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Dáil Éireann debate -
Thursday, 30 Jul 1953

Vol. 141 No. 7

Health Bill, 1952—Report Stage (Resumed).

Debate resumed on amendment No. 2.

Has the Minister anything further to say on this matter? Last night it was suggested that he might widen the scope of appeals in respect of medical treatment.

It is no harm to restate the position. There are two divisions, as it were, under which appeals were discussed on the Committee State. The first is whether the person is or is not entitled to treatment. That would arise, of course, principally on the grounds of means. Secondly, there is the point as to whether, having qualified for treatment, the patient gets the treatment necessary for his particular ailment. With regard to treatment, there is power to investigate any complaint of negligence or neglect. Deputies will realise that the Minister cannot, of course, direct any particular treatment or interfere with medical staffs; whether it is the family doctor in the case of the lower income groups or hospitals staffs, he cannot interfere with the treatment recommended. He can only intervene where there is negligence on the part of any particular officer. The Deputy mentioned that the patient might feel that a particular treatment, because expensive, was withheld from him. There is plenty of power to cover that. The Minister has power under Section 83 of the Local Government Act, 1941, in relation to complaints of that kind. Furthermore, he has power as Deputies are aware of dealing rather drastically by way of suspension with any officer who may be negligent in his duty or, after public inquiry, by way of dismissal if necessary. I think Deputies need not have any anxiety at all as to the treatment that will be given. There is ample power to deal with that.

I may say, as regards the fear that local authorities could not sanction expensive treatment, that the complaints I get from the voluntary hospitals very often are that they cannotafford to give the treatment which the local authority hospitals are giving, so that they anyway look on the local authority service as being very full in that respect.

On the grounds of means, after the discussion here I came to the conclusion that we should have an appeal in certain cases, that is in the case of a certain category of people who might qualify for hospital and specialist treatment and whose family income was less than £600. As I have pointed out, there could be no dispute as to whether a man was insured or not, or as to whether a farmer had land the valuation of which was £50. The only dispute that could arise, possibly, is in the category of family incomes of £600.

I am in this amendment providing an appeal in that case. As I explained before, I also came to the conclusion that it is better to have one appeals officer because that will gradually tend to uniformity in all the counties in the interpretation of any problems that may be put to him. Even if it were to be left to the courts —leaving aside any other arguments that may be made against that—you would be likely to have one district justice perhaps being more lenient than another. Therefore, you would have uneven administration as far as this was concerned. As I say, I think that an officer appointed by the Minister is the better plan, and I move the amendment than an officer be appointed by the Minister. The procedure, and so on, will be laid down by regulations. As I have mentioned already, the regulations will follow very closely those that are already in operation for appeals under the Social Welfare Act.

May we take it from what the Minister has said that the Bill provides for an appeal in respect of means, and that there is power in other legislation to enable the Minister to investigate the cases that were given last night?

Yes, there is full power.

Amendment agreed to.

That governs amendments Nos. 21 and 22.

I move amendment No. 3:—

In page 7, Section 16, lines 10 and 11, to delete "one pound" and substitute "the appropriate amount".

This amendment was submitted, not altogether in the form in which it is now, on the Committee Stage. On the Committee Stage, the amendment would have the effect that a woman in the higher income group who desired to take advantage of the maternity scheme would be eligible by paying £1 per year. That is how the Bill stood. The amendment submitted on the Committee Stage altered that somewhat by saying that after three years a survey would be undertaken, an estimate would be made of what the service was costing and a contribution would then be fixed for the woman coming into the scheme. From that date it would aim at collecting about 50 per cent. of the cost from those participating in the scheme.

Deputies had the fear that a Minister who was anxious to sabotage this scheme would be able to add to the cost and make it altogether unworkable—that is to add to the administration costs which would be rather vague. Although I pointed out that there was no intention of doing anything like that, I was pressed by every Party in the House to make more definite what the limit would be. I am now submitting this amendment which leaves the machinery outlined on the Committee Stage but which puts a limit on the annual contribution of £2 a year. The contribution, therefore, will never exceed £2. It may, although I do not think it is likely, on examination after three years, be reduced below the £1 that is already there.

I take it that amendment No. 4 is consequential on No. 3?

The two go together.

Amendment agreed to.

I move amendment No. 4:—

In page 7, Section 16, to add the following word and paragraphs at the end of sub-section (3):—

and

(c) shall provide that, subject to the provisions pursuant to paragraph (d) of this sub-section, the appropriate amount referred to in paragraph (a) of this sub-section shall be one pound, and

(d) shall provide that the appropriate amount referred to in paragraph (a) of this sub-section shall, for each successive period of five years (the first of such periods being the period of five years beginning on the day after the expiration of three years from the commencement of this section or such later day as the Minister may determine to be the earliest practicable day for the beginning of the first of such periods), be—

(i) for persons other than persons who had paid a contribution in respect of the year immediately preceding such period, either—

(I) such amount as may be fixed by the Minister for that period as the amount which will result in obtaining by contributions approximately one-half of the estimated cost, as determined by the Minister, during such period of the provision of the services for women by or on behalf of whom contributions at the rate fixed under this clause of this sub-paragraph are paid, or

(II) two pounds,

whichever is the less, and

(ii) for persons who had paid a contribution in respect of the year immediately preceding such period, the amount payable by that person for that year or the amount fixed by the Minister as aforesaid, whichever is the less.

Amendment agreed to.

I move amendment No. 5:—

In page 7, Section 16, to add the following sub-section:—

(5) Where a woman avails of services under this section for a confinement taking place otherwise than in a hospital or maternity home, the health authority shall make available, without charge, obstetrical requisites to such extent as may be specified by regulations.

There is a desire, I think, amongst all Parties that we should encourage, as far as we can, domiciliary treatment for maternity because, if we were to make it more attractive for women to go into hospitals to have their babies, the hospitals would be overcrowded. It is not easy to do that in any very positive way, but it did strike me on reading through this clause that it was more attractive for women to go into hospital than stay at home, because, although it would be true that a woman staying at home to have her baby would have free medical and midwifery services, she would have to pay if in the middle income group, but not in the lower income group, for medicines and for surgical dressings. If she went into hospital, of course, she would get these free. This amendment is put down in order to make it possible for the local authority to see that she gets her obstetrical requisites, which will be medicines and surgical dressings, etc., free of cost.

That, of course, will have to be done by regulation because there are many things to be considered. Take an extreme case. We certainly will not supply a perambulator or a cot. We will definitely supply any medicine, probably, that may be necessary at the time of childbirth. We would, I am sure, supply certain dressings, surgical and obstetrical dressings. There will always be certain things that will require a great deal of consideration. The question, for instance, of an aesthetics comes up. The question of expensive medicines will arise. As the medical Deputies are aware, very expensive drugs are used if there is any suspicion of sepsis or anything like that. We have to consider all these things and we must have time to draw up the necessary regulations. The aim is to see that the woman who stays at home to have her baby will beas well treated financially as the woman who goes into hospital, and in that way we hope to try to prevent the hospitals being overcrowded.

I do not know whether the Minister is yet in a position to say what action he proposes to take as regards expensive medicines. Has the Minister any clear idea yet as to what extent he will make available medicines in the ordinary case? There are also the cases to be considered of women who go into private nursing homes. I am anxious to know if the Minister has clarified his mind on the point of making expensive medicines available without the danger of abuses arising. In the case of patients going into private nursing homes the practice is that they are expected to bring in their own requisites. Has the Minister any idea whether he would allow that practice to go on or whether the fee charged would include all requirements? If a woman did bring them in, what would the position be as regards recoupment? Possibly these are points that have not occurred to the Minister up to the present. I want to prevent abuses arising so that a private nursing home would not be in a position to call on a local authority for payment in regard to unlimited supplies of obstetrical requisites which possibly they could use for non-local authority patients.

I think there are three cases that we should keep in mind. There is first the case of the woman not, I should say, in the lower income group, who stays at home or who goes into hospital and for whom everything is paid. There was a certain difficulty with the middle income group because, if this amendment was not put in, there would be no power to pay for medicines in the case of a middle income group woman who stayed at home. I take the middle income group woman because that is the case we will be up against. She either stays at home or she goes to a hospital as directed by the local authority or she goes to a hospital of her own choice. If she goes to a hospital as directed by the local authority it will be either the local authority hospital or a general hospital andmedicines will be free. So, she will get everything free—medical service free, midwifery services free, and all medicines free.

This amendment is designed to be able to say to that woman: "If you stay at home, financially, you will be just as well off. You will get medical treatment free, midwifery treatment free and all medicines, dressings, etc., free, the same as you would in hospital." I think it will not be very difficult to draft the regulations as far as that is concerned because we will try to keep it in line with what the general hospital is giving.

The third case is the woman who chooses her own hospital. She goes to, say, a maternity private home. I have not decided yet in her case. I am inclined to say that she gets her subvention from the local authority for whatever number of days she may be in the home and that is the end of it; she pays everything else herself because, if she goes to a private home, it is presumed that she will employ a doctor— in fact I think she has to if she goes to a private home—and she pays the doctor. If she employs a special midwife or if she avails of the service of the midwife in the home she has to pay for that. All that the local authority is responsible for is the subvention that they pay and she pays the rest. Whether we should take into consideration or not that we should give her some set amount or some vouched expenses or some proportion of vouched expenses is a matter for consideration but I would not like to leave the members of the Dáil under the impression that I am favourably disposed to that. I am quite prepared to listen to a case for that but my present opinion is that it would be better just to give her the subvention and say: "Everything else is your responsibility and the local authority is out of it."

Can we be clear that the words "obstetrical requisites" include medicines?

Yes. I am assured of that.

Amendment put and agreed to.

I move amendment No. 6:—

In page 8, Section 20, lines 2 and 3, to delete ", either, as may be specified by the regulations, without charge or at charges approved of or directed by the Minister."

As the clause was drafted Deputies were rather afraid of these words:—

"... make available—certain services—either as may be specified by the regulations, without charge or at charges approved of or directed by the Minister."

This clause deals with dental and opthalmic services for children. It is intended, of course, generally speaking that they should be free. Anything that may arise as a result of school inspection will be free. It is always intended that defects, as they are called, discovered at these inspections should be treated free of charge. I had to admit that, as drafted, the Minister could make charges and perhaps make them fairly substantial. The only thing that was ever intended was to be able to deal with gross carelessness. If a child got a pair of spectacles, for instance, and came back after a few weeks and said they were broken and she wanted another pair, it might be excused that time but, if she came back again after another few weeks, it is well that the local authority should have the power to say: "You will have to pay for them this time because you are not taking proper care". Now it is made perfectly plain by this amendment that that is the only way a charge can be made.

Amendment put and agreed to.

I move amendment No. 7:—

In page 8, Section 20, to add at the end of the section, but not in paragraph (b), "and the treatment and appliances shall be made available without charge, save that where any dental, optical or aural appliance is supplied as a replacement and the health authority are not satisfied that the replacement has become necessary otherwise than as a result ofnegligence, such charge may be made for the appliance as may be approved of or directed by the Minister."

This goes with amendment No. 6.

Amendment put and agreed to.

I move amendment No. 8:—

In page 8, Section 22, to delete lines 25, 26 and 27.

Section 22 deals with regulations in relation to services and sub-section (2) reads:—

"Regulations under this section may, in particular, provide for services being made available for a particular class of persons only."

Again, this particular sub-section was viewed with a certain amount of anxiety by Deputies. They held that a Minister who was not too favourable to the extension of the health services might avail of this to curtail the services. On examination, I came to the conclusion that that is a possibility. As a matter of fact, I think the Bill can carry on without that sub-section at all. So, I am moving to have the sub-section deleted.

Amendment put and agreed to.

I move amendment No. 9:—

In page 9, Section 25, line 14, to insert ", on application being made to them," before "make".

There is a peculiar situation here. People who choose their own hospital may possibly on the advice of their own family doctor go to a certain hospital. It may then occur to them that the local authority, even though they had chosen their own hospital, should make a certain contribution and that they would be entitled to make application for that contribution. That is what we set out to cover in this section. But my attention was drawn to the fact that as the section was drafted, the local authority would have the obligation of looking for the people who are entitled to this contribution. That would be an impossible task to put on any local authority. This amendment is brought in to provide that the local authority will be obligedto contribute if the application is made.

Will the Minister make it clear that, in order to become entitled to a payment under this section, persons looking for services in an institution of their own choice will not have to give prior notification of the fact to the local authority that they are going to such an institution?

We have tried to make it, and I think we have succeeded in making it, perfectly plain that the person can go to the hospital and apply afterwards because, as Deputies know, sometimes the necessity for going to a hospital may be very urgent and it would be unfair to say that the person must notify the local authority and get their consent before going into the hospital. The fact that they go into the hospital first will not in any way vitiate the scheme.

Amendment put and agreed to.

I move amendment No. 10:—

In page 11, Section 28, line 26, to insert "knowingly" before "contravenes".

Deputies will remember that this section puts an obligation on a person to notify a local authority if his financial circumstances have changed. A person's income might be under £600 but it might happen that the income of a son or daughter living with him would be increased or that his own income might be increased. As the section stands, he would be bound to notify the local authority of that fact. It was put to me on the Committee Stage that a man might get into serious trouble with the local authority if, perhaps, through negligence or ignorance he did not notify them. That was not intended, of course. We only want to deal with the man who tries to defraud the local authority and I think the insertion of the word "knowingly" before "contravenes" will cover that, so that he will not be guilty of an offence unless he is knowingly guilty of it.

Amendment put and agreed to.

On behalf of Deputy MacBride I move amendment No. 11:—

In page 16, Part V, before Section 45, to insert a new section as follows:—

(1) Notwithstanding any statutory provision to the contrary for the time being in force all functions exercisable by a health authority under this Act shall, save where otherwise provided by this section, be exercised only in the case of a county by the council of such county and in the case of a county borough by the corporation of such county borough.

(2) The manager of a county or a county borough shall, save where otherwise provided by this section, not exercise any functions exercisable by the health authority without the approval of the council or corporation of such county or county borough.

(3) The functions of a health authority under this Act which shall be exercised by the manager of a county or county borough are:—

(a) such functions as may, for the time being, be delegated to the manager by the council or corporation of the county or county borough of which he is manager;

(b) the employment of persons and the making of contracts of service with persons whose services are required for the carrying out of the functions of the health authority under this Act, and the dismissal or suspension of such persons and the termination of such contracts of service;

(c) the making of contracts on behalf of the health authority for the supply of goods, materials and services required for the implementation of the functions of the health authority under this Act.

(4) The council of a county or the corporation of a county borough may delegate all or any of its powers to a local health committee appointed by such council or corporation.

The Deputy has authority to move this amendment?

Yes, at the request of Deputy MacBride. It simply endeavours to give back to the public representatives the power of interpreting and carrying out the wishes of the people and taking from the county manager powers vested in him other than the normal powers which are now considered executive functions under the County Management Act with regard to the employment and dismissal of servants. This is an endeavour to give back to public representatives as much of the powers as possible and, at the same time, provide that the powers given back will not be used to do things which are not desirable in connection with the employment and dismissal of officials and the making of certain regulations for payments. The local committee can, if it so desires, under this amendment transfer to the county manager certain powers but the principle of having the powers invested in them will be preserved. I am afraid that the Minister will find that this is a radical change from the general policy of the Bill, but I am putting it to the House in order to comply with the wishes of the person who put it down. It is not an amendment of mine, and, naturally, I cannot put forward the same views as the person responsible for the amendment could put forward, but I put it to the House for what it is worth.

First of all, I think it is hardly appropriate that we should amend the County Management Act through the medium of this Bill. As I stated before, a Bill will be introduced to amend the County Management Act and to take certain powers from the county manager and hand them back to the local authority. That Bill is being prepared and will, I am sure, be introduced after the summer recess. I think I can say without any great fear of going too far that the Bill will go further in the way of taking powers from the county manager than was proposed in the Bill brought in by the Coalition Government but which was not put through the House.

There is one point, however, which I would resist very strongly and that is with regard to the function of thecounty manager in dealing with individual cases. I think that a person who applies for some service and whose means have to be disclosed in order to get that service would be very much happier to have his case investigated by a single person, rather than by the council or a number of people, especially if the council or the other people will be meeting in public. Even if they are not meeting in public, I think some people would not like their private affairs to be discussed and investigated by a number of persons. Therefore, I think the particular point at issue is the decision in individual cases. As far as I am concerned, I would be very strongly in favour of leaving it to a single person to decide and, as matters stand, that person must be the county manager.

Apart from that, however, in the matter of appointments I do not mind very much if the Government bring a Bill before the Dáil handing back the making of appointments to the local authority or, in the case of other matters, such as adoption schemes or the making of contracts or any of these other matters, I do not mind very much whether these powers are taken from the county manager and handed back to the county council. But I think it would be very much better to have the matter postponed until the Bill amending the County Management Act comes before the Dáil, which I think will be immediately after the summer recess.

In view of what the Minister has said, I ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Amendments Nos. 12 and 13 may be discussed together.

I move amendment No. 12:—

In page 20, Section 50, to insert the following sub-section before sub-section (3):—

(3) In making available the service referred to in sub-section (1) of this section so far as that service relates to the making of arrangementswith employers for placing disabled persons in suitable employment, a health authority shall consult with such trade unions (if any) as appear to the health authority to be representative of persons employed in the relevant employments.

When we discussed this matter the point arose that trade unions should be consulted with regard to this question of rehabilitation. I understood that the only point which the members of the Labour Party would be interested in is the placing of a person in employment. I therefore directed my attention to covering that point. On the general question of rehabilitation, there will be, as I explained, a national committee appointed and there will also be at least one committee and probably more than one committee, under each local authority. These will not be statutory committees; they will only be advisory committees. I am quite sure that no Minister with any sense would set up a national committee without having trade union representatives on it. As far as the general scheme is concerned, the trade unions will have their say in regard to these regulations. With regard to the local committees, in all probability the local authorities will take the same view and have labour or trade union representatives on these committees.

Apart from that, I thought the only point as to which trade unions would be very interested and likely to be very much concerned would be where a person had been treated and pronounced fit to take up employment, whether partial or full employment. At that particular point, the trade unions would be concerned that a person should not be put in employment which would displace a worker who had been there for many years. Deputy Larkin made the position very clear on that. He said that a disabled person might not be altogether so important as a man with a wife and family; that a very enthusiastic and philanthropic committee in placing such a person might forget the rights of the ordinary working man with a wife and family. That was quite understandable andquite a sensible view on the part of Deputy Larkin. It is in order to cover that point that I bring in this amendment and I think it should cover it.

As long as the trade union representative is there. I can assure the Minister that even a local trade union organisation could give much help.

Yes, I agree with that, too.

Amendment put and agreed to.
Amendment No. 13 not moved.

As amendments Nos. 14 and 15 involve a charge on the Exchequer, the Bill must be recommitted in respect of these amendments.

Ordered accordingly.

I move amendment No. 14:—

In page 20, Section 50, line 33, to delete "may" and substitute "shall".

As far as amendment No. 14 is concerned, it was considered anomalous by certain Deputies on the Committee Stage that having provided by regulation that maintenance allowances should be given to a certain class of people—disabled people—local authorities should then be free as it were to adopt the scheme or not. I think if the Minister concerned, whoever he may be, after having consulted the various people he desires to consult makes a regulation that maintenance allowances be given it should be adopted by every local authority. I am, therefore, proposing that the word "may" shall become "shall".

Would the Minister say if the certifying person in relation to disability will be the doctor?

Yes, certainly the doctor.

Amendment put and agreed to.

I move amendment No. 15:—

In page 20, Section 50, lines 42 and 43, to delete ", parent, brother or sister of a person" and substitute"or parent of a person, or any brother or sister of a person normally resident with that person".

There was a good lot of talk on this particular clause and many suggestions were made, but I must admit I did not get a very satisfactory solution. The point was that it was expected that a brother or sister would maintain the invalid person under certain circumstances. Of course, it must be remembered that—the words are here —that where the relatives are unable to provide maintenance that does not apply. But it might happen that the local authority would have to say to the person: Your brother or your sister is well able to maintain you but he or she will not do it. It was pointed out on the Committee Stage that the invalid might have a brother in America doing well but not taking any interest in the invalid at home. For that reason, I have now submitted an amendment which says it will only apply to the brother or sister where they are normally resident with that person. I think that would be understandable. If you have a father, say, and mother and two brothers and sisters in a home and two of the brothers are working as well as the father, and the sister is an invalid to be maintained by them—in a case like that there is no difficulty about maintaining the invalid sister and nobody complains about it. We want to be careful that in a case like that we do not remove that kind of family feeling that they should look after the invalid if they can do it. At the same time we want to provide for the case where they are unable to do it. It is difficult to word a clause so as to carry out our intention. It is almost impossible, and I am afraid I may have leaned in the direction of letting the brother or sister out, but it is better to err on that side than the other. However, by this amendment, we can see that the invalid is looked after and if in certain cases a brother or sister who might be able to maintain an invalid get away—well, I suppose we cannot help it.

Amendment agreed to.
Amendments reported and agreed to.

I move amendment No. 16:—

In page 22, Section 54, to delete lines 33 to 45 and substitute "home or similar institution who behaves in a disorderly manner in such home or institution, or causes unreasonable disturbance to other persons maintained in such home or institution or to persons employed therein".

This sub-section (5) of Section 54 deals with disorderly people who might come into a county home, and we had some discussion on it, and we had a division on this matter in the Dáil during the Committee Stage. As I pointed out, there was no intention of aiming at the old people. Some rather far-fetched examples were given. It was said, for instance, an old person might refuse to take his dinner and might be held to have disobeyed a regulation and might be liable on conviction to a week or two weeks in jail. The people we want to get are the casuals who come in and make trouble. As the amendment is drafted, I think that is now clear. The person who behaves in a disorderly manner in such home or institution or causes unreasonable disturbance to other persons maintained in such home or institution or to such persons employed therein—I think that covers everything, "if a person behaves in a disorderly manner or causes unreasonable disturbance". There is a slight difference. I might be asked why I put in the second one. A man might come in in a merry mood and start singing to the great discomfort of others and he is not disorderly. Still, he is causing great disturbance to people who want to go asleep. I think we have covered anything we want to cover by saying a person who behaves in a disorderly manner or creates disturbance.

It is a much more reasonable approach.

As far as this amendment is concerned, the important point is that we still find in the section "shall be liable on summary conviction to imprisonment for a term not exceeding 21 days". Although this rose may have changed its name, I am afraid that it smells very muchthe same. Surely this is still sectional legislation, legislation in respect of an institution under the jurisdiction of the community, the Dáil, the Government, and the people which has been singled out for the creation of specific crimes which are not related to the inmates of our other institutions. We have county hospitals, county and regional sanatoria and various other hospitals, regional hospitals and we have all the inmates of those institutions and all the inmates of the general hospitals and the voluntary hospitals ; we have all sorts of other groups of human beings outside the health service, clubs, public-houses, cinemas, and 100 other things, but in none of them, so far as I am aware at any rate, is it found necessary to create this new situation or rather to perpetuate an old situation, yet a penal workhouse atmosphere has apparently to be maintained in respect of what we euphemistically call our county homes.

I am one of those people who most fervently believe in the idea that whatever private people or private or-ganisations or institutions may do, the Oireachtas in a democracy should legislate equally for its people, whether in respect to health legislation, social amenities or any aspect of its activities and similarly in regard to education—right through the whole gamut of our life. I personally do not think that we should legislate for any retention of the old privileges upon which the essence of this amendment is based. An aged person can find himself locked up for 21 days because he spends 5/- or 10/- or the few dollars remittance that he may get from a son or daughter who has gone away, if he happens to get slightly excited and causes what is called an unreasonable disturbance to other persons maintained in such home or institution. Much as I appreciate the Minister's apparent intention to meet the wishes of many of us here, I believe that in essence this amendment retains the atmosphere of sectional legislation which I feel it is our duty to leave behind us. One of the reasons, surely, why we had our revolution was inorder to break with many of the old traditions. I believe that this provision is in the worst of the old bad traditions. I think it is unworthy of the House to retain it. So far as I am concerned I am still opposed to it on general principles.

In the past I have, against all opposition, and I hope I shall continue that attitude in the future, opposed the suggestion that there should be any differentiation concerning the treatment meted out to any section of our community in relation to health legislation. I feel equally strongly in relation to our social legislation concerning the aged, as I do about children, education, etc. Consequently, I feel that the House should reject this section and this amendment. I feel that it is, as I say, in the old bad tradition, in getting rid of which there is no doubt the Minister has done more than one man's part over the years. He must be congratulated for the very formidable contribution he has made over the years towards ridding us of a suggestion such as this.

I would ask the House to appreciate that there is a very serious principle involved here, the principle of legislating in an objectionable way against a section of our community whether they be casuals, vagrants as they were called, or the aged class. It is quite obvious that "the county home or similar institution" is the one institution chosen by the Minister amongst all the institutions of local authorities in the country for this special treatment. I consider that the fact that specific legislation should be enacted in respect of these institutions is a retrograde and undesirable step. So far as I am concerned it is a suggestion which conflicts with what I consider to be a point of principle—that all persons shall be equal before the law and that in the Oireachtas, as far as we possibly can, we should legislate towards treating all our people equally. I am still opposed to this section.

I with Deputy Dr. Browne regret very much that the Minister has not taken advantage of this stage to remove this section. The Labour Party, Deputy Dr. Browne and those who voted with us on theprevious stage showed clearly that this was a question of principle with us. The Minister has unfortunately placed Deputies like members of the Labour Party and Deputy Dr. Browne in a very awkward position. If this amendment does not go through the old section, which is more abominable in our opinion than the amended form, will be retained. The only alternative left open to us then is to vote against the Bill, a Bill which we think we should support, because it is an improvement on the position as it existed heretofore. I am quite sure that Deputy Dr. Browne and the members of the Labour Party do not desire to be put in that position. We urge on the Minister to change his attitude in regard to this section and to this amendment. Surely it is not necessary —the Minister does not suggest it is necessary—that a person should go into the district hospital under the cloud of this particular section. If it is not necessary for a person to go into the district hospital under such a cloud, why should it be necessary to go into the county home under that cloud? The one reason apparently is that you can immediately indicate to the type of people likely to go into the county home that a special law is necessary to deal with them. You immediately brand the county home and all connected with it by the fact that a special law is required to deal with the inmates. In the case of a hotel or a boarding house no special law is necessary to deal with a person who is disorderly there ; there is no law saying that if you are disorderly or abusive to the people or employees on that premises you are liable to be put in jail for 21 days. We know the present law prevents people being disorderly but there is no special Act of Parliament making it a crime in relation to a particular place and a particular class of people.

The objection the Labour Party has to this section is that the law here applies only to a particular section of our people. Deputy Dr. Browne has objected to this principle. Is the ordinary law not enough? People havebeen entering our county homes for years past. The ordinary police force has always been able to deal with them. The Army has never had to be called out. For the past five or six years I have been a visitor to a county home. I am a member of the board. I am chairman of the board. I can see no reason why the existing law is not sufficient. Is it that the official in the Department has his mind so fixed that he wants to bring us back again to the old days in which the people entering these institutions had branded on their backs their particular destination? We must get away from that mentality. I will fight against that mentality every time it lifts its ugly head. I abhor this class distinction. If people do wrong they will do wrong anywhere. These people go to Church. They go to Mass. Is there a special law to cover their behaviour?

There is a special law to deal with an interrupter at Divine Service.

That covers all the people attending that service and not just one section. This is class distinction.

Any of us may go into a county home.

The Deputy need not twist it. This is deliberately put in to make the people entering county homes a class apart and, if that is the foundation of our health service, then I am opposed to it. I make no apology for that. We are anxious to vote for this Bill and I appeal to the Minister to remove this objectionable clause.

Deputy Kyne says he opposes this clause as a member of the Labour Party. As a socialist I cannot find the same grounds for objection. One must have rules and regulations. An ordered society is the whole basis and philosophy of socialism. I think the Minister should receive the congratulations of the House for the step he has taken at the request of the House as a result of the Second Reading of this Bill.

When this Bill came before us it included a clause providing punishment for a whole series of offences. They were set out in sub-paragraphs (a), (b), (c) and (d) of the relevant section. Undoubtedly that section was objectionable. The Minister appreciated the objections raised and decided to bring in an amendment. As originally drafted, there was a clause dealing with insubordination in relation to an officer of the home or institution. We objected to that and the Minister deleted it. It included a number of other matters dealing with intoxicating liquor, the inability of an inmate to conduct himself and so on. The Minister responded to the wishes of the House. All that is left now, after the removal of these objectionable clauses, is the simple clause that a person who is maintained in a county home or similar institution who behaves in a disorderly manner or causes unreasonable disturbance to other persons maintained in such home or institution or to persons therein shall be guilty of an offence. My whole life has been devoted to sympathy and effort on behalf of unfortunate people. I do not see anything in that section to which exception can be taken. We have special rules and regulations governing our behaviour in Dáil Éireann.

The section provides the greatest safeguards anyone could ask for. It does not say that a disorderly person will be dealt with by the authorities in the institution or by an official of the local authority. It says that if that offence is proved against him in the courts before a district justice he can be penalised to a maximum of 21 days' imprisonment in relation to the seriousness of his offence.

We should be realistic in a matter such as this. We have provided the safeguard that the offence can only be held to be an offence when it is established beyond reasonable doubt before a district justice sitting in a court of summary jurisdiction.

Would you agree with a gatekeeper in a county home saying to an inmate: "If you do not stay quiet you will get 21 days"? Is that a good thing?

It is being done.

Then we will simply deal with the doorkeeper. The doorkeeper has no right to send anyone to prison for 21 days.

He can threaten to do that under this Bill.

Nobody is guilty of the offence until it is proved beyond reasonable doubt before a district justice.

Why not make him amenable to the ordinary law in the same way as everyone else is? You are making a special law.

I am not. There will be rules and regulations and these rules and regulations will be published, in the same way as rules and regulations are published on the buses. The Deputy referred to people attending Divine Service. Any person attending Divine Service is subject to a special law. The great safeguard I see in this is that any individual who offends will not be dealt with by an official. He will be brought into the District Court and the charge must be proved against him there before the district justice. The evidence against him will be given in open court.

I have sufficient confidence in our district justices to know that they will deal with the case fairly and justly. They are not going to give a man 21 days' imprisonment, or one day's imprisonment, if there is a reasonable explanation, even though he did break the law. Does not everyone know that in our District Courts our district justices, day after day, are dealing with the people who come before them in the most generous and sympathetic way? Will anyone dare to say that our district justices are harsh in any respect? They are not. They only send the ruffian and the blackguard to jail.

It is justice we want and not charity.

Justice under our Constitution is administered by the justices in our District Courts. Thegreat protection that I see in the section for the man alleged to be guilty of an offence is that the evidence to support it has to be established in open court before a district justice administering the laws of this State.

I think that we ought to be fair to the Minister when he makes such a substantial amendment at the request of the House. We ought to accept it. I can appreciate the point of view that says it would be harsh to send a man to prison. Of course it would, but if he has been guilty of an offence, and if the district justice should send him to prison, I do not think anyone can complain. We must maintain, and we do maintain, discipline in the Garda Síochána Force by our special laws and regulations. One of the objections to what happens in the case of the Gardaí is that the law is administered by their own officers and not in the District Court. The same thing applies in the case of the Army where we have summary punishments imposed by commanding officers. I would prefer to see some of those cases dealt with in open court by a district justice. I think that we have achieved a great deal in this section, and that we should pay generous tribute to the Minister and thank him sincerely for the amendment which he has brought in.

I do not want to be unfair to the Minister or to anybody else. I am not going to follow the line of argument adopted by Deputy Cowan, but I agree with Deputy Dr. Browne that there is a principle involved in this. I think that, if anything, Deputy Cowan's speech was in favour of what Deputy Dr. Browne is asking to be done. Are we to be told that the man who goes into a county home is different from the man who goes into any other hospital? We all know that from time to time incidents take place even in the voluntary hospitals, due to the fact that someone comes in who may be under the influence of drink, and makes himself obnoxious. If he persists in being disorderly, he is dealt with in the usual way. What I object to is that we are putting a matter of this kind into our Health Bill.

We know that a certain amount of prejudice exists at the present time against our district hospitals and county homes. That is because of the tradition that is associated with them. Let us not perpetuate that by putting a section like this into a Health Bill. If an inmate does become insubordinate or disorderly is the law not there to deal with him? Would there be anything wrong in the hospital or county home authority sending for a Guard to deal with a disorderly person of that kind? I do not think, however, that we should put that into a Health Bill. I suggest to the Minister that he should reconsider the matter and cut out this provision. He should be able to find some other way of dealing with it.

Perhaps I am not as good a socialist as Deputy Cowan pretends to be. I do not want to speak on this matter from that angle at all, because I think it is only nonsense to bring in such a point in the debate. For a long time past we have been trying to lift up and improve the atmosphere of our county homes. A section like this is not going to help in that direction. If patients in hospitals go out in public and take one or two drinks, then come back and become disorderly, there are ways under the law of dealing with them. There is no reason why the same thing should not apply in our county homes. I agree with Deputy Dr. Browne that this is something which should not be put into a Health Bill, and I hope the Minister will reconsider it.

In our approach to this matter we must remember that the county homes are places of last resort for some people who find themselves in distress through not being able to obtain shelter elsewhere. If they seek accommodation in the county home, normally they are treated as ordinary citizens should be in such circumstances. If they go to other places and are in a state that makes them objectionable to other people, they can be refused admission. In the case of the county home, they cannot be refused admission. They must get admission for their own protection, if for no other reason.

It is often necessary to get them in there off the public streets. If, when they are admitted, they act in a manner that may cause distress to people who are ill in the institution they can only be dealt with in one or two ways. Regulations are operated by institutions to deal with people who behave in an unruly way or they are dealt with according to the ordinary law. In this case, a maximum penalty of 21 days' imprisonment is provided in certain circumstances for those who misbehave themselves. Perhaps that might be reconsidered. I am simply making that suggestion. That, however, does not perhaps alter the principle underlying the arguments of Deputy Dr. Browne and the Labour members. The whole point, however, is that the local authorities must have sufficient control to see that proper behaviour is observed by those who are admitted to the county homes.

I wonder could the Minister tell us whether, under the ordinary law in general operation, a person who behaves in a disorderly manner or causes unreasonable disturbance to other persons in such places as a hospital or in churches which have been mentioned, or at a public meeting in a hall or in an auction room or in other such places which are frequented by the public, is punishable under the ordinary law and, if so, whether he is liable to a term of imprisonment, and if so, what the term of imprisonment may be under the present law?

I appreciate fully the question of principle raised by Deputy Dr. Browne, Deputy Kyne and Deputy Hickey. I agree with their viewpoint in that respect. Possibly the Minister could tell us what his real difficulty is. Normally, in the case of a person who behaves in a disorderly fashion or causes undue annoyance to a person in that person's private house or to an innkeeper, he becomes a trespasser and can be dealt with as a trespasser under the ordinary law. Is the Minister's difficulty that he is bound to receive and accommodate persons who seek shelter in county homes and that he has no power toeject them? Normally the ordinary remedy that the hotel-keeper or publican adopts is to throw the fellow out. If a fellow is disorderly or drunk on the premises he puts him out. If he cannot put him out himself he calls in a Guard who will put him out, or who may charge him with trespass or with committing a breach of the peace or of conduct calculated to lead to a breach of the peace.

Is the Minister's difficulty in this case that he cannot do that in regard to the inmates of county homes by reason of the fact that he is by statute bound to receive them and keep them? If that is his difficulty could he get over it in this way? Could he, instead of this section, which does in principle seem to establish a different class of people, put in a very short section providing that a person who is guilty of a breach of the peace or of conduct calculated to cause a breach of the peace may, notwithstanding anything else contained in the Act, be dealt with as a person guilty of the same conduct in a private house, hotel or elsewhere, can be dealt with, so that you will have the same law for them all? That is, if that is the Minister's difficulty.

Under the ordinary law, if it is not for the impediment that is contained in the Bill itself which compels the local authority to receive and keep persons in the county home, the Minister has all the powers he wants of dealing with them in the same way as anyone who comes into a house and starts assaulting somebody and breaking it up and remains until he is asked to get out can be dealt with. That person is guilty of an offence against the ordinary law. He becomes a trespasser and can be charged as a trespasser or as a person guilty of conduct calculated to lead to a breach of the peace. It would not be very difficult to find some formula that would place the county homes in the same position as the occupier of any private house or hotel or club.

I have been listening to the discussion on this particular amendment. It strikes me that most of the Deputies who have contributed to the discussion have little experienceof the running of a county home. I am surprised at Deputy Kyne's attitude to it. I take it that in County Waterford they have their quota of undesirables just as there is in every other district. I can sympathise with Deputy Dr. Browne's outlook on this matter. I know from experience that for his short time in charge of these institutions, as Minister for Health, he brought about very considerable improvements. I feel that is due to be said for Deputy Dr. Browne. I take a personal interest in the administration of these institutions. I visit them occasionally. Even if it is only directed towards the 1 per cent. of undesirables who avail occasionally of the shelter of these institutions, the Minister would be well advised to retain that section. This is not directed towards the ordinary inmates of county homes, not by any means. What I want the Minister to guard against is the type of bully who comes the way and of whom anyone associated with these institutions is well aware. These are the people who should be kept in check. For that reason I support the Minister in retaining this particular section in order to have that deterrent in respect of those people who visit the institutions.

Is not the law there to deal with them?

Deputy Kyne referred to a gatekeeper not admitting certain people. Deputy Kyne must know very well that there are many gatekeepers in these institutions who are very far advanced in years. In Drogheda, only last year, a man had reached the retiring age. I ask Deputy Kyne would he expect a man of those years to tackle some of those people who travel the way and who are obnoxious? When they come to those institutions under the influence of drink, there is no one in the institution to deal with them.

Have not you the police?

It is well over a mile from our Garda station to the institution and by the time the Garda would walk or cycle there a good dealof damage could be done and a good deal of commotion could take place that would annoy the old people who go into these institutions to end their days. These are the people in whom I am interested, not the 1 per cent. who pass the way. I am aware of the ordinary common law. This is a special provision which is in the interests of the institutions and their peaceful administration and the protection of the inmates. No one will know sooner that that deterrent is there than the people for whom it is intended.

Deputy MacBride put his finger on the kernel of the matter when he pointed out that there is a definite distinction between the position of an inmate of a county home and that of a patient in a voluntary hospital or a person availing of accommodation in a hotel.

I am not sure that there is. I was asking the Minister to tell us if there was.

Deputy MacBride indicated that there may be. I think there definitely is inasmuch as a person who is in need of accommodation and cannot find it elsewhere has a statutory right to admission to a county home and to be maintained there. Because of that he is not in the same position as a person who can be put out of an hotel if he is disorderly.

He must conduct himself.

Yes. But if he misconducts himself in any of the other places he may be turned out, as Deputy MacBride pointed out, and there is no more about it. If a person misconducts himself in an hotel, boarding-house or other place of that kind he may be forcibly removed. But an inmate of a county home has a statutory right to remain there, and as he has that right he is in a different position from the many other types of persons who have been mentioned and because of that there is need for a special provision in this Bill. That is the kernel of the matter. If an inmate of a county home was in exactly the same position as a patient in avoluntary hospital or any other hospital, he could be dealt with in exactly the same way as a patient in a hospital. But because he has a special statutory right which these other people have not, it is necessary to make a special provision for him.

Deputy MacBride suggested that there was an easy solution to the problem. I do not think that there is. I am sure that the Minister must have turned this question over in various ways, and if the solution which Deputy MacBride suggests was adopted it might possibly carry with it an injustice to the inmates of county homes, inasmuch as on the pretence of that provision which Deputy MacBride suggests should be incorporated in the Bill that inmate could be turned out on the street at any time and he would lose, so to speak, his security of tenure in the county home.

I think it is recognised by the House that we are dealing with a difficult situation and a very special type of case and for that reason a special provision is needed. If the person who seeks admission to a county home had not the special rights which are guaranteed to him because of his destitution there would be no need for this special legislation. But because he does possess these rights and because he cannot be refused admission or cannot be turned out on the streets it is necessary to have some means of ensuring that he will not do injury to the institution or to the other persons in the institution.

We are all hoping that we will see the day when county homes will be an entirely different type of institutions and be confined solely to the aged and infirm, and when able-bodied persons who are destitute will be provided with accommodation in some other place. But until that reform is put into operation some means must be adopted to protect the aged and infirm inmates from able-bodied people who misbehave themselves.

The first point, of course, is that a county home must admit anybody who is destitute and cannot get shelter elsewhere. As the law stands now and until certain parts of thepresent legislation are repealed by this Bill, this applies to every institution under a local authority. It is only being renewed for county homes because county homes must admit anybody who comes along and who is not able to get shelter elsewhere. In that way, of course, a county home is different from a hospital, because a hospital need only admit sick persons, and it is also very different from an hotel or a boarding-house. I do not know what the law is with regard to hotels, but I believe there is a certain obligation on hotels to admit persons.

We all know, however, that the proprietor of an hotel or boarding-house can make the excuse for refusing to admit any person that there is no accommodation available. If a person is admitted and does not conduct himself he can be thrown out. The county home is therefore different from any other institution under a local authority or any institution under private management.

Then there are casuals coming along. I do not want to be taken as saying that all these casuals are blackguards. A lot of them are unfortunate people. Some of them are quiet people and easy to manage. Sometimes, however, there may be a few who will be inclined to make trouble and we have, therefore, to keep them in mind. As long as casuals are admitted to such an institution we will have that problem. In Dublin they are making provision for putting casuals in a different institution from the county home.

That is the best solution.

It is the proper solution, it is the solution which I am anxious for local authorities to adopt. It may be difficult for them to adopt it, because the number of casuals which they have to deal with is not very large and it may be a very expensive business to achieve that fairly small object. In the bigger centres like Dublin that will be adopted and then the county home will be in a very different position and this section will not be required at all.

There is, of course, this trouble also. Deputy MacBride raised the question of the ordinary law and the power ofthe Guards. The Guards will not come into a county home. I do not want to put anybody in the wrong. I admit that if this power were not there it might be different. But at present the Guards will not come into the county home because they say this is a domestic affair.

That is not so. That is what you are told.

This is brought in because the county homes have complained.

I have seen the Guards do it.

May be you did, but I have got complaints from county homes that the Guards would not come in, and that is why the clause was put in. They may do so in Dungarvan.

They do.

They do not come in in other places. If they do it in Dungarvan it is all right, but it is not all right in other places. The whole trouble is that the Guards will not come in. That is what I am told.

A word with the Minister for Justice will settle that.

The Guards say it is not their business; they say it is a domestic matter. Anyway, we appear to approach this in different ways. It is all very fine for Deputy Kyne to say that the officials of the Department of Health are trying to bring back the old workhouse idea. The officials of the Department of Health have just as much regard for people in county homes as Deputy Kyne has. It was because of regard for them that this clause was put in as we want to protect the old people. I have as much regard for people in county homes as Deputy Kyne and I say they must be protected.

It is all very fine for Deputy Hickey to get up in his usual way and oppose this. But, has Deputy Hickey any regard for the old people in the county homes? Does he say that they must be left at the mercy of anyone who makes noise and says: "You can sleep to-morrow after I go out"? Is thatthe sort of regard he has? Deputy Dr. Browne and Deputy Kyne I know approach this in a very humanitarian way and I give them credit for that. But will they give me credit also? We are not drafting a Bill to go back to the old workhouse idea; we are drafting a Bill to protect the old people. I had the old people's interest in mind when I put in this clause and for their sake I want the clause to remain.

Deputy Kyne or anybody else should not think that I am blaming all the casuals. There is just a comparatively small proportion of rowdies amongst the people who go into county homes, just as you will have them amongst those going into publichouses or race meetings or theatres or anywhere else. The whole thing is that that small proportion are going amongst people who are unable to take care of themselves. The people at race meetings and the people in publichouses are able to take care of themselves.

Sometimes people in publichouses are much more incapable.

That may be, but we need not legislate for them. It may be that we have a different way of approaching this, but I want Deputies to look at this from the humanitarian point of view that old people should be protected. Others, I am quite sure, as well as Deputy Kyne want to see the old people protected, but they are looking at it from a different point of view, that by putting that in we are promoting what might be regarded as class legislation. It is not class legislation. It is a different position from any other, because the county homes, unlike any other places, are bound to take in anybody that comes along.

You are taking power now to make sure they go in for 21 days.

Is there any other remedy?

I am suggesting the ordinary law of the land is there for them as well as everybody else.

Suppose you are a rowdy? Does Deputy Kyne think that heshould be allowed to go in there and stay for the rest of his life? Surely the only place for him would be in Mountjoy?

Why do you suggest that for me? Why do you not suggest it for Deputy Dr. Browne?

Only because you interrupted.

No, but because I am in the Labour Party. I do not support the Government.

You could be in a worse Party. I am only saying we are approaching this from a different angle. I am making the distinction that we are dealing here with institutions where people must be admitted. There is no way out of it. You cannot even throw them out. You must put up with it.

We have a hostel in Cork where 50 or 60 men go in every night and there is never any question of a regulation or punishing them and we need not put it into the Bill.

You are not bound to take them in.

Amendment declared carried.

Could I be recorded as dissenting?

I am dissenting, too.

I thought Deputy Dr. Browne said "Votáil".

On a point of order. Is it correct to say that if we vote against this amendment we will be leaving the whole position worse? We want to dissent, but we do not want to worsen the position.

You would be in a worse position if you defeat this amendment.

Deputy Dr. Browne and the Labour Party recorded as dissenting.

I move amendment No. 17:—

In pages 22 and 23, Section 54, to delete paragraph (a) of subsection (7) and substitute the following paragraph:—

(a) Where a person maintained by a health authority in a county home or similar institution does work on behalf of the authority, he shall be deemed, in relation to the doing of the work, to be for the purposes of the Workmen's Compensation Acts, 1934 and 1948, a workman in the employment of the authority, but, save as aforesaid, the doing of the work by such person shall not operate to create or imply the relation of master and servant or a contract of service between the authority and such person.

On this section on the Committee Stage, there was a clause which gave power to the local authority to make a person work. That was taken out but a person can work voluntarily. I was doubtful whether it was necessary to have the Workmen's Compensation Act applied or not where a person offered services voluntarily. I believe it is, and therefore this amendment is put in to cover cases of voluntary employment.

Amendment agreed to.

I move amendment No. 18:—

In page 24, Section 56, line 19 and line 25, to delete "at their discretion" and substitute "with the consent of the Minister".

There was some discussion on the Committee Stage—in fact I think there was an amendment put down by Deputy Dr. Browne—that if a child is taken from the foster-parents without their consent, there should be an appeal. That was withdrawn on my undertaking to look into the matter. I think "with the consent of the Minister" is better than an appeal to the courts, because the inspectors of the Department have a good knowledge in nearly all cases of the children and the homes they are in, and where they have not.they can pay a visit and investigate on the spot and then give advice to the Minister whether the proposal of the local authority should be accepted or not.

Deputies will realise that there are nursed-out as well as boarded-out children. Nursed-out children are usually sent out by religious societies and guilds of various kinds and the local authority is not responsible except for certain things like registration of homes and so. But boarded-out children are entirely the charge of the local authority. I would like to give some figures in this connection. A sample eight counties were taken some years back and there were 19 children removed from 18 homes in that year.

These counties that were taken would form about one-fifth of the country. Eight children were removed at the request of the foster-parents. Naturally there would be no appeal there. In two other cases, the children were claimed back by their own parents and there could be no opposition there, because the parents have prior right. In five cases, the foster-parents with which the local authorities had contracted died and there was no alternative but to remove them. The remaining four children were removed from the homes for reasons stated by the local authorities; so that there were only four cases really in 1952 where a question of appeal to the courts could possibly arise.

In these four cases, there possibly would have been an appeal, but at least two of them were very well known to the inspectors of the Department and they would have been able to give advice straight away. In the other two cases, inspections could take place and advice be given to the Minister, so that I think this amendment would cover the case better than an appeal to the courts.

Amendment agreed.
The debate was adjourned.
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