Dáil Éireann debate -
Thursday, 16 Jul 1953

Vol. 140 No. 9

Private Business. - Health Bill, 1952—Committee (Resumed).

Question again proposed: "That Section 53 stand part of the Bill."

Question put and agreed to.

SECTION 54.

Minister for Health (Dr. Ryan)

I move amendment No. 78:—

Before sub-section (6), page 23, to insert a new sub-section as follows:—

(6) Regulations under this section shall not prohibit absolutely the useby a registered medical practitioner in medical practice or by a registered dentist in dental practice of any radio-active substance or any irradiating apparatus, or require a registered medical practitioner or registered dentist to hold a licence for the use of radio-active substances or irradiating apparatus in medical practice or dental practice, as the case may be, or for the storage of such quantities of radio-active substances as may be reasonably required for his practice.

The section deals with radio-active substances, and the intention is to regulate their distribution and control. The handling of some of these radio-active substances is very dangerous to human beings, and we want to see that they are handled and controlled in a proper fashion. The members of the Medical Association, however, had some fears that the section might apply to them in their ordinary use of X-rays, although the section was not meant for them. I am moving the amendment to ensure that they cannot be interfered with in their legitimate business. The amendment is to make sure that the section will not apply to medical men and dentists in their ordinary use of X-rays. That is all it amounts to.

Amendment agreed to.

Section 54, as amended, agreed to.

Section 55 and 56 agreed to.

SECTION 57.

Dr. Ryan

I move amendment No. 79:—

To delete sub-section (2) and substitute the following sub-sections:—

(2) A health authority, with the approval of the Minister, may do all things necessary to provide course of instruction for medical officers (including medical officers of other authorities).

(3) Nothing in this section shall be construed as imposing an obligation on a medical officer to attend at a course of instruction provided under this section.

The purpose of the section is, first of all, to give public authorities thepower, which they have not at the moment, to use their hospitals for post-graduate courses. As a matter of fact, some local authority hospitals have been used in the past for clinical teaching, although it is very doubtful if there was any legal authority for that use. However, no one objected, and I suppose there was no harm done. The purpose of the first part of the section is to make the position legally correct where a local authority hospital is used for clinical teaching of any kind.

The second part of the section is designed to enable health authorities to organise post-graduate courses for their own officers. No officer can be compelled to attend such courses. The Medical Association, again, objected very strongly to this particular provision because they held that the teaching of medicine is the prerogative of the medical schools, and that no authority should be allowed to compete against the medical schools. It was never intended that we should compete against them or set up medical schools. The only intention was to enable local authorities to organise post-graduate courses, or special courses, which, indeed, are sometimes necessary. However, in deference to the wishes or the fears of the Medical Association, I am moving this amendment to make it perfectly clear that only post-graduate courses are contemplated, and not that we should start a medical school. I think that the amendment is fairly clear in its wording, and that it does not require further explanation.

Mr. MacBride

Is it the intention that the universities should be tied in with the courses proposed?

Dr. Ryan

Not necessarily. They might be.

Mr. MacBride

Does the Minister not think that it would be wise to integrate the whole system of medical education with the universities, so that you would not have two completely separate sets of courses proceeding at the same time? I am simply anxious to get the Minister's views on that.

Dr. Ryan

If we contemplated medical education in that sense, I think we would be inclined to consult the medical authorities in the existing schools, whether universities or colleges. This, however, is to provide for special post-graduate courses that might be necessary for men working in the public service. Let us take diphtheria immunisation. That, of course, is well known now, and every medical man coming out knows all about it. But, at first, it might have been necessary to call in a certain number of medical men from the country to give them a course of instruction on diphtheria immunisation.

You have the B.C.G. vaccination against T.B. I quite admit that a few hours' instruction would probably be sufficient now for men on a course of that kind. We will always be up against things of that kind. We have no authority at the moment to get men, say, in the provinces to meet at one centre and have a course for a day or two on any particular treatment or method of treatment. This is merely to authorise local authorities to provide post-graduate courses of that kind.

Mr. MacBride

The only thing that occurred to me was as to whether it would be useful, when this legislation was going through, to have some way of intergrating the medical schools with whatever additional instruction and facilities are to be provided through the local authority hospitals—as to whether the whole scheme could be integrated. Any additional facilities that may be provided by a local authority for additional training, additional instruction, are, of course, welcome and probably very desirable in the sense in which the Minister has indicated. The only thing I was wondering is whether it would be possible to tie that in with existing universities so that, apart from the officers of the local authorities, ordinary university students would be able to participate in such courses.

Dr. Ryan

These would be post-graduate courses.

Mr. MacBride

I mean post-graduate students, other than officials of thelocal authorities. Will these courses be open, for instance, to a young man or woman doctor who has just got a degree and who may not be holding an appointment under a local authority? Will they be in a position to benefit by these courses?

Dr. Ryan

I do not know. That depends on the local authorities. I do not know whether they will open their courses to outside people or not. There may be some difficulty about the number that can be conveniently dealt with. The Deputy must be aware that in post-graduate courses sometimes you cannot deal with more than a certain small number because they cannot get proper demonstration if there is too big a number.

Mr. MacBride

Would the Minister leave the door open by adding a couple of words to this section? The section is limited to medical officers at the moment.

Dr. Ryan

They can always consult with the medical schools, if they want to, but I would not like to put into this that they must consult with the medical schools.

Dr. ffrench-O'Carroll

I think the Minister has in mind something more on the line of a refresher course than full post-graduate teaching in the accepted sense of the word. The point that Deputy MacBride makes about the integration of work in the hospitals and the universities is tremendously important. It is the great defect at the moment with post-graduate teaching, as far as medicine is concerned, in Dublin, that there is not a proper integration of the clinical work in the hospitals and the university work. There is a great deal of overlapping on both sides. We must remember that and face up to that position. The greatest difficulty in medical education in Dublin at the moment is the virtual absence of post-graduate courses. I can well understand how it is necessary for the Minister, if he is going to maintain a proper standard amongst the medical officers of the State services, to provide such facilities. It is ridiculous that the State should ever have to provide these facilities but the need to provide thefacilities exists. It is an urgent need. I do not think we will be able to ensure that medical men in the State service will be able to keep really up to date unless there are facilities provided by the State by which they can get these opportunities which they cannot readily get elsewhere at the moment.

Mr. MacBride

I think it would leave the door open if the Minister deleted the last three words, "for medical officers", so that any other doctors could also be given the benefit of any instruction that is available. In other words, it might be possible to arrange that students who had just qualified would be able to attend these courses although they were not officers of local authorities.

Dr. ffrench-O'Carroll

The doctors might take a very different view.

Mr. MacBride

I am talking from abysmal ignorance of the matter. I only mentioned the matter to the Minister so that he could consider it.

General Mulcahy

The section as originally drafted was intended to give a health authority, with the approval of the Minister, power to provide and maintain a medical school for the post-graduate medical education of medical officers (including medical officers of other authorities) and to make arrangements for the post-graduate medical education of any of their medical officers. That is to say, the Minister approached this matter from the point of view of setting up a medical school or a number of medical schools under various health authorities for the purpose of giving post-graduate medical education to medical officers of local authorities.

The amendment would provide that a health authority, with the approval of the Minister, may do all things necessary to provide courses of instruction for medical officers (including medical officers of other authorities) and the Minister just puts in a proviso that nothing in the section shall be construed as imposing an obligation on a medical officer toattend at a course of instruction provided under this section.

The Minister's amendment seems to me to be departing only as a matter of phraseology from the original intention. It seems to me that the Minister is taking power to authorise health authorities to engage in post-graduate medical education. I would like to ask what arrangements the Minister has made or proposes to make with the university authorities responsible for medical education, whose function and whose province it is to look after medical education? What arrangement will be made between the Minister and the medical educational authorities in relation to either the nature of the work or the class of work that will be done in any post-graduate medical education scheme under a local authority? It is vitally important to maintain a central outlook, a central mind and a central direction on medical education.

Captain Cowan

Have we that at the moment?

General Mulcahy

At any rate, there are certain authorities in the country who have the function and the responsibility for directing medical education and, without more information than is given here, it would seem to me that we would be setting up the Minister and local health authorities and giving them power to organise and direct medical education. We ought not to embark on a venture on those lines without having a rather full explanation as to the theory that is behind the idea.

Dr. Ryan

As I explained, a local authority has no power at the moment to allow even a post-graduate course in a local authority hospital. We must give them that power, first of all, if we are going to have post-graduate courses. Secondly, having given them the power, we say they can organise post-graduate courses. I have tried to make it plain by the amendment that we are not going to start a medical school. Some of these people in the Medical Association purported to believe that we were going to start another medical school, which wasricidulous really. Just to reassure them, this amendment is put in. We are only dealing with post-graduate courses. I would not agree to say that they must get the agreement of the medical school because there is a possibility, and indeed the possibility is very apparent at the moment in the way things stand, that if you have an outstanding surgeon in a county hospital, if the university authority were to be consulted, they would say: "No, we do not agree." If you have an outstanding man of that kind, I do not see why his services should not be availed of to give a post-graduate course, if it is thought necessary. Then we might take all our county surgeons. They might all congregate together for a course in one of the hospitals where they could each, I suppose, take a turn in his own speciality, whatever it might be. Amongst general surgeons, as we all know, one man is good at one thing and another is good at another thing.

There are various possibilities. I am only dealing with surgery, but the same thing might apply to medicine or gynaecology, or any of the other branches. But with this spirit which you have at the moment of practically boycotting men who are getting public appointments I think we must provide that they at least will be permitted— that is all we are saying here—to disseminate their knowledge one to the other. We are not going further. We are not saying they must, but that we will permit them to do so.

General Mulcahy

The Minister's last remarks would suggest that this is not so much a practical development for the purpose of improving the education and training of medical officers of local authorities, but a gesture of defiance or an answer to the medical profession who do not seem to see eye to eye with the Minister's proposal.

Captain Cowan

Is not that nonsense?

Dr. Ryan

That is a good interpretation of what I said, is it not?

General MacEoin

The Minister said this is permissive. On its face, it doesappear to be wise in the sense, if you have a very efficient surgeon or specialist in a county hospital, that that surgeon or specialist would get an opportunity of imparting the knowledge or technique he has to others. I agree with that on its face. But the Minister admits that at the present time the diffusion of knowledge to medical officers or students of the medical profession is not carried on in certain specialist centres. He says that if permission was asked to have this done the medical profession would say no, that they would not allow the local surgeon or doctor to diffuse that knowledge, that they would not allow a post-graduate course to take place at the centre selected.

When Deputy Mulcahy says that that was the Minister's reply to these specialists I think that statement is well founded. Somebody said that what Deputy Mulcahy stated was only to create trouble. I think the people who put that interpretation upon it are the people who want to create trouble. Is it not true that American specialists have criticised even our best centralised treatment?

Captain Cowan

Is it true?

General MacEoin

Let us bring it down to local county hospitals. Are we not giving an opportunity to people to criticise still further and say that we are having people trained in this highly specialised profession in backward districts? They will not take notice of the fact that the county surgeon and medical officer operating in these hospitals are specialists. They will not give them credit for that no matter how great their qualifications may be. Nobody knows better than Deputy Cowan that more is thought of a law student if he serves his time in one of the bigger or well-known firms rather than in a less well-known firm. Although the Minister says this is permissive, I think the fewer times he will give that permission the better it will be. I know that not only doctors but others have taken a rather serious view of the new type of decentralisation. I do not know why the Minister should cast them aside and say that they are to be ignored and that he intendsto go ahead no matter what the consequences.

Captain Cowan

Deputy MacEoin says that, on the face of it, this section is a good one and he takes no exception to it. That is a sensible outlook because it is a sound idea. If it is a sound idea, we should put it into practice. There is no question of anybody trailing his coat in front of anybody else. It is simply a matter of doing something which is considered to be sound and right. One of the important things in civilisation is to advance knowledge and the more posts of a post-graduate nature that can be provided for professional people of all kinds, but particularly for doctors, the better. Medical science is not something that is standing; it is something that is moving very rapidly. There are some doctors better than others who study and advance themselves and it is a wise thing that their knowledge should be diffused. Anything that will improve the medical profession and, particularly, the efficiency of dispensary doctors and other doctors employed by local authorities is good for the country.

I certainly can see no reason why anybody should object to the provision that the Minister is inserting. Once we are agreed that it is good let us do it without endevouring to find some obscure reason why somebody might discover that there is something wrong in it. No matter what we do in this House or what is done in any Legislature in the world there will be somebody who will find something wrong or objectionable in it. If we are all agreed that is good we ought to try and put it into practice.

Mr. Cunningham

I think the amendment is a good one. Speakers up to now were only looking at one side of it. They forget that the local authority will use the hospital for a post-graduate training course. Let us take it that a new drug is discovered. A number of local authorities can get together to make provision for training in the local authority hospital in one particular county. For instance, the local authority hospital in Sligo could be used for Donegal, Sligo andLeitrim. If it were necessary, a specialist from Dublin could carry on that course. I wonder if that is envisaged.

Mr. MacBride

I wonder if the Minister would widen the section to enable doctors other than local authority doctors to attend the courses with a view to integrating ultimately the whole medical education that exists at the moment.

Dr. Ryan

I want to get clear on what the Deputy wants. We could not leave it open to everybody but if the Deputy thinks we should not make it impossible to admit them I would agree with that.

Mr. MacBride

Will the Minister remember to do that?

Dr. Ryan

Yes.

General MacEoin

I hope the Minister will not let in any people with cures—the diffusion of knowledge, you see. There are people who have cures of various types and kinds, fingers and everything like that. Just to show you the diffusion of knowledge on this particular amendment—there was a fellow who went down about three years ago to a certain doctor and said: "This finger is very bad." The doctor said: "The surgeon will have to operate on that," but the man said: "There will be no operation. I will go and get a cure from the back of the hill." He went down, got the cure and came back with the finger bandaged. The local doctor took off a little piece of the plaster that was under the bandage and sent it up to the State laboratory, where the plaster was found to contain almost 90 per cent. penicillin. Pencillin had been there at the back of the hill for the last 500 years.

Amendment put and agreed to.

Section, as amended, put and agreed to.

SECTION 58.

Question proposed: "That Section 58 stand part of the Bill."

General Mulcahy

On Section 58—it gives the Minister authority to direct a local authority to provide and maintain a nursing school in connection with the institution maintained by them. Will the Minister say what are the conditions that suggest the provision of a nursing school by the local authority may be necessary?

Dr. Ryan

The nursing board has laid down certain conditions necessary for the recognition of a nursing school by them. It must be a fairly substantial hospital with, I think, more than 100 beds between surgery and medicine. It must be a general hospital and so on. The Minister must have regard to that before he will either sanction a local authority hospital or direct a local authority hospital to provide a nursing school. The fact is that there are hardly enough nurses in the country, and if we proceed with the implementation of this Bill when it becomes an Act, we certainly would want more nurses, and it is feared it will be necessary to get other nursing schools. Some of the big county hospitals would be admirably suitable, like the regional hospitals. I do not think it will be necessary for the Minister to give an Order; I am quite sure the local authority will do this without any great pressure, but it will be necessary for the Minister to sanction it. One local authority hospital has been a training centre for some time, and that is Galway. There may be other local authority hospitals added to that.

Mr. MacBride

May I ask the Minister a question on that? Does the section preclude from using as a nursing school a voluntary hospital? I have a case in mind and probably the Minister is familiar with it— Ballinasloe. Would it preclude the authorities from using Ballinasloe as a training school?

Dr. ffrench-O'Carroll

I welcome this section. I think it is going to be a great help to the State hospitals. It is extremely difficult to run hospitals efficiently and maintain a high standard of care and treatment unlessthe training school is part of the hospital. This is a section which will enable local authority hospitals to become training schools, and apart from that fact it is going to enable these hospitals to raise the standard of nursing and maintenance and care of patients. It is also something that is going to widen considerably the scope of employment and opportunities for nurses in this country. I know it has long been a disadvantage at St. Kevin's. The fact that they are not recognised as a training school has created considerable difficulty in the equipment of the hospital from the nursing point of view and it has delayed the development of standards of nursing. I think this section will be a great advantage to the patients in the county hospitals and to the nurses themselves.

General Mulcahy

I understand from what Deputy Dr. ffrench-O'Carroll says that it is really a proposal for the setting up of hospitals for the training of nurses to serve in State or public hospitals?

Captain Cowan

They could serve anywhere.

Dr. Ryan

They will not be confined to the public hospitals. They will be trained in the ordinary way.

Mr. MacBride

Is the Minister aware that under the section as drafted a local authority may say that it will appoint a voluntary hospital as its training school? I do not think the section is wide enough to cover that.

Dr. Ryan

A local authority cannot employ a training nurse at the moment and if the nurse is being trained at Portiuncula, which is partly Portiuncula and partly local authority, it is doubtful whether at the moment the local authority part of it could use nurses that are being trained, but if this section goes through, they can then establish a school for nurses in the local authority part of it and everything will be quite right.

Mr. MacBride

They could not do it in the other part?

Dr. Ryan

I think they could do it in both parts then.

Question put and agreed to.

SECTION 59.

Question proposed: "That Section 59 stand part of the Bill."

General Mulcahy

Can the Minister tell us what bodies he has in mind?

Dr. Ryan

There is authority at the moment under the Public Assistance Act of 1939, Section 21, under which public assistance authorities are empowered to contribute to anybody who provides similar or ancillary services to what they are providing themselves. This is to replace that section and give health authorities power to contribute to the maintenance of any voluntary body that might provide services that the health authority would be providing itself. There are, as Deputies are aware, certain organisations for nursing, and as Deputies will know even from the appeals that have been made to them for assistance, there are a number of clinics of that nature which have been set up, and the section will enable local authorities to make contributions, either in cash or in kind, to these organisations or give help that they may need.

Mr. MacBride

It is a very good provision.

Question put and agreed to.

Section 60 agreed.

SECTION 61.

Question proposed: "That Section 61 stand part of the Bill".

Mr. MacBride

I wonder if the Minister would like to say something on the section?

Dr. Ryan

There are certain services of a central kind which have to be paid for by the local authorities in general. One is the lymph service which is used for vaccination against smallpox. I think the total cost is about £2,000. It has to be distributed between the local authorities—the expense of maintaining that particular institution. There maybe a few other matters of that kind and there may be some new services like mass radiography or any others of that kind. This is to enable the Minister to distribute the costs between the various local authorities.

Question put and agreed to.

SECTION 62.

Question proposed: "That Section 62 stand part of the Bill."

General Mulcahy

Could the Minister say what the purpose of this section is?

Dr. Ryan

The purpose of it is to enable health authorities to administer certain provisions of the Merchant Shipping Acts which can be more conveniently administered by a health authority. The health authority, as Deputies are aware, will have a sanitary inspector and perhaps a port medical officer at the various ports. It would save a lot of expense for local authorities if these men could take over certain other functions such as the provision of water and matters of that kind. The purpose of the section is to enable a health authority to undertake that type of service.

Question put and agreed to.

SECTION 63.

Mr. MacBride

I wonder if we could take amendments Nos. 80 and 82 together? It seems to me that they could be more effectively discussed together.

An Ceann Comhairle

Yes.

Mr. Larkin

What about amendment No. 81?

An Ceann Comhairle

Amendment No. 81 has been ruled out.

Mr. MacBride

It is a direct negative really.

Mr. Larkin

I move amendment No. 80:—

Before Section 63 to insert a new section as follows:—

Where a person complains to the Minister that he has not been providedwith services to which he is duly entitled under the provisions of this Act, whether such services are subject to a charge or not, the Minister shall cause such complaint to be inquired into, and if he is satisfied that the complaint has been substantiated, shall direct the health authority to provide the services to which the complainant is duty entitled to be provided with under the Act.

The purpose of the amendment is to leave in the Bill some final aid or recourse for the individual who finds that, for some reason or another, he has not been provided with services to which he feels he is entitled under the provisions of the Bill. I speak subject to correction but my recollection is that, under the 1947 Health Act, the Minister did in fact have the powers which it is suggested he should retain in the present Bill by this amendment. What arguments were advanced to make the change I do not yet know, but it does seem to me, following the course of the discussion in this House, that quite clearly the formulation of policy and the determination of the broad lines of the services to be provided will be a matter for the health authority but the actual control and the availability of these services to the individual will be a matter for the county manager. That does raise the question as to what is the position in the event of any individual feeling that he had not been given services by the county manager or his officials to which he felt he was entitled.

At one period in the discussion, when we were discussing the consultative health council, reference was made, first of all, to the fact that the provisions dealing with the consultative health council left no consideration at all for individual cases. On that we were agreed but mention was made of the fact that it still did not prohibit members of the health authority—that is the county council —raising these matters individually if they were brought before them by constituents. That, however, may be a course of action to which the individual concerned might not like to resort, in so far as it would involve theraising of the health problem of that particular individual through the medium of the health authority and might result in the details of the case becoming common property amongst individual members of the council. He might feel on the other hand, that having a grievance in respect of which he could not obtain satisfaction from the county manager or his officials, at least he should be afforded some final court of inquiry of a more restricted or personal character than the health authority itself and that such a form of inquiry should take the form of a personal statement to the Minister, or, as the Minister himself indicated in the course of the discussion, an inquiry as to the facts of the case which might result in the Minister intimating that he was satisfied that the complaint was justified and that in his opinion the particular service should be rendered to that particular individual.

As I read Section 63 it seems to be definitely formulated in such a manner as to remove from the Minister all kinds of general supervisory powers in so far as the individual is concerned while at the same time he can retain very great powers in regard to the policy and determination of the services as a whole. Why the matter should terminate at the point of the county manager, or why the Minister, who represents this House, should divest himself, apparently, of all powers to deal with the individual citizen and his particular rights in relation to the county manager and his officials, I am not clear. It is for the purpose of restoring the position under the 1947 Act that we put down this amendment. I believe the Minister has no valid argument as to why he should insert Section 65 in this Bill. It does seem that the balance of argument is in favour of retaining the Minister as the final court of inquiry or the final protection in so far as the individual is concerned, in relation to any default or failure on the part of the officials who are actually administering the services and in relation to determining, in respect of an individual, whether the services will be made available to him or not.

Mr. MacBride

I can see that there are three different viewpoints in relation to this section. There is, first of all, the provision contained in the Bill which provides that the Minister shall have no function at all, as I read it, in determining any appeals from the local authority, that his functions will terminate with the giving of general directions as to how the services will be provided and that he will have no function at all, and indeed will be debarred from exercising any function, in directing the local authority that in certain cases services must be provided. That is the viewpoint expressed in the Bill. Deputy Larkin's amendment, I think, wants to give a final right of appeal to the Minister that he should have the power to direct the local authority to reverse themselves, if needs be, in given cases.

The amendment which I have put down approaches the question from a completely different angle. I want, in my amendment, to try to get away from what I might call the political influence factor in health services. It seems to me that every citizen is entitled, as of right, to certain services or he is not entitled to them and that, instead of a citizen having to agitate a local county councillor or a local T.D. or the Minister in order to secure services to which he thinks he is entitled, the citizen should have the right to walk into the local District Court and to say: "My means are so and so; I belong to the lower income group or the middle income group and because of that I am entitled to such and such a service from the local authority", and that, thereupon, the local district justice should have power to make a declaratory order which would compel the local authority to provide the service. Of course, at the moment, in the position as it exists it would be open to citizens to go into the High Court and get a declaratory order, but that would be a highly expensive process which no ordinary citizen could afford to undertake. I aimed at trying to devise a simple procedure whereby a citizen could go in himself without any lawyers at all, complain to the district justice: "I am entitled to this service and I am not getting it", and the district justice, havingmade inquiry from the local authority, then determines whether he is entitled to it or not.

This Bill, providing different types of services for different income groups depending on a number of means tests of one kind or another, is bound to raise a great deal of difficulty in its administration. I can see an awful lot of conflict between the local authorities and the ordinary citizen as to whether a person is in the public assistance group or whether his family income is more than £600 a year or not. These are questions of fact. I anticipate that when the Bill comes into operation every member of this House will be approached with complaints from citizens who claim that they are entitled to a service but that the local county manager or the local medical officer, or some other local official has determined that he does not come within the particular category in which he claims the service is due. These are questions of fact and obviously some machine will have to be devised to determine the rights between the local authority and the ordinary citizen. I think it is very unwise not to provide some machinery to determine these rights.

Two alternatives present themselves. Either you give him a right of appeal to the Minister and to a certain extent of political agitation—I am using it in the sense of approaching a county councillor or a T.D.—or you try and do it by a simple judicial process which would enable anybody to walk into the District Court and lodge his complaint. The bulk of the complaints will, I take it, be in regard to the income group to which different citizens belong. It will be largely a question of fact, and I think it would be much simpler and better if the whole of this could be removed from the political arena into a much more objective arena like the District Court. I do not know whether members of this House are approached as often as I have been approached about all kinds of different things. I know that throughout the country at the moment numbers of county councillors are constantly being asked to intervene with the county manager in regard to thepayment of hospital accounts and so on. I think this is an unhealthy system.

Captain Cowan

You will have to change our whole system of existence if you are to change that.

Mr. MacBride

I do not think so at all. I do not think we should permit it. We should try and remove it from the political field. Generally speaking, there seems to be a feeling abroad that a citizen can only obtain his rights by having political pull. I think that is entirely wrong and that if we really co-operated together in the House we could get away from it. Every day every member of the House is approached to use his political influence to secure——

Captain Cowan

His public position, not his political influence.

Mr. MacBride

Would Deputy Cowan just keep quiet occasionally a little bit? If he cannot keep quiet, let him return to where he came from.

Either the citizen is entitled to his rights or he is not. It should not be dependent on the influence that he can wield with a county councillor or with a member of this House, nor should it be dependent on the influence of that particular county councillor or member of the House. These things should be removed as far as possible from the realm of influence. It seems to me that we have an opportunity in this Bill to try to get away from it because this Bill will undoubtedly open a new vista of political influence unless we try to prevent it. It is quite obvious that these services being in the main administered by the local authority, anybody who wants something, who feels aggrieved, who wants something that he is entitled to as of right, or who wants something to which he is not entitled at all, will feel that his only way of getting it is to go and start pulling political strings. We should try to get away from that if we could, and the best way of getting away from it would be to give a right of appeal from the decision of the local health authority to the District Court.

If the right of appeal is given to the Minister as suggested by Deputy Larkin—I would prefer to see a right of appeal to the Minister rather thanno right of appeal—but if it is given to the Minister again it means political influence. It means that if the Minister has the right of appeal that the local T.D.s will be approached to use their influence with the Minister in the hope that the Minister will determine the appeal in their favour. In all likehood the Minister will ignore the political representations made and will determine the issue on the advice of his officials irrespective of political considerations, but nothing will convince the public generally that the determination has not been reached as a result of political pull, so if we could get away from that I think it would be useful.

This is an important question because, quite apart from the provisions of this Bill, generally speaking the tendency of the legislation in recent years has been to vest more and more power in the State and in public authorities. I think that that trend is more or less inevitable but at the same time we have to try to protect ourselves from the full effects of that trend by trying to remove the question of benefits and so on from the political sphere. I would, therefore, ask the Minister to accept this amendment. I do not think there will be any need to interfere with Section 63 because if the Minister accepts the amendment Section 63 could stand. The Minister would have no function in the appeal. It would be to the local District Court and the Minister would be relieved of the duty of intervening at all in a particular case. It would be the function of the local district justice. I think it would save us all a considerable amount of trouble.

Dr. Ryan

I would just like to make a few observation with regard to these amendments. I want to be fairly clear on what Deputy Larkin and Deputy MacBride have in mind. There are various things that crop up under this Bill and under the Infectious Diseases Maintenance Allowances Regulations that are already there. The only case I know of where the Minister has that function, or the duty, if you like, of hearing appeals is under the Infectious Diseases Maintenance Regulations.

It gives me a fair indication of whathearing all appeals under this Bill will amount to. The number of appeals is fairly large and in that particular case the investigations are troublesome and very minute. We have to send out forms to be filled in with regard to means and many other things, and nearly always two or three letters pass before the case can be properly summed up in the Department of Health. There are, I believe, three senior officials working on that business alone and minor staff as well. I do not think any Minister for Health would have time to give attention to any more appeals than are there at the moment. In fact, it is hard for a Minister for Health to find time to give adequate consideration to these appeals, as things stand. As far as I am concerned myself, wherever the official puts up to me that the appeal should be allowed I waste very little time, but where the appeal is turned down I feel I must take time, as I have the obligation of hearing the appeal.

We have experience enough from the Infectious Diseases Regulations to know that it would not be possible for a Minister for Health to have all the appeals referred to him. We have to start on that assumption. There are various classes under the Infectious Diseases Regulations. Under a certain clause in this Bill, with which we dealt yesterday, dealing with incapacity of any kind, there will be a scheme coming along giving a special allowance to a person who suffers from any incapacity and has only a certain amount of means, whatever amount may be defined, and who is over 16 years of age. If we had the same experience there as we have under the Infectious Diseases Regulations, there would be a big crop of diseases, many more than any Minister could deal with.

Under this Bill, as we have it already, there will be matters in dispute, as to whether a person is entitled to free hospital treatment or not, whether he should pay £2 a week or not; there will be the case of a person who says: "I am over the means all right, but for special reasons I must get help". There are these various categories and classes of cases where a dispute may arise and where, if wehave any sort of appeal machinery, the appeals will have to be heard by somebody or other. I say definitely that the Minister is not in a position to do it, as he would never have the time to do it and unless he can do it conscientiously he should not undertake it. Therefore, I am afraid the Minister is ruled out.

I quite agree with what Deputy MacBride said, apart from that altogether, that when we bring in a scheme of this kind a citizen should be entitled to it or not; that no political influence should get it for him if he is not entitled to it and no political influence should be necessary if he is entitled to it. It would be a great thing in our social welfare and our health provisions if that idea of influence were removed. Some people have it and I am afraid some T.D.s give the impression that political influence could be used. It would be a great thing if that could be done away with. My own experience is that, as time goes on, there is less and less of that being used. In the social welfare side I feel that very little of it is being used. People are beginning to know what they are entitled to and do not want a T.D. or anyone else. They are able to look after themselves, or they have friends able to look after them. There is no such thing as influence, or at least very little of it, now being used of the type used ten, 12 or 15 years ago. It is a great thing that that has been ended. I am with Deputy MacBride, and I am sure other Deputies are, too, that we should do away with it completely in the health services also.

Coming to the suggestion of Deputy MacBride that it should be referred to the district justice, I do not know what Deputy MacBride has in mind, as his suggested amendment does not tell us exactly what it would cover. As far as I can read the amendment which he suggests, the district justice could decide only as to whether a person was really entitled legally to the benefit and did not get it. I doubt if it is necessary to put in an amendment of that kind. I am not a lawyer, but I am asking Deputy MacBride that. If a person has a legal right, surely hecan go to court without an amendment?

Mr. MacBride

At the moment, the only way in which a citizen can enforce his right is to bring a declaratory action in the High Court, which would be completely out of all proportion in this case.

Dr. Ryan

If it is a matter of enabling people to go to the District Court instead of the High Court, I think there is something to be said for it, and I would like to examine it from that point of view. Then it would be only on a question of law. I want Deputy MacBride to consider that wherever it is stated in the Bill that "in the opinion of the local authority" such and such is the case, there is no appeal on that, as the district justice cannot interpret what the opinion of the local authority is. If the local authority says that in its opinion a person is not entitled, that is the end of it. There would be no recourse to the District Court there, and rightly so, in my opinion. As far as I can remember, recalling the provisions of the Bill, there is only one particular case where the opinion of the local authority stands, that is, in the case of the person who is above the middle income group and who applies for assistance by way of hospital treatment because of some hardship. Then it is left to the opinion of the local authority. I think we should leave that there and that you could not have a court of appeal.

Mr. MacBride

I agree.

Dr. Ryan

Apart from that, maybe there is something to be said for Deputy MacBride's amendment, and I would much prefer it to Deputy Larkin's. No Minister could conscientiously deal with these appeals, as it would be impossible to do it. There is no use in any Minister undertaking to do this and then getting a number of officials to put up decisions which he would just initial. That would mean that it was not being done. We could have an alternative and do what is done in the Social Welfare Act. We could appoint special officers as appeals officers. The Minister is nolonger the appeals officer in social welfare; he was at one time but not now. He appoints a special appeals officer and is not responsible for appeals in social welfare now. It could be done in that way. I am only giving my views. I do not know what the Dáil may decide about it. I have a rather open mind on the whole thing and on what decision the Dáil should take on this particular proposal. If this whole clause is left out, I do not think that would mean there is no appeal. The only effect of leaving out the clause would be that there would still be an appeal under the Infectious Diseases Regulations. That would still remain. As far as anything in this Bill is concerned, there would be no appeal. I have given my views; I have a fairly open mind and I am quite prepared, within reason, to agree to whatever the Dáil may think.

Mr. MacCarthy

I think Deputy MacBride is getting away from the reality and the practice in the local health authorities. The first thing is that the person is entitled to treatment, being recommended either by the dispensary doctor or by his private practitioner. While all this argument is going on, sometimes that patient might be approaching nearer the gates of death. The first point is that a person must get treatment as soon as possible, if it is a matter of urgent necessity.

I have been a member of local authorities, both borough councils and county councils, where there have been various political representations of majorities on one side or the other. It has never come within my experience that, in matters of public health, there has been any political bias of any kind. The only desire was to give the person in need of medical treatment the treatment that was required as quickly as possible.

If county councillors are not to perform some function as councillors to the people whom they represent, why do they get the name of "councillor" at all? Surely that is their principal function—to give adviceto the people whom they represent and who go to them for advice? If a doctor recommends certain treatment and the patient or his friends need advice, they go to the councillor. The councillor contacts either the county medical officer of health or the county manager, or both, in this particular matter. He presents the circumstances of the case as best he can, and perhaps better than the patient or the patient's friends would be able to do it, and the county manager or the county medical officer of health, or both, come to a decision on the matter. You may be sure that neither of them will deprive the patient of the necessary hospital or medical treatment. They will not take that risk. On the question of who is responsible and who has to pay for the treatment, if the officials cannot come to a decision the matter comes before the next meeting of the county health authority of the city health authority as the case may be. The county medical officer is there and the county manager is there. That has been the practice for years. Without mentioning names, the circumstances of the case are given in the presence of the members. Perhaps the particular circumstances are debated in relation to how far they comply with the regulations, or otherwise. A decision may be reached on a vote and certain advice given to the county manager. If the county manager is not prepared to act on that advice, he contacts the Minister or his Department. In practice, I think that that is as efficient a way as any in which these particular matters can be dealt with. I do not see any necessity for going to court or anything of that kind. The person gets the treatment that is necessary for his particular type of ailment as speedily as possible.

Mr. MacBride

The amendment provides a remedy where the local authority refuses the service. Therefore, there is no question of delay. If the local authority refuses a service the amendment provides a remedy so far as the citizen is concerned.

Mr. MacCarthy

I have never known a case of that kind to happen.

Mr. Larkin

Possibly the Minister's approach to my amendment was due to my misleading him. Neither I nor any of the others associated with the amendment had in mind that the appeal should lie to the Minister in relation to the question of payment. We are dealing with a Health Bill which is providing certain medical services and, purely in relation to the medical side of the Act, there should be some form of approach for the individual. I agree that it would be an impossible task to put on the shoulders of the Minister the detrmination of appeals in respect of means. However, in relation to the medical basis of providing certain services, I think most of us are aware that circumstances can arise in which an individual applicant may feel that he is not being afforded the medical service which he requires or that the service has been terminated too soon or that, in general, he has not been given the medical care to which he is entitled under the Act. From that point of view, I think he should have some access to an independent mind. It might be in the form of an appeal to some medical officer of the Department or it might be something in the nature of what is done under the Social Welfare Act where the appeal is made to the special appeals officer. Something of that nature would meet the case.

I have in mind a particular case in relation to the school medical examination of children. A defect was discovered in a child-one that involved very prolonged and costly treatment. The father of the child found that it was impossible to get the treatment, purely on the grounds that the local authority were waiting for a sufficient number of these cases and for a number of other conditions to be fulfilled. I grant, as Deputy MacBride said, that it is not desirable to have a politician interfere in such cases but, in the case which I have just mentioned, when the politician interfered the child got the treatment. It would be far more desirable if the parent of the child could have brought that matter to the attention of one of the Minister's officers and got the service provided. There was no question of means or payment.It was purely a matter of giving the service that should have been available.

I do not feel attracted to Deputy MacBride's amendment. I think he simplified it too much. Apparently, he is proceeding on the lines of the Rent Restrictions Act. I do not think that, in the final analysis, the amendment would work.

Whenever any question arises with a local authority that has even the remotest resemblance to a legal point, they are always very willing to fight it because they are fighting with our money. It is different altogether in the case of the Rent Restrictions Act. You are dealing with private individuals and very often it is more convenient to allow the temporary order to go in fixing the rent. But a local authority never have any reluctance like that. They seem to revel in litigation, no matter how high it goes.

I should like the Minister to examine our amendment in the light of providing machinery within his Department which would ensure that the person requiring the medical services within the Act would have some final recourse in the event of difficulties such as were mentioned, because I think it would be helpful.

Captain Cowan

I should like to support Deputy Larkin's suggestion that the Minister should re-examine the position. On the particular aspect to which Deputy Larkin has just referred, I think it is desirable that there should be a right of appeal to somebody and I think that machinery can very easily be established within the Act to make provision for that appeal. I take the same view with regard to Deputy MacBride's amendment and I gather that the Deputy himself realises now that his amendment is not workable. The District Court is not the best court for determining matters of this kind. A district justice does not like to be dealing with matters unless they are argued out before him very fully and he can come to some judicial decision. If the Minister's Department is to be cluttered up with appeals, the district courts will be cluttered up with cases and Ido not think that would be in the public interest.

I do not know very much about how things work in many areas outside Dublin, but, so far as Dublin is concerned, if a citizen thinks he has some right that should be dealt with by the corporation or some section of the corporation, or by the Government or some section of it, he goes to his local councillor or T.D. I do not think he bothers about the politics of the local T.D. or councillor, nor do I think that any councillor or T.D. ever questioned a man as to what his politics are. He takes his name and address and helps him as best he can. I find in the Dublin Corporation that, if a member of the corporation goes into a committee meeting and raises a point in regard to a particular individual, and if, having put it forward, the committee think that some injustice has been done to that man, there is an immediate decision to rectify it. No question of politics, good, bad or indifferent, enters into it. I feel that talking about political pull or political strings is scarcely helpful in regard to a matter such as this.

There was an old idea 40 or 50 years ago that the member of Parliament was a person who went shooting in the shooting season and fishing in the fishing season, and did not care two hoots about what his constituents thought. In fact, they had nothing to do with his election because he was usually able to purchase some pocket borough. The machinery has changed and changed considerably. It has changed even since the House was established 30 years ago.

An Leas-Cheann Comhairle

It scarcely arises.

Captain Cowan

The Deputy who does not work hard for his constituents is generally not elected at the next election and we could find perfect examples of that in this House, if we looked around. The person who is oftenest elected is the man who works hardest on behalf on his constituents, but that is not looked on as wirepulling, political string-pulling or anything of that kind. If a person accepts the responsibility of public office, he has to do the public work, howeverinconvenient or annoying it may be at times. When he assumes the responsibility, he has to do the work. It would be ideal if we could have a Utopia where somebody else did the work and we could debate things here, but unfortunately that is not the modern method in this country, in England or in any other country I know of. I ask the Minister to accept Deputy Larkin's suggestion and to examine the section on the lines he has indicated.

Dr. Browne

I am sorry in a way that it has been found necessary by the Minister to withdraw the right of appeal to the Minister, although, as one of the people who has had a certain amount of experience of the particular facility which was there, I agree with him that it would be impossible to deal any way conscientiously with the appeals likely to come up under this Act. The Infectious Diseases Regulations provided many and they ended up, in my experience, in exactly the same situation as the Minister described. I do not think he could conscientiously say that he did examine each appeal as it came forward and gave a judicial opinion on it. At the same time, I should be very anxious indeed to retain a right of appeal to some judicial authority outside the manager.

In the interests of the manager and of the officials, it would be wiser to retain some judicial authority, somebody accepted by the local people as judical and above any influence whatever. It is remarkable how very satisfied everybody I ever had any contact with is once he is told he has a right of appeal to the Minister, who, I am sure, will deal with it, as each Minister would, perfectly conscientiously, no matter what his political colour. The person is completely satisfied even if his appeal is rejected because he feels that it is completely away from any influence. That fear of influence may be completely unreal, but, at the same time, if that fear is in a person's mind, it is a good thing to dispose of it.

In a Bill such as this, in which, as Deputy MacBride pointed out, we do retain, for various reasons, meanstests, the number of appeals that will crop up in the early years of the Bill's implementation will be very considerable. People will be certain that they belong to a particular income group or are in a particular class because of their land valuation or because of the income of the household, and it is going to be an extremely difficult Bill to administer. The local authority will be in difficulties on many occasions and, in the interest of the manager as well as in the interest of the appellant, there should be a right of appeal to some outside authority, some authority outside the manager even— attenuating it and bringing it down to Deputy Larkin's scheme-with regard to the decision on giving a medical certificate in a particular case. I feel that the manager is going to be in difficulties in relation to the broader issues raised by Deputy MacBride.

As to the proposition of having it dealt with by the district justice, while I suggested that myself on another amendment in relation to nurse children last night, I feel that in a case like this the problem is very different and it would be extremely difficult to deal with it by means of an appeal to the district justice. Deputy MacBride may possibly be satisfied with the District Court, but he would find it very hard to deal with the very complicated issues involved in the question of a person's right to a service. My own experience of the Infectious Diseases Regulations was that there was an extraordinarily meticulous investigation carried out by the Department in each case, with the most praiseworthy efforts by the Department's officials to find absolute justice in the different applicants' cases. That, extended to an appeal of this size, would be a gargantuan task, and obviously the Minister could not cope with it. I doubt if the district justice is the proper person to deal with it.

I do not know if Deputy Larkin's suggestion is workable, but my own idea would be some sort of regional council. I do not know whether even that would be possible, nor do I know if the Minister has any ideas for theformation of these councils. There should be some right of appeal to somebody outside the local authority or the county manager. The Minister should bring that appeal as close as possible to himself. By doing so, he will be bringing is as close as possible to the House.

General MacEoin

I should like to add a few words to those of Deputy MacBride and Deputy Dr. Browne. In the first place there should be a right of appeal to someone other than the county manager. To be quite candid, I do not like the idea of the right of appeal to the Minister. I have always felt that when there is an appeal to a Minister it is initiated either in the local Fine Gael club, the Fianna Fáil club or the Labour club. There is then a political aspect right away. Deputy Cowan said that Deputies and councillors do not ask the views of the people or the political opinions of the people who approach them to get some redress in regard to some grievance. I know they do not. They would be fools if they did. But the expectation is, the Deputy or councillor having granted a favour, the fellow should not forget. Automatically, there is a political influence at work from the very beginning.

Captain Cowan

I am not a politician.

Mr. O'Donnell

God forbid that you should belong to any political Party.

General MacEoin

It is strange that, although Deputy Cowan says he does not belong to any political Party, there is not a trick of a politician that he has not got.

Mr. O'Donnell

And a few that a politician has not.

An Leas-Cheann Comhairle

That matter cannot be discussed.

General MacEoin

It is important that there should be an appeal, but whether the appeal to the district justice is the best one or not, I am not prepared to say. Suppose the Minister were to give me a choice in regardto an appeal, either to the Minister or to a district justice, believe it or not, I would go to the district justice because I know I would get the thing I was entitled to in law. I know I would not get it through political influence of any sort and that I would not have to go, with my hat in my hand, to a Deputy, a county councillor, a solicitor Deputy or anybody else. I know that I could go in law to get my fundamental right from the judiciary, the right I was refused for some reason because when I was refused the particular service to which I was entitled there must have been some influence which debarred me from getting that right. If I appeal to the Party in power, whatever that Party may be, they are nearly always the same as the Party in the local authority that refused me. Therefore. I am appealing to the Party in power which supports the unit that refused me in the first instance. Therefore, I have to go with my hat in my hand to the local Deputy or local councillor and I will have to say: "Here are the facts". Deputy Cowan says that the person will not be asked what political views he has. He is not going to be asked that question, but the fact remains that he goes to a Deputy or a councillor to ask a favour.

Captain Cowan

No, no.

General MacEoin

He will ask him in an innocent sort of way and, perhaps, in a subservient way, which I detest ever since the Volunteers were formed. Their idea was that you held up your head, fought for your rights and got what you were entitled to. You did not beg advice of any person, no matter who he was. Therefore, I am inclined to accept and to urge the amendment tabled by Deputy MacBride as being more acceptable to a person of independent thought than an appeal to the Minister. If a local authority refused me as a citizen something to which I am entitled and if they know they are going to answer for it before a district justice, I can tell you that they will think twice before they refuse me that to which I am entitled by law. I urge upon the Minister to accept the right of appeal, but I also say that Deputy MacBride'samendment is a better one than that tabled by Deputy Larkin, because it gives the citizen freedom of thought and independence. He will not have to go with his hat in his hand to anyone.

Mr. MacBride

I would like to say how grateful I am to the Minister and to the other Deputies for the manner in which they have discussed this matter. It is an important question and it is an issue from which can emerge something useful from the point of view of administration generally. I think Deputy Larkin is right when he said we were speaking of two different matters. What he had in mind is covered, I think, by my amendment. My amendment deals with the right of appeal against the refusal of the local authority to admit that a certain person is entitled to a certain service. Let us take a concrete case.

Take, for instance, the case of the £4 maternity grant which is available to mothers in the lower income group. Obviously, there is going to be a lot of difficulty in determining whether a mother is in the lower income group or not. It may depend upon a matter of 1/- a week possibly in wages that come into the house. It may depend upon the wage of some youngster who has not fully disclosed his earnings. These are matters of fact. It seems to me that on matters of fact it would be much better to have somebody like the local district justice to determine the issue. I think that Deputy Larkin had in mind complaints against the type of medical service provided, the inadequacy of the service and so on. I agree with him immediately that that is a matter that could not be dealt with by the district justice at all. I agree with the Minister that the only appeal you could give to the District Court would be in regard to the right of the person to come within the provisions of the Act.

I want to make it clear to Deputy MacCarthy that the amendment, as it is framed, deals only with the case of a person who has been refused a service by a local authority. Presumably, that person has tried his utmost, made his application and the county manageror some officials under him has turned the application down. At this stage, the person has lost his right of appeal and there is not a thing more he can do.

Mr. MacCarthy

He can appeal to the Minister.

Mr. MacBride

There is no appeal to the Minister in the Bill. That is what this discussion is about, Deputy. The Minister quite properly says that he could not possibly deal with the mass of appeals which are bound to arise. I do not think we have yet fully realised the tremendous number of borderline cases there will be. I quite agree with the Minister and with Deputy Dr. Browne that it would be impossible for the Minister to give personal attention to each case that comes up. Obviously, it would be quite impossible. I do not know the number of appeals with which the Minister will have to deal but it will probably be very considerable. It may be said that he need only sign the Order form, but if he is to discharge the duty cast upon him by statute conscientiously, he might have to spend an hour or more reading through a file to decide whether or not a person is entitled to certain treatment.

The question as to whether a person comes within the provisions of the Bill or not is a matter that would be more appropriately decided upon evidence than upon a written report. It will hinge on whether or not a certain set of facts exist or do not exist. To avoid misunderstanding, I want Deputies to bear in mind that there is no question of any delay in waiting until the district justice considers it.

Captain Cowan

Would there be an appeal from the district justice in the Circuit Court?

Mr. MacBride

I think you should have the district justice's decision as final. At the moment there is no appeal to anybody. If you go to a local authority or your county manager and say: "I am in the lower income group and I am entitled to certainservices", and if the county manager says: "No, you are not. Your income is a shilling over the prescribed amount", that person then is out.

Mr. O'Donnell

That is happening every day in connection with other legislation.

Mr. MacBride

It is possible for that person by going to a sufficient number of county councillors who have a certain degree of influence with the county manager to induce the county manager to alter his decision. I do not think that is a desirable approach. A citizen is either entitled to the services or he is not. It is purely a question of fact and it should not depend on the relationship between an individual and the county councillors and the county councillors and the county manager.

Another thing we do not appreciate —it is a matter I mentaioned in the course of the discussion on an earlier section of the Bill-is the tremendous amount of work which is already cast upon the county manager and the local authority. They already have very extensive duties and this Bill will cast a lot more work on them. Certainly in the first few years it will be a very serious problem for every local authority to set up the administrative machinery necessary to deal with even the application let alon the determination of the claim made.

As a simple example, let us take the maternity benefit. Every child born in the lower income group automatically leads to a claim on the local authority for benefit. Machinery will have to be set up to deal with these claims to determine whether the person comes within the particular group which entitles her to benefit. That is probably one of the simplest issues that have to be determined.

Dr. ffrench-O'Carroll

Do you really think a woman would go into a District Court to look for maternity benefit?

Mr. MacBride

I am only quoting that as an example. That is one of the services provided under the Act.

Dr. ffrench-O'Carroll

These are human problems. People are very disinclined to go to court.

Mr. MacBride

At the moment, if some official in the county council says: "No, you are not entitled to it," that is the end of it.

Captain Cowan

The local authority will examine the case then.

Mr. MacBride

At present the initial decision of the local authority is final and closes the case. Might I ask Deputies to approach it in this way? Do they think there should be a right of appeal at all from the local authority? If they are satisfied there should not be, that ends the matter and there is no necessity to discuss it any further. But if we all agree, as I think we must, that in every case of that kind there should be always a right of appeal, that is a different matter. We provide for it in legislation in regard to many less important matters.

Captain Cowan

The right of appeal from the manager to the local authority would probably be much better.

Mr. MacBride

That is just what I want to get away from, the right of appeal from the manager. First of all, it would be unwieldy. The county council could not do it. I do not know whether the Minister has made any estimate of the number of cases he anticipated but I am sure it will be several thousand cases a month. If there is a right of appeal to the county council from the county manager, how can the county council investigate perhaps 200 or 300 cases at a meeting? They could not do it properly.

Apart from that, we should try to get away from it. Inevitably, if there is an appeal from the county manager to the county council, it will mean that the county council will be canvassed. It is useless to pretend that there is no political influence used. We meet it every day of the week. The Minister may be quite right in saying it is on the decline but the number of requests by the public to county coun cillors and to members of this Houseto do things which are little short of corrupt is surprising. It would be an advantage if we endeavoured to get away from it.

The increase in social legislation casts more and more burdens on public administrators; simultaneously with that, there will be a greater effort made to use political influence to secure various benefits granted by social legislation. If we could, as an experiment, try to get away from that in this piece of legislation, we would be making a very useful start. Therefore, I would ask Deputies to approach the question in this way, to determine whether there should be a right of appeal at all. If Deputies feel there is no necessity for a right of appeal that ends the question.

Mr. McQuillan

Would Deputy MacBride say how much it would cost an applicant to bring a case to court?

Mr. MacBride

A provision could be embodied in the law that no solicitor be entitled to collect a fee in respect of it.

Captain Cowan

If a man goes in looking for a dance licence without a solicitor he is not received very well.

General MacEoin

Sure you took the tax off dances.

Mr. MacBride

We are talking about health matters and this gibing is nonsensical. I am quite prepared to include in the amendment a provision making it illegal to charge a fee for appearing in a case like that. If there is to be a right of appeal, obviously someone will have to determine that appeal. Once you admit that it is desirable to have a right of appeal, the next question is to whom the appeal will be made. The Minister says he cannot decide that. As well as that, there is the viewpoint that it would be undersirable to have it dealt with at the political level. The alternative would be the appointment of a special body to hear such an appeal. That again might be difficult. It would probably be expensive. There is already in the country an organisation in the shape of the District Courts. So far as I know the District Courts in thecountry are not overburdened with work. They may be here in Dublin. The District Court is a local court. District justices are permanently attached to particular areas. They know the conditions in the areas. They deal with questions of fact. It seems to me that there is available there ready-made machinery for coping with this work. I do not see any alternative machinery that would be as suitable. If any citizen then felt aggrieved by a decision of the local authority he would have his right of appeal. If we want to make assurance doubly sure we can provide that there will be no appeal from the finding of the District Court. I think one could put in a proviso, too, that it would be unlawful for a lawyer or a solicitor to charge a fee for appearing in a case like that. I think the legal profession would be quite agreeable to that course.

Dr. Ryan

It would be very hard to provide for that.

Mr. O'Donnell

We have it in the Social Welfare Act. Solicitors may not appear at all before the Court of Referees.

Mr. MacBride

There could be a proviso to that effect and a proviso that these cases would be heard in private by the district justice.

Captain Cowan

We will find ourselves in a month's discussion on that.

Mr. MacBride

We can find ourselves in a month's discussion on anything once the Deputy intervenes. The House was quite reasonable in debating this and would continue to be so without the Deputy trying to pour out his usual vituperative poison.

Captain Cowan

Judicial matters cannot be held in cameraunder the Constitution, and the Deputy knows that quite well.

An Leas-Cheann Comhairle

Deputy MacBride is in possession.

Mr. O'Donnell

Judicial cases are heard in camera.Affiliation orders are heardin camera.

Dr. Ryan

What are we to believe with all these lawyers?

Mr. MacBride

There will have to be somebody to whom an appeal can be made. Everybody will concede that. District justices are people who are trusted. They have the responsibility of determining issues, and it seems to me they would be the competent authority to deal with appeals of this kind. I am in favour of any social progress, but we must safeguard ourselves from the danger of permitting through social legislation the danger of bureaucratic domination or the growth of political influence and political pull. This Bill gives us an opportunity of seeing how this type of legisation will work. If it does not work we can reconsider the position at a later date.

There is another problem. I think Deputy Larkin has in mind the nature of the treatment and the efficiency of the service. I think the only way in which that could be dealt with would be by a system of inspection. A health inspector from the Department could investigate the complaint. That would not necessitate an actual formal appeal. It is merely a question of adopting a system of inspection that will keep the local authority health service up to the required standard.

Some Deputy made the point that the number of appeals would militate against the District Court dealing with them. I think there are over 20 District Courts in the country and I think they would be in a better position to deal with these matters than the Minister or some central authority.

Mr. O'Donnell

I support the amendment of Deputy MacBride in preference to the amendment of Deputy Larkin. What happens in practice? How are the means of applicants investigated? I do not know what happens in Dublin or Cork, but I know what happens in the country. The county manager sends the file to the local relieving officer. He interviews the applicant and requests him to disclose his means. He then snoops around amongst the neighbours and, as a result of the information he gets he makes his report to the county manager. Suppose that the county manager finds the applicant's means exceedthe limit under the particular Act, the applicant is then debarred from deriving the benefit to which he thinks he is entitled.

Captain Cowan

It is a £600 limit.

Mr. O'Donnell

I am not referring to the limit.

Captain Cowan

You would not get many people with £600.

An Leas-Cheann Comhairle

Deputy O'Donnell is in possession.

Mr. O'Donnell

I am dealing with what actually happens in practice. Supposing appeal lies to the Department of Local Government. What happens? The Minister, through his officials, requests the county manager to forward the file on which the only information.available is the report of the relieving officer. I believe that the Minister in such cases would automatically affirm the decision of the county manager whereas, if the appeal is taken in the Ditrict Court, all the information will be available. It can be heard in camera.Affiliation orders are heardin camera.

Captain Cowan

There are special reasons.

Mr. O'Donnell

Make the special reasons here also. I move to report progress.

Progress reported; Committee to sit again.

The Dáil adjourned at 10.30 p.m. until 10.30 a.m. on Friday. 17th July, 1953.