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Dáil Éireann debate -
Thursday, 30 Jul 1953

Vol. 141 No. 7

Committee on Finance. - Health Bill, 1952—Report Stage (Resumed) and Fifth Stage.

I move amendment No. 19:—

In page 29, before Section 62, to insert a new section as follows:—

(1) Where a college which awards any of the qualifying diplomas mentioned in the Second Schedule to the Medical Practitioners Act, 1927 (No. 25 of 1927), or a college of a university which awards any such diploma, requires facilities for the teaching of clinical medicine or for the conduct of medical research in a health institution—

(a) the Minister, if he so thinks proper, may by Order declare the institution to be a teaching institution,

(b) on the institution being declared to be a teaching institution—

(i) it shall be the duty of the health authority by whom the institution is maintained to provide in the institution such facilities for the teaching of clinical medicine or for the conduct of medical research as the Minister may direct from time to time,

(ii) in relation to the making of any appointment to the staff of the institution which is considered by the Minister to carry with it duties involving the teaching of clinical medicine or the conduct of medical research under the direction of one or more than one such college, any board constituted by the Local Appointments Commissioners in accordance with Section 9 of the Local Authorities (Officers and Employees) Act, 1926 (No. 39 of 1926), to interview candidates shall consist of a chairman nominated by the Minister and a number of other members, half of whom shall be nominated by such college or colleges.

(2) In this section "medicine" shall be construed as including surgery and midwifery, and "medical" shall be construed accordingly.

On the Committee Stage, I mentioned that I would be introducing an amendment dealing with the teaching bodies, the schools of medicine and their request for facilities for teaching hospitals. There has been a long time of negotiation between the Galway UniversityCollege and the Department of Health and the County Hospital in Galway which is now becoming a regional hospital. The position was that where an appointment was made by the Local Appointments Commission—let us say a surgeon to the county hospital, or a physician or a gynaecologist—University College, Galway, had no option but to accept the same man as their professor, and they considered that this rather handicapped them because they had no choice.

We had protracted negotiations on this matter, and while I felt that we should not depart from the principle that the local authority would have the appointment of a man to their hospital, University College, Galway, thought that they should have some say in the appointment of their own professor. Now after discussing the matter at length, both sides agreed that if they had an equal number on a selection board with a neutral chairman it would be the best solution. When we arrived at that stage, the college suggested that the Minister for Health should nominate the neutral chairman. I would like to assure the Dáil that I did not look for this job of nominating a chairman, but there appeared to be no other way in which it could be done by which to give it a neutral character, so I am therefore introducing this amendment; and the position will be this, that where a college think that they want facilities for teaching in any local authority hospital they will apply to the Minister for Health for an Order, and if the Minister for Health agrees that these facilities are necessary then he makes an Order and the local authority will provide the facilities for teaching in that particular hospital. Providing facilities means, of course, that they will permit their man to give clinical teaching to students of the college and provide for reasonable hours for those clinics and so on. Then, when the appointment comes to be made—it would not interfere, of course, with appointments that are there at the moment—when new appointments come to be made where the college claims that they have an interest in the matter and it is fairly obvious to the Minister that the manappointed will, in all probability, be the professor in the college, then the Minister will make a second Order having this machinery put into motion under which the appointment will be made and the appointment will go to the Local Appointments Commission in the usual way.

They will issue the advertisement, they will do the interviewing and so on, but in setting up their selection board they will have to follow the pattern laid down here in this amendment. They will accept a certain number of nominations from the college—let us say three—and they will appoint three themselves and then they will ask the Minister to appoint a chairman. The selection board having made their selection, the procedure will follow the usual Local Appointments Commissioner procedure with regard to the appointment being made. Of course, even with all this over there is no obligation on the college to appoint that man a professor, but at any rate they will have this machinery and we will have gone as far as possible to meet them.

I wonder will the Minister relate this in a rather ordered way to the position of the teaching bodies as far as medicine is concerned and their general position in relation to medical education. The Minister is, of course, aware of the difficulties which have arisen with regard to doctors trained in our medical schools here in relation, say, to recognition in the United States and the question that is still pending of some visiting body from the United States coming here, I think next month, with a view to looking into the position of our medical schools here and seeing whether they cannot agree to have recognition of our medical degrees in the United States. Some aspect of the difficulty might easily relate to the extent to which the teaching bodies were properly controlled by the universities or by the medical authorities in the universities. The Minister's amendment, as he has indicated, is intended to cover situations in which teaching is carried on in some hospitals that are local authority hospitals and where the local authority wants to have at any rate a say in the appointment of the doctors there. From thepoint of view of medical teaching the university, at least the medical authority in the university, want to be in the position of saying that they will control all such appointments in the hospital as are appointments that are carrying out teaching functions. The Minister has indicated that in relation to Galway particularly some arrangement has been made with the university there. I would like to ask the Minister what is the university authority, what is the body on the university side, that from the medical teaching point of view would be regarded as the authority controlling the appointments that were in any hospitals doing teaching.

I understand that in the teaching hospitals in Dublin the position has now been arrived at that appointments made in the teaching hospitals in Dublin which are positions that have a teaching function are made with the co-operation, and to a certain extent with the control of the university authority. Can the Minister make it clear whether any body in the National University as a whole such as the Senate is supposed to have any function in relation to the appointments for teaching positions, for professorial positions in the universities, and whether the matter has been discussed at the Senate level and, if not, what is the particular university level at which it is proper to have the matter decided and agreed to? I take it according to the Minister's amendment that the provisions would apply equally to Cork, Galway or Dublin, as the case might be if the necessity arose in any of those places to have an arrangement made.

I have had some experience of this problem myself, and I understand the Minister's difficulty. I am glad to see that he has been able to come to this compromise solution while at the same time I regret that the Local Appointments Commission machinery should be interfered with in any way because it has done a magnificent job. In fact, the Local Appointments Commission machinery has been responsible more than anything elsefor the very high standard which at present obtains in relation to our State health services and our local authority health services. I should be very averse indeed to any fundamental change in the machinery.

However, in the circumstances, where there is to be a teaching school established, from our point of view, the advantages are very considerable, because there is no doubt the standard of medicine will rather tend to be improved by virtue of the fact that it will become a teaching hospital to a certain extent.

Consequently, I am very much in favour of this development that the universities should become in some way associated with the local authority hospitals. To a certain extent, it is badly needed. Certain affiliation by one or other of the Dublin universities would be necessary in order to provide the additional beds required for the considerable number of students there and then there is the other effect of improving, as I think it will, the standard of medicine and moving a place like St. Kevin's away from the old workhouse, poor-law type of hospital. The standard of medicine will be upgraded to that extent.

On the other hand, I suggest that the Minister be very cautious to ensure that there will be no further dilution of his nominees, of our nominees, on any proposed board to be established by the Local Appointments Commission for the making of appointments to our local authority hospitals. For instance, in St. Kevin's, the paramount consideration must be the quality of the individual to be appointed and the secondary consideration the association with the university and I ask the Minister to be particularly cautious with regard to giving way on the second to the detriment of the first. We should try to keep as far away as we can in the making of appointments to local authority hospitals from the system of appointments adopted by the voluntary hospitals, which, I think, has largely led to the very low general standard of medicine we find in most of our voluntary hospitals. It is essential that the system of the Local Appointments Commission should notbe weakened to any greater extent than is suggested here by the Minister.

In relation to the proposition that "half of the members of the commission shall be nominated by such college or colleges", in the event of University College, Dublin, Trinity College Dublin, and the College of Surgeons deciding to set up a joint training school or joint teaching facilities in a place like St. Kevin's, I wonder if the Minister could say whether it will be at his discretion, or will the Local Appointments Commission, or the separate boards of the teaching establishment, have the decision in making the allocation of members to the appointments board. Possibly that has not been considered by the Minister—I do not know whether it has been considered by the different teaching authorities—but, if it has, I wonder if the Minister has come to any decision. I hope that each of these teaching establishments will have equal representation, if they are to take part in a joint effort to utilise the local authority hospitals as teaching establishments. I welcome the proposed affiliation, which I hope will come to fruition, between the local authority hospitals and the universities, the teaching centres.

Again, I do not think that the local authority should feel that they should go in any sense cap in hand to these people. We are offering magnificent facilities in many cases which they have not got themselves and we should bear that in mind. They are not bringing all the gifts—we have quite a lot to offer them in facilities which will help their undergraduates and in a number of cases postgraduates, and will help the teaching, enlarging and improving its standard, of their undergraduates in the universities and different medical schools. The Minister should be particularly careful in his negotiations with these people to make them bear that in mind, that we here in the Oireachtas are particularly conscious of the advantages which we could offer to these people; that if there is any bargaining to be done it should be hard bargaining, on the basis that, while they have a certain amount to offer us, we have a lot to offer them;that what we would like to do is what would be in the best interests, first, of the patients in our institutions and, secondly, of the undergraduates and postgraduates and Irish medicine in general, and that under no circumstances should there be any retrograde step in relation to appointments. The standard in the local authority hospitals generally is extremely high due to the mechanism of the Local Appointments Commission, which I believe is absolutely above criticism. We can well understand that there is a special problem in Dublin, Galway and Cork, but we should not depart from the very high standards laid down by the Local Appointments Commission in the past, in the matter of the making of appointments, by which the best qualified candidate is appointed and afterwards the other considerations arise.

The American Medical Society are, I believe, sending some members over here towards the end of this year to examine the condition of the teaching of clinical medicine here, before deciding on the question of recognition of our degrees in the United States. I think they are principally concerned that the college should control clinical teaching and I think this will cover the point, so far as they are concerned. It is not done, however, entirely from the point of view of pleasing the American medical schools, because we have our own much bigger problem here of having proper medical teaching carried out to supply the country with medical men.

Unfortunately, some of them must emigrate, but those who have emigrated to England up to this find no difficulty in getting proper recognition there. I think, however, that, under this amendment and when the scheme is adopted, clinical teaching in the local authority hospitals under the colleges concerned, which are principally Galway and Cork, will make things right. I cannot answer for the voluntary hospitals, but I suppose the colleges will make an endeavour to have appointments from the voluntary hospitals in line with the requirements of the American medical authoritieswhich will give them some say in the appointments there.

In answer to Deputy Mulcahy's question, I think the authority concerned is the governing body. At least, any negotiations I had with the colleges of Galway, Cork and Dublin were almost all with the presidents. As far as I know, they were speaking for their governing bodies. I think the question came before the Senate of the National University and was referred back to that committee for negotiation on this point.

In answer to Deputy Dr. Browne, if more than one college applies in Dublin—that cannot happen in Galway or Cork—for facilities in one local authority hospital, then it is the Local Appointments Commissioners who will decide on the representation of the board in accordance with this section. What they would do, in my opinion, if two applied would be to give them half the representation on the board. If three applied they would give one to each college and three others, the Minister appointing a chairman. It is the Local Appointments Commissioners who decide this under the Order.

The Minister, as Deputy Dr. Browne pointed out, must naturally keep the interests of the local authority hospital in mind. That is his principal duty and he would have regard to that provision when making any Order or giving any direction. It is not his function actually to look after the university or the college. They have their own governing body and their Senate as well. As I interpret this, all the Minister is asked to do is to observe this section and keep the interest of the local authority hospital in mind before he makes an Order or gives a direction. I think that would be the proper interpretation for a Minister for Health in carrying out his functions under this particular section if passed by the Dáil.

Amendment No. 19 agreed to.

I move amendment No. 20:—

In page 29, Section 62, line 36, to insert "from time to time" before "courses."

In some talks which I had with the Irish Medical Association, the Irish Medical Council and those representing or speaking in any way for the colleges, I agreed to certain amendments on the Committee Stage. Afterwards, when I looked up my notes, I found that, although I had undertaken to put in these words, I had omitted to do so. I thought it was only fair that I should put them in as I had given the undertaking. I really want to make it perfectly plain that we do not mean to set up a medical school under this section. We only mean to have postgraduate courses that would take place from time to time. The postgraduate courses might be given for any subject. It is perfectly obvious, as the section is drafted, that all I had in mind in drafting the section was that the local authority hospital could give a course if it had something of value to teach. If the local authorities want to instruct their men on a particular method or a particular technique in regard to some new treatment or other they could give a course in a particular hospital and invite the members of their staffs to attend. It is laid down, of course, that they cannot be compelled to attend. That is what we had in mind. I made it quite plain in my talks with the Irish Medical Association and those speaking for the medical schools that I had no more than that in mind and that I did not ever intend to turn this into a medical school. I had undertaken to put in these words "from time to time" but, unfortunately, when the amendment was being drafted I omitted to do so.

Does the Minister consider that the words "from time to time" are a sufficient safeguard? I take it from the Minister's statement that the object of this is to permit local authority hospitals to instruct their medical officers on certain facts, and that they would then want to be in the position of establishing a teaching centre. What exactly does "from time to time" mean? There seems to be a principle involved. The words "from time to time" will really enable a Minister, whoever he may be, to allow teaching at any time he wishes in the local hospitals. I think it would be farbetter if the Minister amended the wording and inserted the words "in consultation with the teaching authority". The words "from time to time" mean that they can teach for years. There is no time limit. If they decide to teach in local authority hospitals they can go on teaching for years. There is not any limit. It is not limited to a few hours, a few weeks or a few months. They can establish themselves as a permanent teaching establishment. The Minister tells us that it is not his intention to do that, that the intention is to teach as the occasion arises. It would be far easier to meet the situation by inserting the words "in consultation with the teaching authorities". If that suggestion is accepted it would meet the case and there would be no further argument about it. Established teaching authorities would be safeguarded and the Minister or whoever is representing the local authority would be perfectly safeguarded. I would ask the Minister to meet the case that way.

The words are put in, of course, to make it impossible for a Minister to carry on a continuous course. Some people purported to be afraid that that might be done by a Minister. Let us say there is a course for the D.P.H., the M.D., or the M.Ch. I put in the words to show that these postgraduate courses would be single courses. Then another one might be given on something else. I think the words are perfectly plain. There is no danger that a school can be carried on. We are going as far as can be expected.

Amendment 20 agreed to.

I suppose there is no chance of persuading the Minister to change his mind in regard to amendment No. 21?

Amendment No. 21 not moved.

I move amendment No. 22:—

In page 33, Section 70, to add the following sub-section to the section:—

(11) The following section shall beinserted in the Act after Section 279:—

279A. Where a decision taken in pursuance of paragraph (b) of sub-section (2) of Section 15 of the Health Act, 1953, as applied by this Act, is a decision that the yearly means of the adult person are not less than £600, an appeal shall lie from the decision to a person appointed by the Minister, and regulations made by the Minister may make provision with respect to the making and determination of appeals under this section.

As a matter of fact, this amendment is the same as amendment No. 2. Amendment No. 2 provides for an appeal on the question of £600 means in relation to general hospital cases, but this amendment covers mental hospital cases.

Amendment No. 22 agreed to.

I move amendment No. 23:—

In page 34, after Section 71 to add a new section as follows:—

The provisions of the Public Authorities Protection Act, 1893, shall not apply to any action brought by any person for damages for breach of duty and/or negligence against a health authority (or officer, servant or agent thereof) in respect of any act of omission arising out of, or incidental to, the provision of any service, treatment or examination made available by virtue of the provisions of this Act and of the Health Act, 1947.

I do not intend to detain the House very long, as this has already been discussed on the Committee Stage. The amendment is designed purely and simply to ensure that the public authority hospitals will be on the same footing as the voluntary hospitals in regard to any act of negligence or breach of duty which might give rise to a claim by a patient. I think the Minister might well accept the amendment. I see no reason why the public authority hospitals should receive aspecial blanket protection as regards acts of negligence.

I might put this additional consideration to the Minister. Apart from the necessity of ensuring that the rights of anybody who suffers an injury, through the negligence of the hospital authorities or the staff, will be protected, I think that an occasional action of that kind is quite useful from the point of view of keeping everybody on their toes. The mere danger that there will be an investigation, the mere risk of an investigation, acts as an extra safety device to ensure that there is no negligence in the running of the services.

I do not think that this should be left over for the Bill introduced by Deputy Dillon. We do not know how long that legislation may take and, in the meantime, it would be no harm to accept this amendment.

I must say that in principle I am against bringing matters of this kind into a Health Bill. This is a matter that really should be dealt with under some other code. As the Deputy knows, a Bill is being prepared by the Minister for Justice, a Bill which he undertook to prepare when Deputy Dillon introduced his Bill and did not proceed with it until the Minister would produce his Bill. The Minister is definitely producing that Bill and it will be ready, I am told, after the summer recess. I do not know how far it will go. I do not think it will remove the limitation completely; it may only extend the period to 12 months or two years instead of six months. I do not want to give the Deputy an undertaking that the Bill being brought in by the Minister for Justice will go as far as he wants to go here for the health authority.

It would be rather anomalous if we passed this now and left other local authorities as they are. For instance, you would have the sanitary authority, the housing authority, the mental authority and various other authorities with the employees under the disabilities they are under at the moment, whilst we would remove that disability to some extent, by putting in theamendment, for the health authority. I think it would be better to leave it until the Bill is introduced by the Minister for Justice and therefore I have to oppose the amendment.

Would the Minister not agree to have this in pro temand amend it when the Minister for Justice brings in his own Bill?

I do not see that there would be much object in that.

I do not want to be difficult, but I think it is definitely an important question.

Is the amendment being withdrawn?

No, it is not.

Amendment put and declared lost.
Question—"That the Bill, as amended, be received for final consideration"—put and agreed to.
Agreed to take the Fifth Stage now.
Question proposed: "That the Bill do now pass".

When this Bill was introduced, we asked on Second Reading, in a motion, as follows:—

"To delete all words after the word ‘That' and substitute therefor the words:—

‘Dáil Éireann, while of opinion that improvement and extension of the health services are necessary, declines to give a Second Reading to the Health Bill, 1952, until it receives a report on the Bill from a Joint Committee of the Dáil and Seanad having power to send for persons, papers and records.'"

Our experience of dealing with health legislation in the House, apart altogether from the general lines of this Bill, dictated that there would be an examination of the Bill in circumstances where all the facts of the situation could be elicited from people who were competent, by reason of their experience and their position in the country, to give their representatives in the Dáil and Seanad the details that we felt it was necessarywe should have before approving of a general Health Bill of any kind. The Minister refused that and we have had a situation here in which we could say that the present Bill has been bulldozed through the Dáil on Committee without any reasonable chance, either by way of time or by way of opportunity, of discussing the general implications of the Bill.

On the Fifth Stage, we are supposed to discuss what is in the Bill, but, even after the discussions there have been and even with the assistance of the discussions we have had, I doubt if very many in the Dáil would be capable of discussing what is in the Bill. It is intended that it will be put into operation by regulations and Orders made from time to time but the outstanding fact in relation to the Bill is contained in the statement issued by the Irish Medical Association, published in their journal of April, 1953, which states explicitly:—

"We unanimously reject the proposals contained in the Health Bill of 1952 and refuse to co-operate should the Bill become law."

Then they give the grounds. I understand that their attitude was reiterated at a meeting held a month or so ago. Therefore, we have the position that this Dáil has pushed through the Committee and Report Stages a Health Bill in relation to which the medical profession, as represented by the Irish Medical Association, say that they are unanimously rejecting the proposals in the Bill and that they will refuse to co-operate in its operation.

Early in 1939, the Government at that time set up a committee of very representative people to inquire into vocational organisation. That committee reported on the 4th November, 1943, and at paragraph 12 of the report they stated:—

"We have taken, then, the general term ‘the vocational organisation of society or of the community' as meaning the ordering of the structures and activities of the various distinct vocationally organised bodies in the community in such a way as to promote the common good;this promotion to be secured by the co-operation of each vocationally organised body with the others in some intelligently controlled way for some clear aim or purpose."

Before the Minister produced this Bill, he declined to allow representatives of his Department and representatives of the Irish Medical Association to co-operate in reviewing the general position and in seeing whether they could agree to proposals for health legislation.

Then he produces this Bill and he has simply bulldozed it through the House. We are now finished with it here. We have had to discuss it at a time when we ought to be discussing other very important matters in relation to the various Departments of State and in relation to our finances. In 90 days it becomes law. It will be offered to the Seanad for consideration at a time of the year which it is inconceivable that anybody would plan as a reasonable time to ask the Seanad inside 90 days to examine this Bill. However, the Bill now passes from us. We are fundamentally opposed to the general principle upon which it is drawn. According to the Minister, the present public assistance medical services cater at the present time for 1,000,000 of our population and the Bill forces the next 1,000,000 of our population in on top of these people with very inadequate provision. Therefore, it will deprive those who got a fair amount of service from our public assistance health machinery of some of the facilities they had up to the present. By reason of various pressures of one kind or another, including the burden of taxation and of rates, they will be forced to take advantage of the machinery provided making available to them machinery that will be neither adequate for them nor, in many cases, very suitable.

There will be various repercussions as a result of these proposals as it affects the medical profession, as it affects the people who are supposed to be served, as it affects our voluntary hospitals—who, if they do not kow-tow to the proposals of this Bill, may find themselves out of existence—and as it affects the medical teaching authorities. All of these present aspects of the proposals which will become very live issues among these sections of our community straight away, that is, after the 90 days have passed. We can only leave the Bill and its effects to pass then into the more realistic regions, among our professions, our hospitals, our people who bear the financial burden and our people who want the services.

Certainly the manner in which the Minister has treated the Assembly here in dealing with this Bill has reduced this Dáil to a nullity. It has taken away any realism from the suggestion that this is an Assembly where opinions can be exchanged, where facts can be produced and decisions taken in a reasonable way as a result of discussion here. We object to the way in which this measure has been prepared, the way it has been dealt with in this House, and we are opposed to its general provisions.

It was regrettable that this Bill was presented in the manner in which we first saw it. We had a list of amendments. Those of us who sought to amend the Bill found that the Minister had sent in a further list of amendments, amendments, it could be said, to amend the previous amendments. To say the least of it, it made the Bill difficult to follow from the start. Notwithstanding that, I think the Bill finally emerged in somewhat better shape than it was in when introduced. From the beginning the Labour Party took the line that while this Bill did not meet with all we wished for or desired, it was still a step in the right direction. We decided we would co-operate with the Minister, that we would seek to improve the Bill in so far as we could by submitting various amendments. I feel we can claim we have done something in that line.

Many of our amendments were ruled out by the Chair on the grounds that they imposed charges on the Exchequer. Others were defeated in this House. I regret very much that we were unable to secure completelythe removal of Section 54, that obnoxious section from our point of view. I also regret very much that the Minister saw fit on the Report Stage to make an attack on members of the Labour Party, especially in view of the fact that they were not in a position to reply at that stage having spoken once on it. He suggested that the Labour Party members were motivated by the desire to protect blackguards in the county homes who came in to annoy and upset the ordinary people there. That certainly was not the motive of any member of the Labour Party in supporting the line taken by Deputy Dr. Browne. Our argument was that there was a principle involved.

I do not want to comment on Deputy Peadar Cowan's suggestion that he is an extreme socialist, that because he saw fit to accept this then all the Labour people in Ireland should immediately follow. If his brand of socialism appeals to him we are quite prepared to leave it to him whether it is vanguard, rearguard or any other guard.

He is not extreme.

No, he is not extreme.

He did not say he was extreme.

We cannot discuss that on this Bill.

I do not intend to discuss Deputy Peadar Cowan's socialism because I think it is non-existent now whatever it was in the past. Tell me your company and I will tell you what you are. Our opposition is based on principle. We do not believe in merely giving lip service to the principle. We hope that in regard to all sections of life, education, hospitalisation and everything else, there will be one law for all and that all, as wise citizens, will obey that law.

I made a remark on the Report Stage which, on reflection, I would like to modify or withdraw. I suggested that the officials put this provision into the Bill and the Minister for Health automatically accepted it. What I intended to say was that the attitude of officials to sectionssuch as this has shown itself for a long number of years in previous Bills. I admit that they are only doing their duty and that it is not their place to make revolutionary changes. If that was taken as reflection on the officials concerned I would like to take this opportunity of withdrawing that and stating that I did not intend it in that manner. It is not recognised as good policy to attack in any way people who are not here to defend themselves. I want to make it clear that no personal reflection was intended. What I wanted to convey was that the attitude of those who frame Bills is naturally a conservative one. It is their duty to maintain established ideas and it is our duty to change that as we think proper.

We feel that we have done good work in this Bill. It is not a comprehensive Bill and we hope that the time is not far distant when it will be possible to introduce a Bill which will meet with the approval of all sections of the House. I hope that when the Bill becomes law, the members of the medical profession whose duty it will be to implement it will give it their full co-operation. Let us not have in case of any dispute between the Medical Association and the Minister, a situation in which the ordinary workers of this country will suffer. That would be regrettable. Whatever disputes or arguments may arise, they can be settled but let me once again appeal to the parties concerned, to ensure that the people are not going to suffer as a result of any prolonged dispute there may be between these parties.

I should like to congratulate the Minister on the patience he has displayed in the very difficult trial he has gone through in recent weeks. I think Deputy Mulcahy has been unfair in suggesting that the Minister has bulldozed this measure through the House. Quite honestly, I think that at times he would have been very well justified in trying to bulldoze the Bill through the House, and I admired his restraint in not doing so. I think that politically and factually the charge is untrue because the records of the House will showthat there was only one challenge to a vote. Surely the Opposition have the right to challenge a vote if they wish. There was, I think, only one vote on the Bill and it was I called that vote. On the whole, there was no attempt to stop the Opposition from carrying out their ordinary function of criticising the Bill, of putting down amendments to the Bill or voting against the Bill. So far as I can see the Labour Party, a number of Independent Deputies and to a certain extent the Clann na Poblachta, appeared to be on the side of the Bill. Consequently it is quite untrue for Deputy Mulcahy to say that the Minister bulldozed the Bill through the House, merely because it did not get the consent or the collaboration of the Fine Gael Party, who, in my view, spent their time, generally speaking —I think it is a fair charge—obstructing the Bill on behalf of vested medical interests, and the Medical Association.

As to the suggestion that it is not right that the Bill should now go to the Seanad owing to the lateness of the year, the Seanad if they have any grievance can blame Deputy Mulcahy as being the person who directed most of the obstruction to the passage of the Bill through this House. Quite honestly, from my short experience of seeing legislation carried through this House from the Department of Health, it has surprised me that there has been so much opposition to the simple proposition which is contained in part of this Bill, at any rate, and which has nothing to do with means tests or whether or not there should be means tests.

That is a phrase that is used in order to convey a certain impression in relation to health legislation in the country but the proposal in the Bill to which I refer is intended to ensure that no matter who a person is, no matter whether people are wealthy or are poor, they shall receive exactly the same treatment when they fall ill. That is the simple postulate which, so far as I am concerned, and I am sure so far as the Minister is concerned, was contained in this whole legislation.The idea of that was simply to provide equal opportunity for treatment in hospitals, in dispensaries and everywhere else for our patients—that when a person falls sick he or she should be treated according to the best medical advice and by the best health service available.

It is difficult to realise after all that has been said here and a lot more that has been said outside, that that is the simple postulate, the simple principle at which we are aiming, at which certainly the Labour Party, the Minister and myself were aiming in trying to establish a no-means-test principle. It was not from any doctrinaire, nomeans, socialist idea or anything else of that kind, that we supported these proposals. The only consideration so far as I was concerned was that equal opportunity in our health services should be provided. I am quite content, no matter what has been said here or elsewhere, that the seed of that idea is here in the maternity and child section of it. There are two ways of proceeding—this way and the quicker way. I do not mind which we go though, perhaps, I would prefer to go the faster way. I am certain that under this Bill, in spite of any opposition, from whatever quarter it may come, there are those who will continue to work assiduously for the extension of the principle of equal opportunity in all our legislation but particularly in our health legislation. In so far as the Minister has so rigidly and valiantly, in my view—because few people know as well as I do from my own experience what he has had to put up with—fought for the Bill, we must congratulate him for his firm and rigid stand on the important principle he has included in the Bill. That principle is retained. It is from that principle there will spread out, through all our health legislation and I hope any other type of legislation, the ideal of so many people who have tried to make this a true democracy. Consequently, I should like to congratulate the Minister for his firm stand in face of vested interests and to assure him that he will have in time, the full appreciationof the people of the country for his work in this legislation and in all the other social legislation for which he has been responsible.

I regret that I am not able to extend to the Minister the same measure of congratulation as has been extended to him by Deputy Dr. Browne. Frankly, I feel that in this debate all the advantages have been with the Minister. Because of the limitation imposed by the Standing Orders of this House in respect to the imposition of charges on the public purse, a Minister bringing in a Bill of this type starts with a tremendous advantage, an advantage that the Minister for Health has enjoyed to the full throughout these discussions. Consequently, the most basic parts of the Bill, those sections which, in fact, give the Bill its whole character have in the main not been subjected to the type of cut-thrust-and-parry debate which can only arise not merely on the basis of a general discussion of a section, but on the relative merits of the section as put down by the Minister and amendments tabled by somebody else other than the Minister. For that reason, I feel, as I say, that the advantage has been with the Minister. I grant that he has exercised a certain measure of patience. On that aspect of the matter, it seems to me that in the course of the prolonged debate, the main contribution that has been made towards trying to improve the Bill, in all of its grave implications, has, in fact, come from the Labour Benches.

The Fine Gael Party, just as Labour or any other Party, is quite entitled to pursue any policy or tactics they consider best. It does seem to me, however, that even from their own point of view it would have been much more effective, since they were so violently opposed to the principle of the Bill, had they fought it tooth and nail and utilised all the facilities at their disposal in this House to carry that particular tactic. There were one or two occasions upon which we might have shaken the Minister a little more if we could have relied upon a few more votes. But not only had the Minister the advantage of being relieved of pressure from certain quarters in whichthere was a fundamental change, but he also had the advantage of knowing that if any matter came to the test on division, even if Fine Gael were opposed to the Bill, they would afford him silence in so far as the Division Lobby was concerned. That left the members of the Labour Party and Independent Deputies in a somewhat forlorn position in really utilising their votes to carry to the fullest extent the expression of the views they had implemented in the House.

The Minister has not had a too unhappy time. I can recollect other Ministers piloting Bills through this House who had a much more difficult time. Indeed, it is regrettable that we have not been able to make things a little bit more difficult, not from the point of view of opposition but in the hope of improving the Bill still more. The Bill as it now leaves the House is not fundamentally very much different from what it was when it was first introduced. In respect of a number of points which it was possible to deal with on the basis of amendments, the Minister on a number of occasions sought to meet the points of view put forward. To that extent the Bill has been tidied up and improved.

I am in somewhat of a difficulty in following Deputy Dr. Browne in his search for the seed of this idea of equal opportunity in so far as medical needs are concerned. If the seed is there it is buried very, very deep. Of necessity it must be buried very deep so long as we try to operate under a system which denies equal opportunities not only in respect of health services but in respect of every other type of social service in a civilised community. In our existing legislation we have enshrined this whole machinery of the means test and that of necessity operates, as we know only too well, to reverse the very idea with which we are concerned here, namely, equal opportunity. Even where a citizen has got a statutory and a legal claim his poverty often denies him his rights. It often denies him the treatment he should be accorded and nowwhere can we see that better than by going down and observing how an unemployed worker with a statutory claim to benefit under the SocialWelfare Act is treated in our labour exchanges. It is not his medical need or his social need that determines this attitude. It is his poverty. The position will be the same under this Bill because, whether we like it or not, we still have a poverty means test being applied and we still have a situation wherein those who are well equipped with the world's goods will get the preference. Until we fundamentally change our attitude on social legislation that will continue.

In so far as the Bill itself is concerned Deputy Kyne has made a plea, one that I think we will all support, that as the Bill is now far advanced in its progress towards the Statute Book, despite all its defects it still represents an advance in our health legislation. It provides some improved services, however limited, which can be availed of in the interests of those people who require medical attention and medical services.

Whatever may be the view of the medical profession in relation to the Bill, the most effective way in which the medical profession and all of us here who are concerned with the ultimate welfare of the ordinary people can show up the defects of the Bill is by making the fullest possible use of it. If we do that we will very rapidly demonstrate that this Bill will have to come back before the House for a short period, and by the measure of our experience we will then be in a position to remedy the defects that appear in it in its present form. The medical profession may be disinclined to follow that course or to accept any advice from us. In the course of the Second Reading debate it was pointed out from these benches that, irrespective of views, as a professional organisation doctors have got not merely a medical duty to the people, but also a social duty. However much they may dislike this legislation, this is still a democratic Assembly and, whatever may be our views and our decisions, whether they be right or whether they be wrong, they are still the decisions and the views of our people for the time being, and to that extent the medical profession, like any other large and important section of thecommunity, must accept that point of view. The best way in which to demonstrate the defects of the Bill, either from a social or a medical point of view, and to enlist the understanding and enlightened sympathy of the House and of citizens generally will be for the medical profession to operate the Bill in such a wholehearted fashion and in such complete form that they will rapidly prove the Bill requires further drastic amendment. That will have to be done before much time passes.

As the Bill leaves this House, those of us who have tried to improve it wish it well. We hope it will be possible to make available the machinery, such as it is, provided under the Bill as quickly as possible. We hope that that seed to which Deputy Dr. Browne has referred and which he seems to think is accepted and cherished by the Minister, namely, the seed of the idea of equal opportunity for all in relation to medical service needs and treatment will quickly germinate and grow a little stronger so that the next time we have health legislation here we will have a more enlightened, more Christian and more civilised approach to the problem, and will not be called upon to pass legislation which has in it this objectionable means test because, so long as we retain that in our legislation here, those who require effective and proper health services more than any other section of the community will be denied them merely because of their poverty: and poverty, whether we like it or not, is still the dividing line between many sections of our community.

I think it is right that a few words should be said on this Bill before it leaves the House. The Bill is an important Bill not only from the point of view of the provisions it contains, but also from the point of view of the approach made to the Bill and the mentality shown on the Bill. This Bill is an important and vital part of our social legislation and the majority of the Deputies support it as a progressive measure.

It is important that it should berealised by the House, and by the country, that the Bill was strenuously opposed and strenuously fought by one of the major Parties in this House, the Fine Gael Party. They opposed it on principle, on the principle of opposition to progressive measures. I think that is important from the point of view of the country, and it is important from the point of view of the House. It will be difficult, a little more difficult in the future, for the lamb to lie down with the Fine Gael wolf.

There are means tests in this Bill. It is regrettable that there should be means tests in the Bill, but at least there is that seed of principle in the Bill to which Deputy Dr. Browne referred. It is well that we should have that expression of view from Deputy Dr. Browne, because he is the man who sacrificed himself on the principle of a no means test for our mothers and infants. Speaking on this stage of this Health Bill, I feel proud to have stood with Deputy Dr. Browne on that issue. I feel more proud that my constituents supported me and supported him and supported those of us who went out in defiance——

What is under discussion is, what is in the Bill.

Yes, but I say that I am proud of that. I am proud of the support we got from our constituents when we stood for that issue. Now, so far as any means test is concerned in this Bill, it is a small seed, but it will grow, and there is nothing going to stop it. We have reached a certain distance. The clamour and the appeal from every side of the House, as we go on from year to year, will be for improvements in this Bill, and for the bringing in of new sections. I look on this Bill as a sort of bridgehead that has been secured. We have got to advance from that first bridgehead, and advance we will. The whole country will advance from that bridgehead, and the Minister, in securing that bridgehead, has assured progress in the future.

This Bill has been subjected to a terrific barrage of opposition: opposition from the medical profession, and opposition from the Fine Gael Partyin this House, but it has been welcomed by the ordinary people, and it is welcomed by the ordinary people although I agree with what Deputy Larkin says, that there are defects in the Bill. Those defects will be removed in the very near future. I am confident of the future. I have absolute confidence in the future. I realise that this Bill gives us an opportunity to progress and advance, and I only hope that the pressure will come from what I may term all the progressive elements in the House on the Minister, such strong pressure that we will have an amending Bill in the near future which will advance us further towards the ideal of a free for all medical service for the entire people of this nation.

The extensive discussions that we have had on this Bill definitely prove, I think, that it is impracticable. It was impracticable in the beginning, and all the amendments that have been introduced do not make it a practical Bill, We have maintained, and still maintain that, in this House. We have always said, and we stick to it, that we wish to see improved medical services. We feel that, as regards the maternity services, particularly for the middle income groups and some of the higher income groups, it is essential that they should be improved, but this Bill is not offering anything definite or tangible to the people. We said in the beginning of these discussions that you would have too many queueing up for too few places. The amendments introduced, and the discussions on the Bill, have brought it out that such is the position from beginning to end.

Some Deputies have stated that they would like to see a free for all—with no means tests whatever. I do not object to them espousing those principles. We have to remember that, if you are going to have a free for all medical service, without a means test, somebody has to pay for it. We have never had from the Minister, on any stage of the Bill, a statement indicating what it is going to cost. In fact, he has been quite frank about it. He says he does not know what it is goingto cost. Therein lies the weakness of the Bill. No discussions have taken place with the parties who are going to implement it—with the medical profession. There have been no discussions with them other than discussions behind the scenes. There have been no discussions with regard to the cost of the Bill, or as to the fees that are going to be paid to the doctors, or as to the implementation of the service.

What seems to be standing out, right through all these discussions, is that the cost of the administration of these services is going to be enormous. There is no getting away from that. Where you introduce a medical service, and where the greater part of the finance is going to be used in the administration of the service, only proves what we have been arguing throughout when we told the people that this House is sending out a Bill purporting to offer them something which they are not going to get. That is what we have been arguing from the beginning, and we stick to it. Therefore, when this Bill goes out of this House, it will not be long, as Deputy Larkin has very truly said, before there will be many amendments to it——

Hear, hear!

——to try and work it because, as it is, it is an unworkable Bill. It is an impracticable Bill. I believe myself that I am quite justified in saying that it is a falsehood from beginning to end because it purports to offer something to the Irish people, and they are not going to get the goods. You are offering them a Bill which is of no great advantage to them. The people throughout the country are puzzled. They are puzzled in my constituency, which is the Minister's constituency, and they do not want this Bill.

I should like to congratulate the Minister on his courage in putting this Bill through the House. I suppose there was never so much political propaganda used against any Bill as there has been against this Bill. There was continued obstruction here by the Fine Gael Party who afterall the obstruction, never went into the Division Lobby to support any of their views. There was intimidation on all sides used against the Minister on this Bill. Every effort was made to direct and help the medical profession to object to working this Bill. I suppose the delays and discussions of every little section of this Bill were unprecedented. There were three Fine Gael Deputies sitting over there and at times they did not know whose turn it was to get up and oppose a section and there was not another sinner of Fine Gael in the House. There were discussions between the three of them as to whose turn it was to speak. These were simply delaying tactics and obstruction.

This Bill will give hope to many people who at present are afraid to go into hospital on account of the bills they would incur for hospital charges and doctors' fees. They can now go in with an easy mind with the hope of being cured.

I believe that ultimately this Bill will be a saving to the country. Already there are signs in Cork that T.B. is well in hand, that we are in a position to provide beds for our patients. That is due to the Bill introduced by the Minister for Health, Dr. Ryan, in 1947, but I would say—and it is not because he is supporting this side of the House—it is due to a great extent to the energy of Deputy Dr. Browne, when Minister for Health.

What is being discussed is, what is in the Bill.

We are discussing the health services in the country.

We are not. We are discussing simply what is in this measure.

I am just comparing. We are beginning to control T.B. and I am looking forward to an ultimate saving in the health services in the country by means of this Bill when it is put through this House and the Seanad.

If we proceed to comparisons we will never getfinished. What is to be discussed is what is in this Bill and nothing else.

I understand that this is really an extension of the 1947 Bill and I am pointing out all the good that was done by that Bill, despite the statements by other people. I do not think any Cork Deputy of any Party would stand up here and talk on any Health Bill without offering that compliment to Deputy Dr. Browne. His work in T.B. and in getting us thoracic specialists and orthopædic specialists will be remembered for many a year by the people of Cork. I am looking forward to seeing just as great an improvement in the health of the people by means of this further extension of that Bill. As I said before, even though there will be an expense for the time being, I think there will be an ultimate saving of life and money to the country.

Deputy Larkin said here on Second Reading that the poor man was entitled to have his life saved as well as the rich man and, no matter what expense it would be to the country, expense should not count in the matter. Deputy Costello said that he did not mind the expense at all; it was not the expense of the Bill that was worrying him at all; he would be prepared to give a lot more. Then we had Deputy Dr. Esmonde and other people trying to tell us about the expense.

We should do all we can to give the best health service possible to the people, especially the people that cannot afford it. This Bill is heading in that direction. Like Deputy Cowan and others, I believe there will be amendments to this Bill before very long. The people will see the good that is in it. I conclude by congratulating the Minister on his consistent defence of this Bill and on bringing it through the House.

One of the somewhat worrying aspects of our democratic process is the complete self-confidence we seem to indulge in in this House when discussing any topic under the sun. We all claim, apparently, to know everything that is to be known about every topic and to be omniscient about health services, the law, mineral development, industries, economics,banking and everything. It is sometimes alarming that we should seem to have that degree of self-confidence. It is a pity that we do not more often seek to have matters of this kind considered by committees. Small Committees of the House representative of different Parties would at least have an opportunity of obtaining evidence and views from experts. However, be that as it may, I think this Bill suffers from the main defect of having been introduced in the wrong type of atmosphere and not having received the objective consideration it should have received from different sides of the House.

The Bill, undoubtedly, is a step forward, a step forward that was needed for a long time but, I fear, a step forward that falls very far short of the step forward that could have been taken had we considered this whole question in a different atmosphere and more objectively.

I do not propose at this stage to try to review the Bill in any detail. I would like to urge one or two considerations on the Minister. The principal one I want to urge upon him is— and this, I think goes to a certain extent to the fundamental error that seems to lie in the approach to our health services—this Bill is not worth the paper it is written on unless and until we provide the necessary accommodation and machinery to implement it. I know of one case at the moment, a county hospital, County Cavan, where there are 120 surgical cases waiting for admission. No Bill, no paper scheme, no speeches in this House will remedy that position. The only thing that will remedy that position is the building of a hospital there. The only thing that can deal with the overcrowding in our city hospitals at the moment is the building of additional hospitals, the provision of an adequate number of beds.

I think one of the errors of this Bill is that we are laying out on paper a grandiose scheme without having made available the physical facilities that will be necessary to implement any scheme. At the moment we know that the maternity hospitals in the City of Dublin are completely inadequate, overcrowded. How will this Bill remedythat position? There is not one section in this Bill that enables the Government to build one more hospital or provide one more bed. So that I should like to avail of the occasion to appeal to the Minister to concentrate in the first instance on ensuring that the physical requirements for the implementation of any health scheme are made available and that depends on the provision of money. It is the Minister's responsibility, if he is to implement this Bill seriously, to ensure that a sufficiency of money will be made available for the provision of hospitals. In many cases hospitals were planned as long as 15 years ago and have not been built yet, although the necessity for their provision is admitted by the Government.

It is quite true that we have not been given any clear estimate of how much this Bill will cost to administer. I do not want to misquote the Minister, but I think that, tentatively, he mentioned a figure of £2,000,000. I think he mentioned it with a good deal of reserve, probably realising that it would cost a good deal more. One of the things which puzzles me about this Bill generally is that on going through it I do not see anything upon which the £2,000,000, £3,000,000 or £4,000,000 which it is going to cost to administer is to be spent other than by payments to doctors and civil servants. This Bill does not contain any provision for the spending of money on hospitals. It does contain provisions for payment for medicines, but that will be a very small percentage, I would say, of the total amount involved. It also contains provisions for the payment of maternity benefits, which again will be a small percentage of the total amount. It also includes provisions for the payment of maintenance in hospitals, which would be a more substantial amount. But I am willing to make this bet, that if this Bill costs £4,000,000 to administer, £2,000,000 of that will be spent on salaries and fees either to additional officials or to the medical profession. If we are in a position to spend that amount of money, I would prefer to see that amount of money spent at first on the provision of hospitals.

The only principle involved, in my view, as regards medical services is to ensure that no persons, whether they have or have not money, will be deprived of the best medical services that we can make available, that no question of cost, no question of lack of means should prevent any citizen of the State from obtaining the best treatment possible. To my mind, that is the only principle involved. I think it is only a purely functional problem as to how you will achieve that. You can only achieve that by making available the necessary facilities.

I think we have been wasting a good deal of time and doing a good deal of damage to the whole concept of health services by engaging in many theoretical arguments which have little or no application to the realities of the problem with which we have to deal. However, the Bill does contain some steps in the right direction and to that extent I welcome it. I am sorry that it was not conceived in a better atmosphere. I am sorry it is not a better Bill. I am sorry that we have started in this controversial way instead of doing the thing in the proper way by the provision of the necessary hospitals.

I am sorry that Deputy Kyne should have thought I made any attack on the Labour Party. I certainly did not mean to. I am very sorry if I said anything to offend Deputy Kyne because I did not mean to do any such thing. Deputy Kyne has been a very straightforward debater in this House and he certainly never said anything personally offensive as far as I am concerned. If I said anything which he has taken up and which I did not mean, I am sorry.

Deputy Kyne, Deputy Larkin and other Deputies expressed the opinion that the Bill is by no means perfect. I am not including Fine Gael in that, because they have a different view of it. I am speaking of Deputies who are genuinely anxious to make this a good Bill. I agree, of course, that it is not a perfect Bill. I do not think that any Minister could ever claim that he produced a perfect instrument here.But as far as some of the provisions in this Bill go, I think they are as good as we can afford at the moment financially. Even if Deputy Larkin was in my place, I do not think he could implement a Bill which would go very much further. I would say that for three or four years to come it will be as much as the local authorities can do to implement this Bill. Deputy Larkin says he wants to see this Bill implemented to the full because it will show its defects. He is probably right there and I am with him in that. Then after three or four years we can see what the defects are and it will be possible for the Dáil to improve matters at that stage.

Deputy Cowan and Deputy Dr. Browne expressed themselves as pleased that the Bill has gone through and also expressed themselves much on the lines of Deputy Larkin, that it is by no means a perfect instrument. They have given me their blessing for the future implementation of the Bill for which I am very grateful. Deputy MacBride said that it was a step forward, but a step very much short of what is required. I do not know what Deputy MacBride may have in mind, but I think that he is unaware of the division of functions under my Department as between hospital building and the implementation of these health schemes, because it would be altogether out of line with the general procedure to provide for hospital building in a Bill of this kind.

There is a provision in the Estimate for my Department this year of £4,500,000 for hospital building. As well as that, it is expected that we may get over £1,000,000 from the sweepstakes fund. That amounts to £5,500,000, which is a very big sum indeed for hospital building. That is part of the £37,000,000 programme of hospital building which was started by my predecessor in 1948.

I do not think we would be right in waiting to have hospitals before we do anything in the way of improving our services. I am sure that if Deputy MacBride put it up to me to improve the services and I said I must wait until the hospitals are improved he would be the first to attack me andsay that we should provide the services at the same time. Now, it is the easiest thing in the world to make a case like that—build the hospitals first and then produce the services. The same thing could be said about T.B. The T.B. business was tackled, but the sanatoria are not even built yet. But although the sanatoria are not even built yet, in the last month of June—for the first time, I think I might say—the waiting list is practically gone. I do not want to be contradicted on that because any Deputy here might make inquiries from his own local authority and find that there are seven or eight or even 17 waiting, but I am saying that to all intents and purposes, the waiting list is gone. If we had waited on T.B., and said we will tackle T.B. when the sanatoria are built—that is to say we would tackle it next year— then that waiting list would not be gone, perhaps, for the next ten years. It is ridiculous to say you must build the hospitals first and then produce the services. It is only a thing that an Opposition man would say when he wants to find fault with the scheme and he could not say that for any other reason except to find fault.

We are going on with this scheme. Again, what does Deputy MacBride think? Take the man in the lower income group for whom we are going to provide free treatment. He is not going to go to hospital unless there is some reason for it. Suppose it is something like hernia that can wait for a while. We produce this service and say to him: "You are entitled to come in and get that dealt with in the county hospital. You can get free treatment because your valuation is under £50, but you may have to wait a few weeks". Is it better to do that now, even if he has to wait a few weeks to get in or should we adopt what Deputy MacBride says, and wait for ten years and then say to the man: "Now go, and get your hernia dealt with"? Is it not better to go on now; is it not better to take a chance?

Take the woman who is going to have a baby. She cannot wait for ten years.

She has nowhere to go now.

She can have it at home as the women have done for the last 100 years in this country. Deputy MacBride thinks we cannot bring in a maternity scheme unless we have hospitals. In the most hospitalised countries in Europe, such as Denmark and Sweden and those other countries that we read about in the papers and that Deputy MacBride would quote at us, there are not any more maternity beds per head of the population than we have here and we are going to provide more. Let Deputy MacBride have a little pride in his own country and let us try to remember that we are not so far behind those other countries at all.

That is a dangerous mentality, Minister.

If we can provide in the hospitals for the women that must go to hospitals, either for the reason that their condition necessitates hospital treatment, or that their homes are not fit places to have babies, well and good, but let the women who have good homes, whose cases are normal cases—and that is 97 per cent. of them—let them have their babies at home.

I think on the whole, that we are doing much better in this way and I am quite sure that if we had adopted another attitude we might possibly have an attack from Deputy MacBride.

This Bill, as I said, has no provision, of course, for hospital building. That is provided elsewhere. It is quite true that I have given an estimate here that this Bill would possibly cost about £2,000,000 a year to implement, half of that to be met by the local authorities and half being contributed by the Department of Health. It must be remembered what I said before. I want this on record because I may have to quote it when unscrupulous T.D.s get up in five years' time and say: "You said it would cost £2,000,000." There is a lot of expenditure yet to be incurred under present legislation apart from this altogether, so I am not saying the whole additional cost of health is going to be limited to £2,000,000. Sofar as this Bill is concerned, it is going to be limited to £2,000,000. That will all go on either maintenance in hospitals—there are two big items—maintenance in hospitals or provision of services, whether doctors or nurses, etc.

Did you say half and half?

Well, perhaps so. Some Deputies say it is nearly all going into administration, and if you count medical staff, a lot of it will go into administration, but not on administration as we usually mean it in the Department of Health—or on local administration, that is, lay administration.

Of course, Deputies opposite have painted a picture of the county manager and his staff losing time reading the medical records. I do not think that is going to happen. The staff will not be increased to any great extent. Deputy Esmonde said I did not tell him what the cost was going to be. I did, but I might as well be idle. When the Opposition Deputies go down the country—I read the papers —they put terror into the people, and they have the life frightened out of the people down the country about what this is going to cost. If Fine Gael were anxiously looking for the figure and then going to go down the country and be very scrupulous and say: "The Minister told us that this Bill is going to cost so much", and not exaggerate it, it would be all right. But I suppose I cannot expect that from Fine Gael. Then they say it is unworkable, that it is a fraud, and that it is against the teaching of the Catholic Church and all sorts of things that they have learned I do not know where. They tell these things to the people all over the country and I suppose they consider it good politics. Well, if they think that, I do not object. I suppose it is all right.

Deputy Mulcahy said they had put down an amendment on the Second Reading which I did not accept and that it had led to a lot of trouble. I did not accept that amendment—I may have been wrong or oversuspicious— because I looked on it as a politicalmove. It was the type of amendment that was patently drafted to try to bring the Labour Party and Clann na Talmham all in on the one wing. Naturally, I said we are not going to adopt that. It did not altogether condemn the Bill, because if they did that then the Labour Party could not vote with them, but it was a device to have the Bill referred back for further consideration. However, it did not come off. When it was put, Fine Gael voted and the others did not vote with them. Fine Gael said "No", but nobody appeared to hear them at the time, not even the Official Reporter.

The Minister is misrepresenting the Official Report.

The Official Report says that it was agreed. Then Deputy Mulcahy said here this evening that I bulldozed this through the Dáil without giving an opportunity for discussion on the Bill itself. I suppose a bulldozer is fairly slow-moving and we certainly took our time on this Bill, but it is rather funny to say we did not give much time for discussion. I do not think any Bill in the history of this House ever lasted so long in Committee. The object of the Committee Stage is to give Deputies an opportunity of talking on every detail of the Bill, but Fine Gael did not confine themselves to the Bill. They mostly talked on what was not there and in that sense Deputy Mulcahy may be right. Deputy McGilligan spent two days alleging suppression by the Government of a document from the Hierarchy.

Deputy Mulcahy took about four days to vilify the county managers. I suppose there are several other things I could mention, but certainly they were not things in the Bill. The Committee Stage was spent in that way. Deputy Mulcahy deplored the fact that I had not got agreement with the Irish Medical Association. I met the Irish Medical Association. They said that they would not co-operate. What was I to do? Would any Deputy on the Opposition side of the House—even Deputy Esmonde, who is a member of the Irish Medical Association—say nowthat a Minister for Health, no matter what Party he belonged to, who was told by the Irish Medical Association that they would not work the scheme or co-operate with it, should say: "All right, boys. I will bring in a Bill with which you will co-operate". Was I to do that? Was I to let this Legislature down by caving in to the Irish Medical Association and saying: "If you will not work this scheme I will bring in one which you will work". I know that Deputy J.A. Costello got round that by telling the Irish Medical Association to produce their own scheme. When I came into office I found these men in possession in the Custom House. I told them to get out and I said that it was not their job but my job. Of course, I said it very politely. I thanked them for their services, and so forth. I do not think it was their job to produce a medical scheme because they have their own point of view about these things and I suppose we have our own point of view, too. Anyway, the Irish Medical Association have adopted the attitude of non-cooperation, all through. It has been the same with Fine Gael.

Neither the Irish Medical Association nor Fine Gael have given the slightest help so far as this Bill is concerned. There may be defects in the Bill. I quite admit that there are brains in the Fine Gael Party, and that there are brains in the Irish Medical Association that might possibly see defects in that Bill which I have not seen. But, all through, I did not get the benefit of those brains either in the Fine Gael Party or in the Irish Medical Association. If there are defects in the Bill that the Irish Medical Association and Fine Gael can see, it is their own fault if they have not pointed them out to me. They have not pointed out defects; they have only maintained the attitude that they are against the Bill in principle and that they will not co-operate.

Deputy Mulcahy says that I sort of threatened the voluntary hospitals. I did not. I remember the incident very well. It was put to me by certain medical men who were talking to me on the subject of this Bill that if the voluntaryhospitals did not co-operate with the local authority, what would they do: would they get no cases? I said that I supposed not. Then I was asked what would the voluntary hospitals do, and I said that I did not know what they could do if they got no cases except to close down. The report of that conversation appeared in the Irish Medical Journalas a threat to the voluntary hospitals. It was a mere statement of opinion on my part Can anybody contradict me when I say that? If the voluntary hospitals refuse to co-operate and will not take patients from the local authority they will have no patients in their wards and then what can they do but close down? What can I do about it? But, because I gave that answer truthfully, as my opinion, I was accused in theIrish Medical Journal—and the accusation was quoted here to-night by Deputy Mulcahy—of threatening the voluntary hospitals. I am not threatening the voluntary hospitals. I hope they will work this Bill, and I will do everything I can to get them to work it. Surely, however, we are not going to be dictated to here either by the Irish Medical Association or by the voluntary hospitals or, indeed, by Fine Gael.

We will go on and do what the country wants us to do. It is quite obvious what the country wants in this case, because the great majority of the members of this House want the Bill. I am sure that some members of the Labour Party and some members of the Fine Gael Party and, indeed, some members of my own Party might like a better Bill. So would I, if it were possible. A big majority of this House are for this Bill and, therefore, we may assume that a big majority of the community want the Bill. Why should we be dictated to by any section— either by the doctors, the voluntary hospitals, Fine Gael or anybody else?

You may be sure the voluntary hospitals in Cork will work it, at any rate.

I am sure they will. This Bill has had a peculiar history. The Second Reading went through with very little discussion and no audible opposition. Then the Committee Stagetook days and days and days of the most merciless obstruction from Fine Gael. The Fourth Stage went through to-day fairly easily and the Fifth Stage is now going through fairly well. I hope that Fine Gael will raise their protests now. I hope that, even now, on the Fifth Stage, they will make their position clear, so that in a month's time we shall not have them telling us that they said: "No" when the question was put or—above all— saying in two years' time, when theBill is a success: "We did not oppose the Health Bill". For goodness' sake, let us know now, one way or another, how Fine Gael stand in relation to this Health Bill. Do not say "No" behind your hand so that we will not know whether or not you are for the Bill. Make your position clear now. If you do not vote against the Bill I will say that the Bill went through unanimously—and do not contradict that statement.

Question put.
The Dáil divided: Tá, 79; Níl, 40.

  • Aiken, Frank.
  • Allen, Denis.
  • Bartley, Gerald.
  • Beegan, Patrick.
  • Boland, Gerald.
  • Brady, Philip A.
  • Brady, Seán.
  • Breathnach, Cormac.
  • Breen, Dan.
  • Brennan, Joseph.
  • Breslin, Cormac.
  • Briscoe, Robert.
  • Browne, Noel C.
  • Buckley, Seán.
  • Burke, Patrick.
  • Butler, Bernard.
  • Byrne, Alfred.
  • Byrne, Thomas, N.J.
  • Calleary, Phelim A.
  • Carter, Frank.
  • Childers, Erskine.
  • Colley, Harry.
  • Collins, James J.
  • Corish, Brendan.
  • Cowan, Peadar.
  • Crowley, Honor Mary.
  • Crowley, Tadhg.
  • Cunningham, Liam.
  • Davin, William.
  • Derrig, Thomas.
  • de Valera, Eamon.
  • de Valera, Vivion.
  • Dunne, Seán.
  • Fanning, John.
  • Flanagan, Seán.
  • Flynn, John.
  • Flynn, Stephen.
  • Gallagher, Colm.
  • Gilbride, Eugene.
  • Harris, Thomas.
  • Hickey, James.
  • Hillery, Patrick J.
  • Hilliard, Michael.
  • Humphreys, Francis.
  • Kenneally, William.
  • Kennedy, Michael J.
  • Keyes, Michael.
  • Killilea, Mark.
  • Kyne, Thomas A.
  • Larkin, James.
  • Lemass, Seán.
  • Little, Patrick J.
  • Lynch, Jack (Cork Borough).
  • McAuliffe, Patrick.
  • MacBride, Seán.
  • McCann, John.
  • MacCarthy, Seán.
  • McEllistrim, Thomas.
  • MacEntee, Seán.
  • McGrath, Patrick.
  • Maher, Peadar.
  • Moran, Michael.
  • Moylan, Seán.
  • Murphy, Michael P.
  • Norton, William.
  • Ó Briain, Donnchadh.
  • O'Reilly, Matthew.
  • Ormonde, John.
  • O'Sullivan, Ted.
  • Rice, Bridget M.
  • Ryan, James.
  • Ryan, Mary B.
  • Sheridan, Michael.
  • Smith, Patrick.
  • Spring, Dan.
  • Traynor, Oscar.
  • Tully, John.
  • Walsh, Laurence J.
  • Walsh, Thomas.

Níl

  • Barry, Richard.
  • Beirne, John.
  • Belton, John.
  • Blowick, Joseph.
  • Browne, Patrick.
  • Collins, Seán.
  • Cosgrave, Liam.
  • Costello, Declan.
  • Costello, John.
  • Flanagan, Oliver J.
  • Hughes, Joseph.
  • Lehane, Patrick D.
  • Lynch, John (North Kerry).
  • McMenamin, Daniel.
  • Madden, David J.
  • Morrissey, Daniel.
  • Mulcahy, Richard.
  • Murphy, William.
  • O'Donnell, Patrick.
  • O'Gorman, Patrick J.
  • Crowe, Patrick.
  • Deering, Mark.
  • Dillon, James M.
  • Dockrell, Henry P.
  • Dockrell, Maurice E.
  • Doyle, Peadar S.
  • Esmonde, Anthony C.
  • Fagan, Charles.
  • Finan, John.
  • O'Higgins, Thomas F.
  • O'Higgins, Thomas F. (Jun.).
  • O'Reilly, Patrick.
  • O'Sullivan, Denis.
  • Palmer, Patrick W.
  • Reidy, James.
  • Reynolds, Mary.
  • Roddy, Joseph.
  • Rogers, Patrick J.
  • Rooney, Eamon.
  • Sweetman, Gerard.
Tellers:—Tá: Deputies Ó Briain and Hilliard; Níl: Deputies Doyle and Palmer.
Question declared carried.
Ordered: "That the Bill be sent to Seanad Éireann."
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