Minister local authorities will be expected to provide facilities for the training of disabled persons for suitable employment in relation to their condition of health, ete. They will also be expected to help in finding employment for these people when rehabilitated. That is the first part of this section. I have not fully made up my mind yet but I got advice from various people and my idea is to have a central committee advising on this whole subject of rehabilitation. The central committee would give advice and lay down a scheme for local authorities to follow. The local authorities would also have a voluntary committee composed of certain people, perhaps some members of the council and some others who would be helpful in looking after this matter of rehabilitation and who would be especially helpful in finding employment for the rehabilitated people. The medical officer of health would, of course, be responsible for the medical part of the treatment.

There is also a sub-section which puts the onus on the local authorities to provide the necessary equipment and so on. Then the Minister may make regulations with the concurrence of the Minister for Finance providing for the payment of maintenance allowances to the persons specified in sub-section (5) of the section. In sub-section (5) the persons specified as being eligible for maintenance allowances are those over 16 years of age who are incapacitated to the extent of their not being able to earn a living for themselves and have no means. That is qualified to the extent to which the person's family should look after them.

It is a new scheme—no new principle is involved—introduced for the first time to look after the disabled people in this country. When I was bringing the Social Welfare Bill before the Dáil, I drew attention to this. I said Ithought we had now succeeded in covering all the different classes that needed help from the State to meet the ordinary hazards of life but that there was one class, this particular class of disabled people, who were not insured, who had no means and who were incapacitated from earning a living and who should be covered by some scheme. It seemed more appropriate that they should be taken in under this Health Bill because the patients suffering—from infectious disease already have this scheme at their disposal. This is an extension of the scheme, which refers to infectious disease, to other members of the population who are disabled and unable to make a living for themselves. I am not able to go any further than that at the moment. It requires a good deal of thought and so on.

One thing I am very keen on is that the local authorities and the Minister should have the assistance of voluntary organisations in working this scheme out. I think it will be necessary to have a central committee composed of various people Who would be interested in this subject and, perhaps, people who have knowledge of this subject to advise on the best scheme to be drawn up for the local authorities. Again, I think that the local authority will in turn require a voluntary committee to advise them on the administration of the scheme and in placing people in employment. As a matter of fact, when we come to that question, it may be necessary to have more than one voluntary committee in a county. It may be necessary to have them in various places so that they can help in procuring employment for disabled people.

I am sure Deputies will realise that a person who is suffering from some physical defect may be quite as good a worker in some occupation or another as the person who is physically fit but the employer is always reluctant to take a person of that type into his employment. It will require a lot of persuasion and a little appealing to his better senses and so on to get him to help in placing these people in employment when they are rehabilitated. I think that really covers thesection as far as I have made any progress in getting it ready to put into operation.

Mr. MacBride

This is probably one of the most useful and constructive provisions of this Bill and one which certainly deserves the support of the House. I agree entirely with the views expressed by the Minister in regard to the necessity for some advisory body and also for enlisting the co-operation of voluntary organisations to make it effective. I do not know, however, whether the Minister has really examined the section very carefully. Sub-section (5) seems to nullify a lot of the provisions of the section. Sub-section (5) says:—

"The persons referred to in subsections (3) and (4) of this section are disabled persons over 16 years of age who are unable to provide for their own maintenance and whose relatives within the meaning of this sub-section are unable to provide maintenance for them."

What does "maintenance" signify in that sense? Is it the old poor law definition or is it some new definition? I can quite well visualise a number of cases where a person's family might actually be able to feed and clothe a boy or girl who is deformed, badly injured or blind, but might not be able to afford the necessary treatment in regard to occupational therapy. I do not know whether I have made myself clear to the Minister. Maintenance is one thing. A family might easily be able to pay for the actual food and clothing for a youngster of 17 or 18 years of age, but be unable to afford the course to have that youngster trained in an occupation that he could pursue later on, because most of the training in respect of persons who are physically defective is specialised and is fairly expensive. I do not know whether the Minister intends this section to cover blind persons or not. As the section is framed, I think it would include blind persons.

Dr. Ryan

It could. The blind have their own scheme.

Mr. MacBride

I take it that this will apply and place on the localauthority the responsibility for providing facilities for the blind as well.

Dr. Ryan

It will.

Mr. MacBride

It imposes an additional function on the local authority. If that is so, I do not know whether it is wise to have an age limit of 16 years. In the case of blind persons the main problem is to train them from an early age. As the section stands, I think it precludes the local authority from making provisions for the training of a blind child of ten or 12 years. It is really at that age that training is particularly important.

Dr. Ryan

The theory I am following is that the parents are responsible for a child under 16 years. If their means permit, the parents can get help to educate that child up to 16 years.

Mr. MacBride

The problem in connection with the blind is that the actual cost of teaching the Braille system to a blind child and teaching him the general use of his other senses is quite an expensive process which can only be carrisd out in a few places in the country. I think it would be of tremendous benefit if this section could include blind children and place on the local authority the responsibility of defraying the cost of having that child trained.

I take it, too—I do not know whether the Minister has considered this, or whether it may not be covered somewhere else in the Bill under an omnibus section—that, in many cases, a local authority will be enabled to provide the necessary training itself. Perhaps there should be power given for a local authority to provide, jointly with other local authorities, for the training visualised in the section. For instance—I am sure the Minister had in mind the case of children affected by polio—it might be feasible for each local authority to have a training centre of its own. You might have only two or three training centres altogether.

Dr. Ryan

That is right.

Mr. MacBride

I do not know whether the Minister has considered ifenough power is given in the Bill to enable local authorities to provide such centres, or whether it would be wise to include a further enabling sub-section to enable a local authority to arrange with other local authorities to provide such training. I think the Minister should consider fairly carefully whether it is wise to include this age limit of 16, because the mere fact that it is included will mean that a local authority will have no power to provide training for a child under 16 though, in many cases, it would be highly desirable that such training should be provided for it.

Dr. Browne

I agree with Deputy MacBride that the sentiments expressed in the section are excellent if they are ever capable of implementation. I am afraid that will not depend solely on the goodwill of the Minister which, I am sure, is there in full. Speaking from a certain amount of experience of dealing with rehabilitated persons, I am afraid I cannot see that this section will help to any great extent until we reach the position when our numbers of unemployed will be very much smaller than they are at present, that is the number of able-bodied persons who are able and willing to work and who cannot find work. As far as I can see, in attempting to rehabilitate persons you are going to be up against that problem of having so many able-bodied men, able and willing to work, who cannot find work. Consequently, there is bound to be great difficulty in trying to place a disabled person in any kind of employment against a healthy person.

I welcome the section because it will give the Minister power to encourage local authorities to set about trying to rehabilitate disabled persons by this extra provision of extending the rehabilitation facilities, not only to the persons whose disablement is due to infectious diseases, but to those suffering from poliomyelitis, to the paralysed child and those suffering from general disability of whom we have so many throughout the country. Their very serious distress is due to the fact that there is no such provision as this in any of our existing health legislation. While, however, we are faced with thefact that we have 50,000, 60,000 or 70,000 unemployed, healthy persons, I am afraid that the disabled person is going to have very little hope of competing against them, even though he is highly trained and skilled in some occupation or other. The employer, with his eye on profits, is going to go for the healthy man who can give him a full day's work or a full week's work. I am afraid the majority of employers will do that, though, I agree, some of them are magnificent. They are very good; but, generally speaking, the employer is going to take the man who can give the best output for the money he pays him. These are hard facts.

There is another point to be borne in mind in this connection. It is this, that in this particular matter, the State itself—that is to say, ourselves in our representative capacity—is not above reproach in relation to the rehabilitation of disabled persons. I am afraid that so far as State—local authority—institutions are concerned, they are too rigid and too inflexible in their consideration of these problems. Personally, I find that it is much easier—my opponents can take this for what it is worth—to get voluntary boards to consider the problem of disabled persons than it is to get the local authorities to do so. I am speaking specifically on this from the point of view of those whose disablement is due to an infectious disease. My point is that the local authorities are too rigid and too inflexible in their consideration of these problems. There are many individual examples of that to which I could refer the Minister. In my opinion, the local authorities appear to be bound too much by considerations relating to the superannuation code—that is, on the question of giving permanent and full-time employment to disabled nurses, disabled gardeners, porters, telephone assistants and clerical assistants of the secretarial type. We cannot afford, therefore to be too hard or too critical of private enterprise or of industrialists in relation to this problem if we leave ourselves open to what, in my view, is the legitimate charge of being particularly hard-hearted ourselves where State institutions are concerned.That certainly is true of any local authority institution of which I have any knowledge.

There is one other consideration which, I think, is important. It is referred to by Deputy Larkin and Deputy Kyne in their amendment. I hope that the Minister covered it in his references to the Bill—that is, that the trade unions will be consulted, or will be part of the consultative body, as regards the type of training—and the type of person to be trained— which will be provided. It is absolutely imperative that trade union representation should be included on any consultative body. Speaking from my own experience, one of the difficulties which trade unions appeared to find themselves up against was that if they had many of their members idle, men who were quite capable and competent to do work, and in such a situation accepted the principle of a disabled person being employed on a particular type of work in some particular institution, it would mean putting an able-bodied man out of work. I move to report progress.

Progress reported; Committee to sit again.