Health Bill, 1954—Second Stage.

Minister for Health (Mr. O'Higgins)

I move that the Bill be now read a Second Time. The Health Act, 1953, which passed into law on the 29th October, 1953, was a large and very complicated measure of some 72 sections. It covered an extremely wide field, from the control of filling materials for bedding and upholstery to a complete repeal of the Public Assistance Act, 1939, so far as that Act relates to medical care and assistance for persons not able to provide such services for themselves. It provided for the introduction of two new forms of cash grant, one in respect of maternity and another for disabled persons unable to provide for their own maintenance, either by their own efforts or with the help of near relatives who might reasonably be expected to help them. It amended, extended and codified the existing provisions for services and it provided for new services.

This Bill, the Second Reading of which I am moving, does not interfere with the general framework of the Act. It does not interfere with the many miscellaneous amendments of the Health Act, 1947, with the integration of the public assistance services into the health code, or with the regulation of local authority institutions. Its purpose is merely to enable me to provide, step by step, certain services which are provided for in the parent legislation according as appropriate arrangements can be made and adequate facilities can be provided.

In order that Deputies may properly appreciate what is sought to be done under this measure, I think it might be helpful if I explained briefly the situation which obtains here now, that is, before the coming into operation of the Health Act, 1953, and the situation which will obtain after that Act comes into operation.

The present position is that general medical services, hospital and specialist facilities, and various essential services of that kind are made available for two sections of the community. First of all, they are made available for the sick poor—those commonly called the public assistance classes. Every person who cannot, by his own industry or other lawful means, in accordance with the definition, provide for himself, when sick, obtains full general medical services, full hospital and specialist facilities, and he is also provided for in so far as possible in accordance with our existing facilities. That right, and the obligation to satisfy it, is provided by the Public Assistance Act, 1939.

That statute brought up to date various other provisions relating to public assistance, but the right of the sick poor to get the necessary medical and hospital attention they require is enshrined in the Public Assistance Act, 1939. Under that Act the obligation is placed upon each local authority to provide for the sick poor in the local authority area the services envisaged in the Act of 1939.

These services have been provided, of course, for a number of years, and, in order to appreciate the purpose of the Bill, I would like Deputies to understand the machinery under which the necessary public assistance for the poor is now provided. The obligation is placed on local authorities to provide the services, and they in turn utilise first of all the local authority hospitals and the medical services available under the local authority to provide what is required for the poorer sections of the community. Where their own services are inadequate, they enter into agreements with the different voluntary and teaching hospitals in the country, particularly with the voluntary and teaching hospitals in Dublin City. Under the agreements made by the different local authorities, the voluntary hospitals in this city and elsewhere agree to provide hospital and specialist facilities for every person who is poor and who is sick on the terms that a payment will be made to the hospital of £5 12s. per week per patient by the local authority which sends a patient up to the hospital. That machinery is working now and has been so working for some years past.

The machinery which I have mentioned so generally is only apt, however, to describe the arrangements made by all local authorities, except Dublin itself. In Dublin, a slightly peculiar situation exists of a particular kind. The Dublin local authority has not in the past had to provide any local authority hospitals. At the moment, there is in Dublin City, as a local authority hospital, only St. Kevin's, and in fact for years the voluntary hospitals in this city have filled the same need as local authority hospitals fill elsewhere. Hospital accommodation was available in this city, and is available, because the voluntary and teaching hospitals are functioning here. Accordingly, in Dublin the machinery for the care of the sick poor did not depend so much on agreements made and all the rest of it. In Dublin, 1/- in the £ each year in rates is levied to raise a certain sum of money—I have not the exact figure—of something of the order of £120,000. The hospitals undertake to provide the necessary services for every person who is poor and who is sick on the understanding that, at the end of the year, the sum raised by 1/- in the £ in the rates is divided according to a certain plan among the voluntary hospitals in this city. In that way, the necessary provision is made for the public assistance classes in Dublin City.

Now, the second class of persons who at the moment get the necessary medical, hospital and other facilities are those who are insured under the Social Welfare Act of 1952. Of course, the services were there for many years before the Social Welfare Act in accordance with the National Health Insurance Acts. An insured worker who has 156 contributions to his credit, and who gets sick, is entitled, in accordance with his insurance and his contract, to full medical, hospital and specialist facilities. The machinery under which those services are provided for him is operated at the moment by the Minister for Social Welfare and the Department of Social Welfare to ensure that workers in benefit get the service they require. It has entered into contracts and agreements with all the local authority hospitals, and, secondly, with the voluntary hospitals in Dublin and elsewhere, whereby each hospital concerned undertakes to provide and care for insured workers at a payment of £5 12/- per head per week.

That machinery is now functioning and has been functioning for some years back, and those classes are provided for now in the manner in which I have indicated. What I have said represents the present position in the country.

Mr. MacBride

Could the Minister, before passing from that, give the numbers covered in the two classes mentioned, the public assistance classes and insured persons?

Mr. O'Higgins

With regard to public assistance classes—this, of course, is only an estimate or rather a rule of thumb method, which has been adopted for quite a while back and seems to be correct—it is accepted that one-third of the entire population is covered by the public assistance group. Accordingly, so far as the country generally is concerned, one-third of the population is provided for under the Public Assistance Act. That fraction is not quite true in Dublin. In Dublin, the fraction would perhaps be nearer one-half than one-third so far as insured workers are concerned. The figure of 450,000, covered under the National Health Insurance Acts, is incorporated in the Social Welfare Act.

Having dealt with the present position and before passing to the position projected under the Health Act, 1953, I would like Deputies to understand and appreciate how, generally speaking, these services have worked. First of all, everyone will appreciate that no person who is sick and who requires urgent hospital attention in this country fails to get it and there is, generally speaking, an effort made to ensure that those in danger do obtain immediate attention. That, indeed, is a tribute to all concerned with the care of the sick and needy in this country and everybody interested in the health of the community will appreciate that this country's code of honour in that respect is very high and has always been very high.

Having said that, I pass to a more gloomy side of the picture because, while urgent cases are and have been consistently provided for, existing machinery is and has been for years labouring under very extreme difficulties. The position is that accommodation available now for existing services is far from adequate. I would just like to put it this way: in local authority county hospitals at the moment more than 100 per cent. bed occupancy is experienced. In other words, county hospitals at the moment are taking and accepting more patients than they can satisfactorily provide for. It is done by putting in stretchers and couches and cluttering beds together and generally endeavouring to provide for more patients than the hospital was built to provide for or can provide for satisfactorily.

That is the position throughout the country in the local authority county hospitals. In relation to the voluntary hospitals, each one of them is also working to its fullest capacity, stretched to the very limit to provide urgent medical care for those who need it.

Deputies may say: "Oh well, that means, of course, that both the sick poor and the sick rich are at the moment being provided for in all these hospitals." That, unfortunately, is not so. Under the Public Assistance Act, 1939, which will be repealed on the 1st August, priority must be given in every local authority hospital to the sick poor. They are entitled to the first bed available and if there are only three beds and four applicants the three who qualify as sick poor get the beds.

In addition, insured workers, in accordance with the contract between the Minister for Social Welfare and the local authority hospitals, are also entitled to equal priority so that, generally speaking—and I want to assure the House that I am only talking in generalities in the hope that it may be of assistance to Deputies— at the moment existing facilities are being taxed to their utmost to provide for those who have not the money or the means to fend for themselves and at the moment all the hospitals are being taxed not merely to capacity but beyond capacity to provide necessary services for those to whom the State owes an obligation either in Christian charity or in contract.

That, generally, represents the hospital position so far as ordinary illnesses and surgical cases are concerned. Before I pass on to the proposed or projected position under the Health Act, 1953, I would like to deviate for a moment and deal with the special problem of maternity cases. At the moment every woman of the public assistance class defined in the Public Assistance Act, 1939, is entitled to free maternity treatment in a hospital in accordance with the Public Assistance Act, 1939. In relation to country areas all the maternity facilities are provided in the different county hospitals and they are already included in the percentage figure which I have given to the House. In other words, part of the lack of accommodation and overtaxing of county hospitals is due to the fact that our people continue to have children.

In Dublin, however, the position is quite different. I would like Deputies to consider these figures, because I am not endeavouring to advance any stronger arguments to the House than the facts that are known or should be known to every Deputy. In Dublin, the average birth rate provided for in the maternity hospitals is 16,000 per year. It is reckoned, apart from heart cases and apart from other complications of one kind or another, that each maternity hospital bed can deal with 25 cases a year, so that, to provide hospital accommodation for all the maternity cases dealt with in this city would need a minimum of 640 beds. The situation, of course, need not be approached from that point of view because, as Deputies will be quick to point out, various nursing homes do fill in to absorb quite a number of cases and, generally speaking, the better-off sections of the community have been able to fend for themselves.

We all appreciate that a nursing home may be quite a considerable expense, but just for the moment I do not propose to consider that. Those who are able to afford it and have an obligation of saving for it are generally able to find nursing home accommodation for their wives in maternity, so that, in fact, in Dublin 640 beds probably are not needed unless we had a successful hospital sweepstake every week. Nevertheless, looking for the minimum requirements of the poor people, the position is appalling in the city. I said a while ago that it is usually reckoned that about one-third of the population could be regarded as coming within the framework of the Public Assistance Act, 1939. In fact, in Dublin the position is not exactly the same and the figure is somewhat higher.

It is reckoned that in Dublin 6,000 births a year qualify under the Public Assistance Act for maternity hospital treatment and accordingly something around—I have not worked it out—220 or 240 beds are required for public assistance cases. Those are the requirements—what is the position in this city? There are available in Dublin at the moment as public beds some 220; private beds total 117, so that the total hospital accommodation for maternity cases is 337—far short of what is required even for a reasonably good hospital maternity service.

What I say can be tested by experience. Yesterday, or the day before, the National Maternity Hospital issued its 60th annual report and it referred to the conditions obtaining at Holles Street Hospital. The report made an appeal to my Department to provide the money and the permission necessary for an urgent extension of Holles Street Hospital in view of the fact that the hospital has become more and more seriously overcrowded in the past five years. I would like Dublin Deputies particularly to test what I am saying against their own experience in their own constituencies. The average safe minimum period in a hospital for maternity cases is ten days. At the moment, in Holles Street Hospital poor women are lucky to have six days in a bed in that hospital. Six days is the average for the poor people of this city at the moment and it is only by an extensive use of antibiotics that serious infection and disease are not caused in the National Maternity Hospital. That is an appalling situation and a situation that would call for very responsible action by any Minister for Health and certainly a situation that affects me very deeply.

I mention these things to the House so that every Deputy on every side of the House may realise that I am not coming in here with this Bill indulging in special pleading or to make a case. I am coming to this House as the Parliament of this country to state a problem and to state facts in the hope that Deputies on all sides of the House will join with me in doing something worth while to provide better services for the people of this country.

I hope Deputies will appreciate from what I have said, speaking in a reasonable way and on the information available to me, that facilities are inadequate to provide even reasonable services for the poor and for the insured.

Let us pass on now. What is going to happen on August 1st, 1954? What situation will then obtain were I prepared to be irresponsible or should this House discard its responsibilities? Under the Health Act, 1953, ordered to come into operation on August 1st next, the Public Assistance Act, 1939, is repealed. In addition, every insured worker in this country is taken from the Department of Social Welfare, his contract going, his agreement, disappearing, and he is added to a new group of citizens for whom health services are provided in Sections 14 and 15 of the Health Act, 1953. Those sections create in this country a new pool of people all with equal rights, all with the same claims to services of a hospital, specialist, nursing and general medical kind.

That new pool consists of the following five categories of people: first of all, the sick poor—the unfortunate people who up to August 1st will have been provided for by the Public Assistance Act, 1939, and who enjoy absolute priority in every local authority county hospital. They are category No. 1—the sick poor. Secondly—insured workers, who at the moment and up to August 1st in accordance with their contract enjoy priority in every voluntary and local authority hospital in the country—they are category No. 2. Those are the existing categories. Now the new groups come in, and thirdly, we have all persons whose income is less than £600 a year. Fourthly, we have all farmers whose valuation does not exceed £50 a year; and fifthly, everyone else who can show that payment of bills in a hospital would cause him hardship. These are three new groups or categories thrown into the pool without a single additional bed being provided, a single additional hospital being built, without facilities being increased in the slightest. Three new groups are thrown into the health pool in this country and it is suggested that it is a wise thing to do nothing about it.

I want Deputies, in a responsible manner, forgetting in this connection past controversies and past differences, to examine with me what is likely to happen on August 1st, should the House have been prepared to do nothing. All of those people in that pool I have mentioned have equal rights, one with the other. Under Part III of the Health Act, each person in Sections 14 and 15 is entitled to demand as of right from every local authority in this country the services set out in Part III. Each of them has equal rights, with one slight exception that I shall have to mention later. So far as the provision of accommodation is concerned, equal rights each of them has. Now this extended pool, as I have indicated, has to be provided for from existing facilities and by whatever machinery may be at present available.

May I digress for a moment in order to help Deputies? Assuming that there were no difficulties of accommodation or anything of that kind, the machinery under which all these different categories are to be provided with the services set out in the Act, has to be defined in accordance with regulations to be made by the Minister for Health. Broadly speaking, the scheme is this: The Act imposes an obligation on the health authority, a statutory obligation, to provide for A, B, C, D and E. in accordance with regulations, the various services set out in the Act. Under the Act, the Minister for Health, in making his regulations, must provide everything for everybody or nothing for anybody. Under Section 22, the regulations must give, not merely to the impoverished, poor, out-of-work man, but to the fine farmer with the £50 valuation, the right to demand accommodation from the local authority. Under Section 22 of the Act, the Minister cannot pick and choose. He cannot provide for the needy in priority to the better-off sections of the community. He cannot do what Christian charity would impel him to do. That is broadly the scheme enshrined in the Health Act of 1953, in legislation. It imposes a statutory obligation which provides health services by words in an Act of Parliament. It provides these things in one of the statutes of this Parliament, but how is it to be carried out in fact?

People do not retain their health because of the enactment of Health Acts and people do not get better because this Dáil orders them to feel better. You have got to provide what the Dáil by its statutes orders. To bring the Act of 1954 into practice, some urgent steps will have to be taken. Many of the steps will have occurred, if not to Deputies here, I am certain to the people outside. First of all to provide adequately for all these people to whom our statute gives equal right of hospital accommodation, the initial step is to provide hospitals. The first thing to do is to increase the existing hospital accommodation so that county hospitals will not be working at more than 100 per cent. of their capacity, so that Holles Street Hospital will not be turning out unfortunate women at 3 or 4 o'clock in the morning. I can see Deputy Briscoe shaking his head. I can assure the Deputy that I have made personal inquiries and I have found that unfortunate women in Holles Street are being shifted out at 4 o'clock in the morning and sent home in ambulances and cars because other urgent cases of women in labour have come in. Surely, the first thing that must be done is to provide facilities in hospitals and elsewhere to deal with the added classes to whom our legislation gives these statutory rights.

Need I say that, with regard to the provision of extra accommodation, nothing has been done? On August 1st we shall not have available any extra beds in this country. On August 1st Holles Street Hospital will still be overcrowded. On August 1st every county hospital in the country will still be catering for more than it reasonably should. Consequently, in order to make this Act work on August 1st, as the House would have liked it to work, it would be necessary that discussions should take place and agreements be reached with the different voluntary and teaching hospitals in this country. If the voluntary and teaching hospitals were not available to provide for and care for all the people set out in Sections 14 and 15, then indeed an appalling situation would arise in this country. Accordingly any Minister sincerely desiring to see these services provided for the people of this country, should regard it as incumbent upon him to discuss the position with each voluntary and teaching hospital and to meet whatever reasonable proposals they may put forward in the desire to reach agreement—not in the desire to reach disagreement.

Since this Act was passed by Dáil Éireann, no effort, good, bad or indifferent, has been made to have such discussions with the voluntary hospitals and the teaching hospitals in this city or elsewhere. No agreement even of the scantiest kind has even been contemplated or hoped for. Nothing has been done.

Thirdly, anyone who sincerely desires to see this Act come into operation should contemplate that some discussions with a view to agreement should be carried out with the different other interested bodies in the country, with the medical profession, with the nursing profession, with the chemists, with the dentists, with the different people who have to provide the services enshrined in the Act under discussion. Again, I regret to have to inform the House that no effort, good, bad or indifferent, has been made to enter into such discussions, to ascertain the views of the nursing profession, to meet the dentists, to see what the chemists have to say; nothing again has been done.

Fourthly, an Act of this kind imposing as it does and must a substantial added burden on the county hospitals throughout the country must require very definite arrangements by all the local authorities. What is the position in regard to that? When I went into the Department of Health, concerned as I was sincerely to see that we would have in this country better health services, I caused inquiries to be made throughout the country to see what steps had been taken by local authorities to provide the services set out in the Act. The Dublin Corporation told me that if a series of conferences could not be arranged at a very early date the operation of the Act from 1st August would lead to most unsatisfactory consequences and that the operating date should be put back. From Kildare it was stated that it would be impossible to implement the regulations from 1st August because arrangements for hospital, specialist, general practitioner and midwifery services or for the provision of drugs, obstetrical outfits, etc., had not been made because the local authority did not know what fees to pay and because neither the staff nor the council had had time to familiarise themselves with the regulations.

Wexford County Council said it would be difficult to guarantee the additional bed requirements for the maternity and child health services which they thought would be necessary immediately the regulations became effective. Carlow County Council said they had deferred the making of detailed arrangements for the operation of the services until they had got instructions about how they were to work them. Waterford Corporation also spoke of their difficulty in implementing the regulations by the date suggested. There is a further complication here which I may have to explain later. Clare County Council reported that no child welfare service could be established at present, nor could the existing school medical service be expanded.

Donegal County Council, while stating that the general institutional and specialist services would be implemented as far as their existing facilities would allow, said that as they had not got a county hospital with its allied services, it was not feasible to provide the services of a county surgeon, a county physician, etc. Certain difficulties were expected also in operating the free milk scheme, particularly in getting milk supplies. The Dublin Board of Assistance said it had not been possible to make complete and detailed arrangements for the operation of any one of the services because they did not know what they would be required to operate.

The position in Dublin, Cork and Waterford is complicated considerably because, while the corporation and county council of these areas deal with health services, the entire medical assistance service that is given by the dispensary doctors and by the local authority hospitals is operated by local boards of assistance. Before the health services can be implemented in those areas Statutory Orders must be made setting out what services under the Health Acts will be administered by the boards of assistance and what financial arrangements will be made for meeting expenses. The health authorities in Cork and Waterford are not finding it easy to agree locally on the financial basis of the new service which the local boards of assistance will operate. In default of agreement, the matter must be settled by the Minister for Health, and that is not a matter which can be settled easily.

These are some of the results of inquiries which I have made with regard to the local authorities generally. Many other replies that I have received show that the extent to which arrangements have been made is the filling of forms to deal with the services set out in the Act. I have shown to the House, and I am sure it will appeal to the good sense of the Deputies, some of the steps that should necessarily have been taken to provide that the services in the Health Act of 1953 would not only become law—that is an easy thing to do—but be enjoyed by the people of this country. I hope I have shown that the necessary steps in fact have not been taken.

Let us consider for a moment what has been done. My predecessor, from time to time in this House and outside it, after the passing of the Health Act, 1953, expressed his intention to have the services in operation on April 1st. I would have thought that he would have utilised the time from the passing of the Health Act in October, 1953, to the 1st April to carry out these essential steps, but he did not. Not an extra bed was provided; no discussions were held with the voluntary hospitals; nurses were not seen; dentists were not talked to; the chemists were not consulted—no one was consulted and, accordingly, time went on and April 1st drew nearer and nearer and nearer, but still nothing was done until a by-election was held in Cork and another one was held in Louth.

Mr. J. Lynch

You should keep away from political controversy.

Mr. T.F. O'Higgins

After the result of these elections, it was announced that a general election would be held. After that announcement was made, action was taken—not to build hospitals, not to meet in discussion voluntary hospital authorities, not to talk to the nurses or see the dentists or chat over it with the chemists—but a memorandum was submitted to the Government on the 22nd March. It was then recognised, of course, that the Act could not come into operation on April 1st, and the Minister for Health in his memorandum to the Government stated as follows:—

"The Minister for Health has indicated on several occasions in reply to Dáil questions and otherwise that the more important of the new services under the Act would be made available on 1st April, 1954, or as soon as possible thereafter. He now desires to submit for the information of the Government his proposals for the commencement of the remaining sections of the Health Act, 1953, and for making regulations relating to the new services."

The memorandum goes on to suggest that a commencement Order should be made bringing the Act into operation on July 1st and providing for the making of different regulations. I do not know what happened, but I assume that the Government, having considered this memorandum—the Budget was, of course, approaching—decided to postpone the operation date until August 1st. Whatever happened after that memorandum had been submitted, my predecessor took action.

Again, I want to state the facts so that Deputies can appreciate what took place. On the 31st March, without any further step being taken, without anything else being done, the commencement Order was made bringing the Health Act, 1953, into operation on 1st August. That meant that the Minister for Health there and then became functus officio so far as the Health Act was concerned. The Order could never be revoked. Nothing could stop the Act coming into operation except new legislation.

On the 31st March this commencement Order was made. The following day—All Fools' Day—the National Health Council was formed. That body consists of persons nominated by different bodies interested in health services to the extent of one-half; the other half is nominated by the Minister for Health. The National Health Council was formed on the 1st April. On the 15th April, Holy Thursday, the National Health Council was handed seven sets of regulations in draft. I should explain that under the Health Act, 1953, it is obligatory on the Minister for Health to consult the National Health Council in relation to any regulations he may make. There is a saving provision in the section that if any regulations are certified by the Minister for Health to be of an urgent kind he may make them and, having made them, he must then send them to the National Health Council for their advice.

On the 15th April, Holy Thursday, seven sets of regulations in draft were sent to the National Health Council and the members of that body were asked by the Minister to give their recommendations by the 5th May. The National Health Council set about considering these regulations. Some of them were complex; some were not so difficult; but they found that they could not do what they had been asked to do within the time suggested by the Minister and they requested the Minister on the 30th April to extend the time for considering these different regulations. They suggested extending the time to the 19th May. The Minister did not feel able to agree to that extension but he did extend it to, I think, the 15th May. At any rate, some extension was given.

The National Health Council considered these regulations. These regulations were regulations dealing with, from recollection, free milk for mothers; no difficulty arises with regard to that: regulations dealing with mental hospital treatment; again, no difficulty arises there: regulations dealing with boarded-out children— no difficulty there; regulations dealing with institutional services—no difficulty there. Of the seven sets of regulations, no difficulty arises with regard to five of them. But two of them must obviously cause concern to any body such as the National Health Council.

These regulations deal with the two big difficulties that I have endeavoured to put before the House, namely, the general hospital and specialist regulations in relation to the hospital and specialist facilities for all those set out in Sections 14 and 15 of the general nursing and maternity regulations. These two must cause, and did cause, difficulty.

The National Health Council proceeded to consider the general hospital and specialist regulations. They went through them and considered them in detail and they had completed their consideration by the latest date mentioned by the Minister, namely, the 15th May. On that date the Minister made all the regulations law. He made the hospital and specialist regulations law; and he made the maternity regulations, which had never been considered at all by the National Health Council, law also. He certified them to be urgent, and, having so certified them, made them law. That was the 15th May.

Mr. MacBride

What was the date of the election?

Mr. O'Higgins

The people polled three days later.

Mr. Cunningham

Deputy MacBride has three good reasons for remembering.

An Leas-Cheann Comhairle

Order!

Mr. O'Higgins

The important thing that I want Deputies to appreciate is that those regulations were made on the 15th May without adequate consideration by the National Health Council, one set not having been considered at all, and without any extra accommodation, any discussion with the voluntary hospitals, any discussion or agreement with interested bodies and without adequate arrangements having been made by the local authorities.

As the House knows, the general election resulted in a change of Government, and a short while later I became Minister for Health. I took over that situation, a situation in which the Health Act, 1953, must come into operation on August 1st; a situation in which regulations had already been made, in which an egg had been scrambled and it could not be unscrambled; a situation in which I had to take a decision either to stand idly by and watch chaos develop on August 1st or go through all the political disadvantage of coming in here, as I have come in to-day, and responsibly asking this House to enable me as Minister in charge of the health of the people to do something to avert real hardship and real suffering.

Let no Deputy say to me that I am talking nonsense or making a case. I am not. If this Bill is not passed into law, then, on and after the 1st August, those who will suffer will be the poor people of this country. I do not think that my predecessor, Deputy Dr. Ryan, who spoke on this matter a few days ago, can have given it any real study when he said it was absurd to suggest that the poor would suffer. Of course, they will suffer. On the 2nd August, any poor person in the country who gets sick down in Wexford, Cork, Carlow, Kilkenny or anywhere in the country——

Mr. McGrath

Or in Laois-Offaly.

Mr. O'Higgins

Or in Laois-Offaly, or anywhere in the country, will find a very great change. Instead of having priority in the county hospital, instead of being entitled to a bed in preference to his better-off neighbour, he now walks the same road, wearing the same clothes, and is only entitled to rank with the farmer of £50 valuation, and he is not a pauper. He is only entitled to rank with the man whose income does not exceed £600, and, again, he may not be a pauper. His rights of priority have disappeared, and he then has to take pot luck with everybody else.

I decided not in any way that could be avoided to interfere with the Health Act, 1953. I voted against that measure when it was before the Dáil. I do not think that it incorporates the best that could be obtained in this country. I was against it and spoke against it but I do feel that a contribution can be made in this whole turbulent controversial subject of health by accepting what has been done by those who went before me. I propose to accept the Health Act, 1953, in so far as the services are concerned, in full. I do not intend to change them. I do not intend to alter them, to minimise them, to counteract them in the slightest. I do intend to see that they are made available. I do intend to see that the Health Act works and that is the purpose of this Bill.

It may be that, later on, some of the ethical objections to the Health Act may have to be dealt with by me. To what extent, I do not know. But that does not affect in the slightest the services contained in the Act. I intend to see that those services are made available for the people of this country.

It will not be done and it cannot be done by sticking our heads in the sands like so many ostriches and hoping that hospitals will grow like mushrooms overnight. It cannot be done by waving wands and picking hospital beds off trees. It can only be done with common sense, with co-operation and with sincerity and that is the way I see that it will be done.

I am not asking for anything big from this House. I am not asking for any extreme measure. I am not asking Deputies opposite to lose face in the slightest. I am merely asking them to empower me to get their Act working. As I see it, it cannot be worked by shoving four or five people through a doorway wide enough to accommodate two. If you try to squash five people through such a doorway, no one gets through. I merely ask the House to let me stand at the doorway and say: "Wait a minute. You were first; you will come after; go one by one." That is the sole purpose of this Bill. It is not unreasonable; it is not extreme; it is an ordinary way of doing it. I believe the Romans used to say that Rome was not built in a day. Ireland may say: "I ndiadh a chéile deintear na caisleáin." That is the only way a service of this kind can be made to work, and that is the purpose of the Bill.

May I say that, if the Bill proves acceptable to the House, I intend, with all sincerity, to provide these services to the other classes as quickly as possible, but I do not propose to do it until I am satisfied that it can be done, and I do not propose to allow any person in this country who is unable to fend for himself or herself to suffer?

After the passage of this Bill, I hope to have regional conferences throughout the country. I hope to go down to Munster to meet the Lord Mayor of Cork—I am sure he will meet me—and other members of local bodies down in the South to discuss with them their problems——

Mr. McGrath

We do not want to wait 20 years until a hospital is built; we want it now.

Mr. O'Higgins

Glory be to God! I hope, in regional conferences, to discuss with responsible and sensible public representatives their own particular problems and how far the Act can be extended in their own areas. In that way, I think I will be doing the proper thing and carrying out in a sensible way the intentions of the House.

Mr. McGrath

The Parliamentary Secretary behind you can tell you it was already discussed—the voluntary hospital.

Mr. O'Higgins

Might I just say one or two words about the Bill itself very briefly? The Bill is a very short one and in effect it only seeks to do two things. It seeks to amend Section 22, which is the regulation-making section, to empower me instead of having to give everything to everybody, to give to those to whom I can give, the services envisaged by the Act, and later on, in accordance with added facilities, to provide for others. I have endeavoured to explain to the House the reasons for that.

In addition the Bill removes the right of a health authority to charge a socially-insured worker who has 156 contributions paid, the 6/- a day or two guineas a week set out in the parent Act. It removes the right to make any charge in connection with that for the reasons that I have already stated to the House. The consequential section—Section 3—also arises in relation to Section 25 of the parent Act, which is the section entitling a choice of hospitals. Under the Act as contemplated, any person within the categories mentioned who required hospital accommodation could go either to the county hospital, the local authority hospital, or to another hospital if a bed were available— another hospital of his or her own choice. If that person went to another hospital, then the local authority made a contribution of £3 10s. and the balance—two guineas a week or 6/- a day—had to be paid by the person who exercised the choice. We are removing that charge of 6/- a day and we are endeavouring to maintain in relation to insured workers their existing rights.

Needless to say I hope no Deputy will be under any misapprehension. There is no other change in the Health Act and the various other sections and the various services contemplated or designed in the Act will all go into operation. There may be some slight difficulty with regard to the provision in relation to new services, the provision of institutional facilities in some sections. For instance, the allowances scheme for disabled persons will go into operation on October 1st and payments will be made on that date. Disability payments will be made to each person entitled to them but it may be some time before the institutional facilities will be available. That is not the same problem as arises in relation to the insured workers where existing facilities are not sufficient. The scheme for disabled persons is a new service and I may not be able to have institutions ready on October 1st, but payments will be made.

In addition, I also propose, if I can arrange it, to provide a choice of doctor for every maternity case in the public assistance class. The red ticket that figured so prominently in our debates here will disappear and the white card or ticket will take its place.

I think from what I have said it will be, or it should be, clear that there is no intention to set aside the Health Act, 1953. I make no secret of the fact that I do not regard it as ideal and as I said something may have to be done to meet any reasonable ethical objections which may exist. The Act provides us with a basis, such as it is, for improved health services for a large section of the community and it will be implemented in full according as the necessary arrangements can be made. Over and above the services to be provided under it, however, some further provisions will have to be made and I propose at the earliest possible opportunity to have that entire matter inquired into. At the moment I have not decided what form that inquiry should take but I sincerely hope it can be conducted in such a way as to avoid the spirit of acrimony and contention which has been for so long associated with the efforts of all Parties to reach the common objective of a fully adequate health service being brought within the reach of all. For these reasons, I move the Second Reading of this Bill and recommend it to the House.

Mr. J. Larkin

May I ask the Minister a question? What advice have the officials given him now as to whether it is possible to implement the full Act on the 1st August?

Mr. O'Higgins

The advice I have received from my officials has been incorporated in my speech—that it would be impossible to implement the services fully.

Dr. Ryan

The Minister wound up on a very conciliatory note in saying that he wants to avoid acrimony. It was a pity he did not think of that before starting to make his speech. I am all with him when he says that there should be no acrimony in this discussion. I do not see why there should be political capital made out of this and we will let the Minister's speech go and try to forget about it as a thing that has a bad smell, as quickly as we can. The speech was all the time about his sincerity, my irresponsibility. For the benefit of the new Deputies in this House, I think if they go back and read his speech, when they get to know the Minister they will have a laugh at that—his sincerity.

The Minister says nothing was done. He repeated over and over again that no effort, good bad or indifferent, was made to bring this Act into operation. Unfortunately, I do not keep a diary and, unfortunately, I have not kept notes of what was done. The Minister probably could get them. I cannot. But I think those of us who were listening to him know that when he said that I never met the doctors, never met the dentists, and did nothing about the voluntary hospitals and so on—that that was not true. It is a very serious matter to make an accusation like that against me. He knows it is not true, and he has made the accusation with political motives and you know what you call that. It is defined in the catechism. I did meet the doctors, and I met them several times. I tried to meet them oftener, but they were not prepared to meet me. That is all I am going to say about the doctors—the Irish Medical Association. I am only trying to show that I did my best to get agreement with the Irish Medical Association—I should not be surprised if the Minister will get it because he is in a much better position to get it than I was, and I am sure he will get that agreement.

I also saw the dentists—I think it was twice. I had discussions with them but I did not get agreement with them. I admit that, but it is not to be expected that organisations of that kind would agree with me straight off, because they come in the capacity of negotiators intending to make the best bargain they can for their own members. Naturally, they are not going to agree with what I say straight off and say: "We accept that, thank you very much." It was extremely difficult to get agreement with these organisations, but I am sure the Minister will get these agreements.

When the Act was passed we sent a copy of the Act and a memorandum pointing out how the Act affected the voluntary hospitals, to the voluntary hospitals. We also sent, as far as I recollect, a copy of the regulations which affected the voluntary hospitals. We asked the voluntary hospitals to consider the matter and they did. Some of them asked an officer of the Department to go around and discuss the whole matter with them. That has been done and negotiations, if you like, in that respect, were going on with the voluntary hospitals. That is what the Minister calls "doing nothing good, bad or indifferent". Is it not appalling—the Minister used the word "appalling" very often; apparently he could not get away from it; he used it in every second sentence— is it not an appalling thing for a man in a position of responsibility, such as that of the Minister, to make a speech like that, to try to raise some doubt in the minds of people who want to see this Act operated? He repeated over and over again that nothing was done but he apparently is going to see that something will be done so that the Act can operate smoothly and properly.

There were certain things the Minister said that are true. The lower income group are entitled at the moment to general medical services. Insured workers are not, as insured workers. They may be entitled to general medical services if they are in the lower income group. They are entitled to hospital services, to a limited extent, if they are qualified as insured workers. To give you an idea of the number qualified, the Minister said that there are 450,000 insured workers entitled to hospital benefits and there are 700,000 insured workers altogether. Therefore, you have 450,000 out of 700,000 qualified. I agree with the Minister that no person who is sick and requires urgent hospital attention fails to get it.

I agree with the Minister that the beds in the county hospitals and in the voluntary hospitals in Dublin are full. It has always been that way in this country, although many hospitals have been built since 1932. Nothing was done for ten years before that, absolutely nothing. Since 1932, many hospitals have been built and yet while all these hospitals have been brought into operation year after year, still they are always full. It is the same in, as far as I know, every single country in the world. It is not that more people are sick than there used to be 30 or 40 years ago but it is, I believe, due to the fact that people are more health conscious and that they seek hospital treatment nowadays more frequently than in the past.

We shall probably have to go on building hospitals for many years to come before we catch up on the requirements of the people but, as my friend, the Lord Mayor of Cork, put it very aptly have we to wait for that before the Act is brought fully into operation? Are we to wait for the next 15 or 20 years before we implement the services outlined in the Health Act? Had we to wait for the T.B. scheme until all the sanatoria that are to be completed within the next six or 12 months were built? Was it not better to go ahead, as far as we could, with the existing facilities until more facilities were provided? As a matter of fact, that has been proved to have been a wise policy because the death rate from T.B. has been cut 25 per cent. in the last seven or eight years.

It is all right for the Minister to come into this House and talk about the 640 beds required for maternity cases in Dublin. That is on the assumption that every single woman in Dublin who is going to have a baby goes into hospital. She does not, of course. Many of them stay at home. If you want to make a case, a convincing case, of course you can take figures like that but you have no regard to facts. You assume, and you expect everybody to be foolish enough to assume, that all women are going to go into hospital in future although they have not done so in the past. The Minister said for instance that the Health Act of itself does not improve the health of the people; neither does the Health Act increase the birth rate. The Health Act is not going to bring about more births in the country. We shall have about the same number of births and, if we are able to deal with them at the moment, why should we not be able to deal with them after the Health Act comes into operation? That is the net point I want the Minister to explain. That is the difference between his outlook in this matter and the Fianna Fáil outlook.

We know that every maternity hospital is full. We know on the other hand that there are not many people turned away from hospitals at the moment, certainly not serious cases. We were hoping to operate the Health Act so that the services would be improved and that people would be enabled to avail of services that they cannot afford to avail of at the moment. That does not mean that we want more beds. As time goes on, we shall have more beds as new hospitals are erected but we are just in as good a position to go on with the Health Act to-day as we shall be in 15 or 20 years' time because it has been the history of this country and every other country at all times that there was a shortage of hospitals beds. Even though the shortage might be only a few hundred, the provision of additional accommodation will not mean that you will not still be a few hundred short.

I do not see why we could not implement the Health Act as far as hospital beds are concerned. There is no case whatever for not doing so and I do not think the Minister has made a case. He has made no case by giving the number of births in Dublin, the number of beds and the number of maternity homes because, at any rate, we have been carrying on reasonably well up to the present moment. My idea, as regards that regulation, was to make it as attractive as possible for the mother to have the baby in her own home. Under the regulations, if she decided to do so, she would get free medical attention, free nursing attention, and everything provided in the same way as if she went into hospital. Therefore, there would be no inducement from the financial point of view, to make her go to hospital. There may be, of course, the consideration that you have at the moment—that women think it better to go into hospital because of the domestic difficulties in their own homes but there is no reason why the implementation of the Act should make the problem any more difficult, because if we are implementing the Act properly and if we give the same inducement to women to remain at home, there should be no change as far as beds are concerned. The Minister has devoted a great deal of attention to an effort to prove that nothing was done good, bad or indifferent. He has referred to the number of hospital beds available but I say that the Act could have been brought into operation in spite of all the assertions that are made about a shortage of hospital beds.

What the Minister says is true, that the lower income group at the moment, who are called the public assistance group, must get priority from the local authority, but the Minister gave us a great idea of his sincerity. If the Act is brought into operation what happens? You have that lower income group who are entitled to service in the hospitals just as they are now and nobody should deny them that service under the Act. You will have added to them the middle income group, the insured people, the farmers under £50 valuation and all persons in receipt of less than £600 a year. They will have an equal right to demand accommodation in the hospitals, and the Minister is afraid that in the ordinary way the officials in the counties, the county managers and others, will show favour to the influential person or perhaps show favour to the man who is able to pay something. Could we not prevent that? If the Minister is so sincere that he can only think of the poor person and does not care about the rest and if, as he says, he stands at the door and says: "You stand back," the place for the other fellow, as Deputy Allen says, is the cemetery. If that is a sincere expression of opinion from the Minister, let him bring in an amending Bill which will give the lower income group priority and we will all support it, everybody on this side as well as on his own side. He will then have put the lower income group into the same privileged position they are in at the moment and, as far as I can see, his two big arguments are gone: (1) the hospital bed; (2) priority for the lower income group. A simple Bill giving priority to the lower income group will settle this question and the Health Act can be operated.

This is a difficult Bill although it is short. Sections 1 and 3, as far as I can see, deal with insured people only. The Bill ensures that on the 1st August insured people will come under the Health Act and will be no longer the concern of the Minister for Social Welfare and withdraws the privilege, I do not think it is a right, of getting hospital treatment under the Social Welfare Act. Now they will get it under the Health Act. That is all right; I do not object to that. But why is it done for that particular class and not for everybody else? Why were they not left under the Social Welfare Department for the present, until the Minister stands at the door for a while to see whom he would let in? Why were they changed over? After all, it is a very easy matter to leave that class as they are. It is a very easy matter to leave them under the care of the Minister for Social Welfare and let them get the hospital facilities. The only difference is this, that if they are left as they are, the Minister for Finance must pay the whole cost, but if they are changed over the local authority will pay half and the Minister the other half. I am responsible for that because I put that in the Act but it was a very different matter then because when it went into the Act it put them in as a group amongst other groups. At present the insured worker is only entitled to limited benefit in hospital—I think it is six weeks. He is only entitled to that for himself. He is not entitled to it for his family. When I was putting the Health Act through the Dáil, I pointed out to Deputies, because the matter was raised, that under the Act the man and his wife and family would all be entitled to hospital treatment and therefore they must take their place the same as the other groups who were coming in, such as the farmers and those under £600 incomes.

The Minister stated that he was going to visit the local authorities. I went around also and I remember that amongst one of the groups I met was the present Minister for Finance who was then Deputy Sweetman. Deputy Sweetman made a very strong objection to the insured person being brought in and the local authority having to bear half the cost. I argued against it and Deputy Sweetman held to his point, but he evidently has let it go now. Deputy MacEoin said that not only that service but many other local services which are now financed by the local authorities should be taken over by the central Exchequer; not this alone, but many others. There has been a change round in the attitude of people in regard to this matter.

I am still prepared to agree that the insured worker, if he has the means, should be in the very same position as the other person with under £600 a year. The reason why a second class, those under £600 income, were put in is that if a person is working on his own and is not insured, I felt, the Government felt, and the Dáil felt that he should get the same facilities as the insured person. We put £600 in it because £600 is the limit for the insured person. Therefore, what it amounts to is this. Under the Health Act, insured people come in. Those who are not insured but who have the same income come under the Act and they are supposed to get equal treatment in every way.

This Bill removes the obligation of the insured worker to pay 6/- a day, or two guineas a week, for hospital treatment. To be logical, the Minister will have to come along with another amendment to remove the obligation on the person who has less than £600. How is a person with an income of under £600 and who is not insured better able to pay that 6/- than the person who is insured? Is he not in the same position as regards means? Why should the county manager be permitted to go to the person who has less than £600 and who is not insured and say: "You must pay 6/- per day," but when he comes to the next bed and finds a man who has under £600 income but is insured say: "You are insured; I may not touch you." Does not that look very unfair? It is very unequal legislation and is so unfair that it looks like a bargain between two Parties. That is the only way in which it can be described. I think it is a shame that it should be done.

I suppose we can say that there are many small farmers who are not earning the equivalent of £600 a year. You have to go to a little bit of trouble to compare them because the farmer has goods in kind that the other person has not got, but still it can be done. Many small farmers in receipt of less that £600 are liable to pay 6/- a day. The only person exempted by this Bill is the insured worker. I think it is unfair. I am not objecting to the Minister doing it.

When I was bringing in the Health Act in 1953, if the Government had asked me to do that I would have done it if I thought we could afford it. But now the Minister is removing one group from the obligation to pay, I think he should remove it from all in order to give fair play all round. If he does not do that, he can be accused of being unjust to certain parties.

I am not sure about Section 1, but perhaps the Minister will answer when he is replying. It is perfectly plain that if the insured worker chooses his own hospital, then he is all right; he cannot be charged his 6/- per day. But, if he does not choose his own hospital, if he goes in under Section 15 to the hospital he was told to go to by the county manager, then I am not so sure that the county manager cannot make him pay 6/- per day.

Mr. T.F. O'Higgins

I intended to say that in Section 3 there is a drafting amendment actually necessary.

Dr. Ryan

That is all right. I am not a lawyer and the Minister has the advantage of being a lawyer, but when I read Section 2 first, I could not make out what the necessity for it was. When I read the section first I could not make out what the necessity was, because it gives the Minister power to make benefits available for a particular person of a particular class, or a sub-class. One would imagine, when looking at Section 22, that the power there was nearly sufficient to enable the Minister to do anything of that kind already. Section 22 says that the Minister may make regulations applicable to every health authority, every health authority of a particular class, or a particular health authority, as to the manner in which and the extent to which they are to make available the services specified in Sections 14 to 21.

Surely the Minister can come along and say that he is only applying this to a particular class of health authorities or only to a particular health authority and he can then give instructions to the health authority as to the manner in which, and the extent to which, they can give these benefits. Surely he has enough power there to deal with the matter. Apparently he has come to the conclusion that he has not.

Evidently Section 2 of this Bill has the effect of postponing this Act, though I did not appreciate that until the Minister explained it in the way he did. An explanatory memorandum was issued with this Bill and it gives the reasons why the Government feel they have to postpone the operations of the 1953 Act and this memorandum is an apologia, if you like, officially supplied to the members of this House and, through the Press, to the public for this action of the Minister's in postponing the operation of the Health Act.

After consultation with his colleagues the Minister evidently made up his mind that the Act must be postponed. He gave his reasons here, to some of which I have already referred. I must admit I have not been convinced by them. The Minister gave some reasons why the Act should be postponed. The interesting thing is that he obviously got the agreement of the Parties forming the Coalition and then, having got that agreement, he went to the National Health Council to get their advice. Now when a Minister goes to the chairman of the National Health Council and asks him to call a meeting for a certain purpose he must convince the chairman that he has good reason for a meeting being called, and he will naturally use all the arguments he can to persuade the chairman that it is necessary to postpone the Act. What happened in this case was that the chairman called the meeting and the meeting considered the very carefully-worded resolution put before it after the Minister had addressed the council. It is very hard to believe that a member of the council drafted that resolution either while listening to the Minister or immediately after hearing the Minister. It is a very well-worded resolution. It is very carefully put. It shows concern for the poor and for the insured worker. It gives the reasons why the Act should be postponed. So well drafted is it that one is driven to the conclusion that it was brought in in somebody's pocket.

That resolution was put before the council and the council considered the matter and agreed. Someone asked how that council is formed. Under the Act at least half must be elected by medical and auxiliary interests. Of the other half, the great majority are nominated by certain bodies at the request of the Minister—at my request at the time. Those bodies are the Employers' Federation, labour organisations and so on. I thought the Minister had power to appoint four. I am told it is five.

Mr. O'Higgins

The Minister can appoint 50 per cent.

Dr. Ryan

Four or five are appointed by the Minister and two-thirds of the other half are appointed by various interests at the request of the Minister. I accept the Minister's figure of five. There was no complaint from any local authority that they could not bring the Act into operation. There was no complaint of any kind of that nature to the National Health Council. It was the request of the Minister. I admit the Minister gave his reasons. The Minister asked for advice, having persuaded the chairman to call the meeting. The advice he wanted was fairly obvious and he got that advice from the council.

With regard to the council, that council was set up as an advisory or consultative council under the 1953 Act and under that Act all regulations must be sent to the council for their observations. They are, of course, advisory and the Minister need not take their observations if he likes. But they must be asked for their observations and they must report. Beyond that there is no obligation on the Minister to consult them and I do not think it was ever visualised that they should be brought into politics; and it is going very near politics and political controversy when a Minister goes to that council and asks for their advice on the postponement of an Act which everybody knows was, and is regarded as, a political question.

Mr. O'Higgins

I want to assure the Deputy I did not ask that. The Deputy is assuming something that is not so. I did not ask the council for its advice on the postponement of the Act.

Dr. Ryan

No, but is it not plain to everyone that if the Minister persuades the chairman to call a meeting he must at least forecast that something will have to be done about this Act; otherwise the chairman may well ask for what purpose he wants the meeting. Having brought the council together the Minister told them of his difficulties, putting his difficulties in the lurid way in which he put them here to-day. Naturally he was advised to postpone the Act. The Minister, after all, expected that advice. I am quite sure he is long enough in politics not to call the council together if he thought he would get the opposite advice. He expected to get the advice he got. I contend that the Minister realised, the Fine Gael Party and the Labour Party having agreed to postpone the Act, that he would meet with some opposition in the country and he would bolster up the position by getting advice of this nature from the council. He was thereby bringing the council into political controversy. It was never intended that that should be done, and it should never have been done.

Mr. O'Higgins

As long as the council agreed with the Deputy, it was non-political.

Dr. Ryan

As a matter of fact, they hardly ever agreed with me and the documents the Minister read out to-day were all against me. The Minister should have the courage to stand over the Act himself. If he was convinced he was right in postponing the Health Act, 1953, why did he ask the council to meet and why did he bring them into this matter at all? Why did he not come out boldly and say that he was postponing the Act because he thought it was the right thing to do? He need not then have brought the council into it at all.

We are told in this explanatory memorandum that the intention is to bring the Health Act, 1953, into operation as soon as possible. As a matter of fact, we are told in the memorandum that it is being put into operation for certain classes and for certain services. All that is being done, of course, is that where a person in the lower income group is entitled to general medical services, or where a school child is entitled to treatment due to defects arising from a school medical examination or an infant to treatment in a clinic, they are being passed over to the Health Act. In future, those people will come under the Health Act instead of the Public Assistance Act.

The Minister, by adopting the Order which was made by me bringing the Act into operation on the 1st of August, is leaving people exactly as they were, but he is bringing the Act into operation. This House would never have given so much time and consideration to that Act, when it was a Bill, in order to leave people as they are. When they put that Bill through the House, their intention was to see that it would operate and bring in new services for other classes. That is all being put aside now. We do not know for how long. If we are to follow what the Minister said in his speech it is being put aside until we have sufficient hospitals. I do not know when that will be, but it is going to be many years before we reach that very desirable position.

Those in the lower income group are being brought in for maternity services under Sections 16 and 17 on the 1st of August. There is a sub-section of Section 16 which, I think, I should quote for the information of Deputies because they should be aware of what it says.

"Regulations shall provide that any woman entitled to receive medical services under this section may receive them from such registered medical practitioner who has entered into an agreement with a health authority for the provision of those services and who is willing to accept her as a patient as she may choose."

That was always referred to as the choice of doctor. Where a woman in the lower income group comes under the Health Act on the 1st of August, she has a choice of doctor under this sub-section. If the Minister is such a sincere man as he is being made out to us here, I am quite sure that he will not bring in the section without giving these people all the benefits they are entitled to. As regards the lower income group, there were only two benefits added under the Health Act which they had not got before. One was the maternity benefit which came in on the 1st of January and the second was the choice of doctor. Are they going to get that benefit? It would be unfair and entirely against the spirit of the Act if that section were to be operated and if the choice of doctor was not provided for.

Mr. O'Higgins

I said they would.

Dr. Ryan

I am glad to hear that.

Mr. O'Higgins

I said that in my speech, and the Deputy must not have been listening.

Dr. Ryan

I am delighted that the Minister said that. I would have thought that the most difficult thing, if you like, and the thing that would cause most delay would be to provide the choice of doctor. What must be done in regard to that? First of all, the local authority must make an agreement with the doctors.

That means that they must make an agreement with the doctors for fees for maternity cases. There are some things to be taken into consideration in connection with that. If a doctor is looking after a woman until the night before the birth and then says that she must go into hospital, what part of the fee is he going to get? I presume he will not get the full fee. All these things must be fixed. The doctors must agree. That means, if you like, a national agreement with the Irish Medical Association. All these things must be fixed. There must be an agreement with the Irish Medical Association. All that is going to be done before the 1st of August. Having made the agreement with the Medical Association, the local authority must prepare a list of the doctors going on the panel. The woman in the lower income group will get the list of doctors and she makes her choice. She has the right to do that.

I am surprised at the ease with which the Minister is getting over that obstacle. As a matter of fact, I thought that when coming in here to-day he would tell us that one of the big obstacles, as regards the operation of the Act, was going to be the making of an agreement with the Medical Association, but evidently he sees no difficulty in making an agreement with the Irish Medical Association before the 1st of August. It must be made well before that date because the local authority will need to have their list ready. After all, a woman coming under this section on the 1st of August would like to choose her doctor a day or two before that. In all fairness, therefore, the panel must be ready three or four days before the 1st of August. That means that the local authority must know how they stand with regard to what they are going to pay, and with regard to who is going to agree to go on the panel, which means an agreement with the Medical Association. If the Minister can do all that in a short time, then I will say that he can move mountains.

There would be no necessity to bring in this Bill at all if the Minister can do all that in such a short time. If he can do that, then he certainly could provide hospital accommodation for the sick and all the other things that are troubling him. Is it not very curious that the Minister should baulk at things that do not give much trouble at all, and that he should pay no attention to obstacles which appear to be very serious ones?

Mr. O'Higgins

Perhaps it is due to a difference of approach.

Dr. Ryan

Yes, a difference of approach. I want to put this to the Minister that the lower income group, at the present time, are getting hospital treatment. They are entitled to it and must get it if they apply for it, but I do not think that other people in the country are dying because they cannot get treatment. They may be suffering because they cannot pay for treatment. A man may think that he would have to pay a fair amount of money for treatment. When he knows that he has to pay a doctor, he will postpone getting treatment. He will say that he cannot afford it as he has to keep his wife and family. He may keep postponing it until maybe it costs him his life.

I do not see at all that we are going to overtax our hospital accommodation any more than we are at the moment by bringing the Act into operation. The Minister can, but I cannot. If the Minister says that I did not do anything, all I can say is that since Fianna Fáil came in in 1932 there have been a lot of hospitals built in this country. If the Minister is going to take a hand in building hospitals, how long is it going to take him—to provide a bed for everyone? I do not think that such an approach on the part of the Minister is fair.

There is another point. If the local authority is going to be in the position, by the 1st of August, of having a panel of doctors ready for the lower income group, then it is a very easy matter for it to say that it can take all comers, whether in the lower income group, the middle income group or those paying £1 a year. It is going to be easy for it to say that everything is ready for them. The only thing is that we come back again to the question of hospital accommodation. The Minister talked about hospital accommodation in Dublin. There has been a fair amount of maternity building added to our hospital accommodation during the last few years. Within the next few weeks there will be 80 beds added in St. Kevin's hospital, and a bed is able to accommodate 25 patients in a year.

I do not know why all this trouble and all this difficulty is being created. If the Minister had approached it in a different spirit, if the Minister had come into that Department and said: "The Health Act is a good Act and I want to see it operated as soon as I can," there would be a very different approach. It could have been done. Maybe I might say this: a new Minister coming in might be justified in saying: "You could hardly expect me, coming in here now to operate this by the 1st August without at least examining it for myself." There might be some justification for asking for a postponement for a short time. But this big general review of the question, the statement from the Minister that nothing was done, that the Act cannot be operated, appealing to Deputies here to be responsible and to see that the services cannot be administered before they are brought into operation —all that is unnecessary. It would be much better if the Minister had come in here and asked for a short postponement on the plea that he had to have time to look around and see that the necessary preparations were made.

There is no financial difficulty. Every local authority struck a rate for the Health Act. Some of them, I thought, did not strike enough but that did not matter; at least, they had some money in hands.

Mr. O'Higgins

£250,000 short.

Dr. Ryan

It might be but, at any rate, they struck a rate. Some, I thought, did not strike enough, but one of those that I know told me, when I asked them, that they were quite prepared to provide more money if necessary. In the Estimate for the Department of Health, money is provided for the central part of this. Therefore, financial difficulty does not arise.

I am just as confident that the Act could be administered as the Minister is that it could not be administered, so we have to leave it at that. I am just as confident that the Act could have been operated on the 1st of August provided there was no general election and that sort of thing to take our attention and to take up our time, but the general election did come and, for that reason, as I said already, the Minister perhaps is entitled to a short respite to make up for that time, but I do not think that it would be necessary to give a very long time.

This Act is very urgently necessary. I do not know whether Deputies on the other side have been getting letters or not but I have been getting letters. I quoted many letters here when the Bill was under discussion in the Dáil last year. I do not want to repeat them. There are many cases I could quote. Only last week I was told of this case by the person concerned— a widow whose income is £3 10s. per week and whose only son was ill for a fairly long period got a bill when he came out, cured or supposed to be cured, for over £70. Unfortunately, the woman did not send the son in under the authority of the local authority. In other words, she chose her own hospital without telling them. Her position would not be as bad if this Act were in operation, because it would be a hospital of her own choice and she would get some subvention. That woman can get nothing from the local authority. She intends to pay that £70 at the rate of 10/- a week. It will take her three years to do it. There is any amount of cases of that kind that we hear of every day of the week. The Act is urgently necessary. There is no doubt about that. The Minister should make every effort to bring the Act into operation.

The Minister told us that he intends bringing Section 50, dealing with disabled people, into operation on 1st October. I am very glad to hear that.

The Minister made an appeal at the end to drop acrimony and, if you like, take this health legislation out of politics. It would be a great thing if we could. It is a great pity indeed that we should have these differences of opinion with regard to health legislation. The Minister has gone one step anyway. He accepts the Health Act and he means to work it. Could the Minister give any undertaking— that is the point—in regard to Sections 15, 16 and 17—the three main sections we are interested in—when he will be ready to operate these three sections in full? I do not mean piecemeal but when will he have completed the job of bringing all the classes mentioned in all local authorities into benefit under Sections 15, 16 and 17? If that could be done within a reasonable period we might all agree that the Minister is entitled to some time to get things done according to his liking. If it is not done, of course, we cannot agree. That is all. I would ask the Minister if he can give some undertaking of that kind. If he did, as far as we on this side are concerned, we would not be inclined to oppose this Bill but to let it go through after the ordinary discussion.

Mr. J. Larkin

Listening to Deputy Dr. Ryan it seemed to me that the one clear statement one can get from his speech is that the Health Act is urgently necessary but, as one who is concerned to see, not merely the Act on paper but the Act operating, I regret that if one were to look for arguments which would press forward the point of view that there should be no delay or postponement in reference to any part of the Act, one would search very carefully through his speech and find very little to support that argument.

I think it is important, and I have expressed the view before in this House, that if we are going to do anything effective in regard to health matters we should try to remove health questions from the cockpit of political discussions.

I do not suggest that Deputy Dr. Ryan brought the present discussion into that atmosphere but I do say that, judging his speech by the standard that it was delivered by the immediate predecessor of the present Minister, by the member of this House most charged with responsibility for health matters immediately following the present Minister and by one who piloted the Act through this House and had the period from the 20th October, when the Act became law, up to the change of Government, to implement that Act, I do not think the speech is worthy of Deputy Dr. Ryan or helpful to those who want to see the Act pressed on. It was, on the whole, a somewhat low standard debating speech and I think that is not helpful.

As far as I and, I think, the Labour Party are concerned, our attitude is— I am speaking possibly for myself at the moment but I have no doubt the Labour Party adopt the same attitude —that even at this moment if we could be convinced that there are not good and sufficient reasons why there should be any postponement of the Act, we would vote against the present Bill because we think it is so important, but we are entitled to expect from those who have been so immediately in contact with the preparations to implement the Act something more helpful than we have got from Deputy Dr. Ryan.

First let us look at one or two of the factors that have been raised—the question as to whether the present hospital bed accommodation is sufficient to meet the impact of the Act and, if it is not, whether we should take a chance; the question of the number of maternity beds, and so on. They are largely matters of opinion unless we get very strong expert and technical advice and, apart from the present Minister and his advisers, nobody should be in a better position to give a firm answer on that than Deputy Dr. Ryan and to tell us exactly, up to the point at which he relinquished office, what exactly had been done to implement the Act and justify bringing it in on the 1st August.

I notice that in his speech he somewhat lightly passed over a number of points that seemed to me to be important. The first was that while he challenged the Minister's statement that nothing had been done and made the point that the Minister had kept on repeating that in a nauseous fashion, he did not point out what had been done up to, say, the beginning of March from the 20th October. He referred to discussions with the doctors and dentists but regretted he had no diary and no particulars. In matters of importance like this, while I recognise that Deputy Dr. Ryan, like other members of the House, is busy and has a great many appointments and engagements to keep, I feel in a matter of this importance he should readily have been able to tell us at what period, from the 20th October to the end of March, he had these discussions and had either reached agreement or failed to reach agreement and to what point he had got then; seeing in the light of his public statement that he was expecting to implement the Act on the 1st April, whether he had laid the foundations not so much for himself as Minister but for the local authorities to implement and carry out the regulations made by him and made necessary arrangements with voluntary hospitals and institutions. These are two points on which we do not seem to have got very much information.

So far as the Act is concerned, apart from those who are to be recipients of its benefits and the professions who are to operate the medical services, the main people concerned with its implementation are the Minister and the Department of Health and the local authorities, and I think, frankly, the National Health Council. I think most of us stressed very strongly the importance of having that particular provision in the Act and gave considerable weight to the opinion of the National Health Council.

The Minister has made his case to the House. That is a matter for himself. The question of the National Health Council has been dealt with both by the Minister and Deputy Dr. Ryan. May I say, with all due respect to Deputy Dr. Ryan, I do not think the manner in which he tried to undermine and weaken the value of the opinion of the National Health Council was in keeping with his previous relationship with the council and with some of the existing members of the council because while we have had an explanation of how the members of the Health Council were appointed we were already aware that on that council there were members with opinions as strong as those held by Deputy Dr. Ryan in regard to the Health Act and the need to implement it at the earliest possible date? It is remarkable that the Minister went into the council and induced them to pass a resolution or coerced them or compelled them to do so. It is still more remarkable that that particular resolution was passed unanimously, and that includes many members of the Health Council whose opinions we know publicly in regard to health matters. I have one in mind in particular, although I do not want to mention his name, to whom not sufficient credit is given in this House for the role he played in earlier years in starting us off on the particular path which has brought us to the present position in regard to health. I think most Deputies know to whom I am referring, and I think it can hardly be said that he had been coerced, misled or induced to agree to postponing the implementation of the Act.

Mr. Kennedy

He was misled.

Mr. J. Larkin

I am referring to Dr. Con Ward. I am referring to his previous work on health matters. He was at that meeting of the Health Council where the resolution was passed expressing this point of view to the Minister, and as far as Press reports go—that is all we can judge by—he did not express any dissent with that point of view.

To me, that carries considerable weight because, quite frankly, I would take it that Dr. Ward or an individual of his background would be very careful in accepting any statement that it was necessary to postpone any portion of this Act because the 1953 Health Act stemmed from the earlier Health Acts, with which he had a very close association. That is in so far as the National Health Council is concerned. I am also aware of other members sitting on that council, some of them representing sections of either the political or industrial labour movement, and again I would attach a great deal of weight to any opinion they would express. As far as I know—and they probably have a more intimate knowledge of the preliminary steps that have to be taken to implement the Act than the majority of us in this House could have—there again there was no expression of dissent. I am not going to make any reference to those who have dissented but were not there. That is their responsibility.

Finally, we come to deal with local authorities. We are quite well aware that, so far as the contact between the Department of Health and local authorities is concerned, it is in the main a matter of contact between officials. At the same time, having regard to the powers of the managers, it would be a mistake on our part to take the view that the elected members of the local authorities have no say in this matter at all. They have been consulted with regard to the financial provisions, and I am aware in many areas that they have been closely associated with much of the preliminary work connected with the coming into operation of this Act, and from a selection of opinions expressed by local authorities and submitted to this House by the Minister in the course of his statement it is clear that, so far as any firm opinion is concerned as to whether the Act can in fact be implemented on the 1st August, there is, to say the least of it, a very mixed view taken by the local authorities. Personally, my concern is with Dublin more than anything else, and there are members of this House who are members of Dublin Corporation and I feel that, leaving to one side altogether whatever political views we may have in regard to health legislation or to the part we took on either side in the course of the debate in this House, it would be helpful if members of local authorities who are also members of this House gave us the benefit of their opinions as members of the local authorities. That is very important and apart altogether from the opinion of the officials.

Finally on this question of the weight to be attached to the points made I noticed in the reported speech of Deputy Dr. Ryan the other day that he stated that he originally intended to bring the Act into operation on the 1st April and had been advised by his officials that it would not be feasible and that he should postpone it until the 1st July. As he was a very cautious person he decided to make it the 1st August. That was the advice of the officials of the Department of Health given to Deputy Dr. Ryan when he was Minister and I take it that Deputy Dr. Ryan, a member of the Fianna Fáil Party, had the same view as I had, that the integrity of officials of the Civil Service in any Department is not affected by the Minister in office at that particular time and that that advice was the most honest opinion they could give to whoever was Minister. Deputies will remember that when the present Minister finished his speech I asked him a very definite question. I asked him what advice had he been given by his officials as to the possibility of bringing the Act into operation from the 1st August and he said he was advised that it was not possible in the opinion of the officials, the same officials who, according to Deputy Dr. Ryan, advised him it could be brought into operation on the 1st July. Either they have completely changed their outlook, or in the present case they are not being honest with the Minister, or not basing their opinions on the same standard of knowledge as when they advised Deputy Dr. Ryan. The opinions they gave Deputy Dr. Ryan earlier in the year can be of no greater value than those given to his successor. If Deputy Dr. Ryan makes the point which he is entitled to make that he was advised by his officials to postpone the operation of the Act until the 1st July and accepted their advice and went a little bit beyond that because he wanted to be quite sure there would be no difficulty in getting things done, we find the view given by the same officials of the same Department to Deputy Dr. Ryan's successor is just as dependable, just as conscientious, just as helpful and just as good a guide to the members of this House in respect of operating the Act on the 1st August as that given to Deputy Dr. Ryan.

When I first heard of the difficulties in regard to the Act, I frankly considered it in the light of the suggestion that the whole of the Act should be postponed and the operative date changed from the 1st August. I felt that would be an unfortunate step to take and that it could be in many instances disastrous. When, however, I came to learn a little more about the problem that had arisen, I frankly was glad that whatever may be the views of the Minister in regard to the Health Act—and he has expressed them in this House—at least he was accepting the position that the Act was now the law of the land and that it was his responsibility to implement that Act and carry it out and that he was going to try and avoid interference with the rights which already existed in regard to certain classes by postponing the operative date from the 1st August—that what he proposed to do was to take powers, first, to maintain certain legal protection for the lower income group in so far as the continuation of the Public Assistance Act is concerned and also to extend the provisions of the Act to cover insured workers, and, secondly, to take powers to deal with certain services under the Act on a step by step basis. One would imagine that the latter proposal was entirely new whereas, as a matter of fact, that is the basis on which the Act was intended to come into operation. We have already the step by step basis in regard to one section of the Act which came into operation on the 1st January. There are other sections which come into operation on the 1st August, other sections on the 1st October and finally the dental and ophthalmic sections which are to come into operation on the 1st January next. So that when the proposal is made in regard to the institutional services to be provided for farmers and other sections of the lower income group, in principle, there has been no alteration from the basis on which the whole Act was to operate.

The question to be considered is whether there is justification for it. An argument has been made in regard to availibility of hospital beds, and the case has been made that if it were possible to introduce and extend services in respect to T.B. when there was an acute shortage of sanatoria beds, surely no difficulty should arise in respect to institutional services for all sections covered by the Health Act in so far as hospital beds and institutional services are concerned. Basically, of course, there is a big difference. At the time that the T.B. services were introduced, as many of us recollect, people suffering from T.B. waited anything from three to nine months, and in some cases up to two years—I knew of cases to go over three years—to get into a sanatorium. The problem was not a question of throwing an additional section into competition with those who had already got beds; it was a question of trying to ease the lot of those who were waiting for beds.

Of course, the immediate solution was to build more sanatoria and to provide more beds, which was done, and in addition to that generally to improve the standards of the whole medical service for T.B. and to provide for the sustenance of patients. But in providing these additional facilities for the treatment of T.B., at no point were we at any time throwing an additional demand on the available beds. The demand was already there. Patients were waiting for six months to two years. All that was done was to try and ease the demand by building sanatoria and at the same time, in so far as those suffering from T.B. were concerned, to try to provide better treatment in the clinics and hospitals and also to provide some form of monetary assistance for them where they had to give up work in order to get treatment. In the present case the picture is not quite the same.

I am not trying to score debating points. I am trying to understand the relative viewpoints of the two members of the House principally charged with the responsibility of guiding us in the matter—the present Minister and the former Minister. In the present case we are told that a certain number of hospital beds are available. As the law stands at the moment, there is so far as the local authority hospitals are concerned and also in regard to voluntary hospitals where an agreement has been made with the local authorities, a prescriptive right on behalf of the lower income group and a more limited right in regard to the insured worker. There were also those of the lower income group who got treatment depending on their ability to pay. As Deputy Dr. Ryan says in many cases there were those in that particular section, where they have got to pay, who were putting off seeking treatment because of the financial cost involved. Immediately we come to Section 15 of the present Act we are going to place these two groups, the farmer group and the £600 a year group, in a position where they will now complete in a much more direct way with the lower income group and the insured worker.

I am not very much concerned with the point made that, in so far as the powers of local authorities to charge for hospital maintenance are concerned, they might prefer to give beds to those who are prepared to pay as against the lower income group. That is largely a hypothetical question and, in practice, I do not think it would affect the position very much, but if local authorities are to operate that section of the Act in a fair and equitable manner as laid down in the Act, they must have equal regard to the claims of insured workers, farmers, the £600 a year group and also the lower income group because they are all placed on a common footing under the Act. The only difference in regard to the three sections is that provision is made for payment in certain cases. They are all sick persons for whom hospital treatment must be provided. If we have a limited number of beds, if we have got already a certain number of people who enjoy priority in regard to those beds, and if we now add two more groups it seems to me that we are not going to make the position easier, to say the least of it. Somebody, somewhere along the line, is going to be left out.

It is all very well saying: "Oh, well, there have been enough beds to meet the demands of the lower income group and of insured workers up to the present." Many of us have spent long hours telephoning hospitals to try to get beds for those even with these rights. If now we are going to throw these two additional groups into the pool with the probability that in certain respects the farming community will have a better opportunity of having their case considered, I think that many of the lower income group are not going to find their present position improved.

Equally when we come to the question of the number of maternity beds available, Deputy Dr. Ryan says that it is not fair to take the position that there are so many beds per year available in Dublin and that as soon as the Act comes into operation, every woman will want to go to hospital. I want to say that in my opinion it would be a lot better if every one of them did go to hospital. I differ fundamentally from the Deputy on that. However, that is by the way. Again there is the question that we have got to have regard to what we have and what is likely to happen. There is no use trying to get away from the fact that in many instances the period of childbirth is the only period during which a working woman gets a rest and the best place to get a rest is in hospital.

Mr. Briscoe

Giving birth to a baby?

Mr. J. Larkin

If Deputy Briscoe smiles, it just shows how little he knows about it. From that point of view I have no doubt that there will be an increased demand on the number of beds. My opinion is no better than anybody else's, but it seems to me that if, after the 1st August, you say to any working woman in the City of Dublin who is going to have a baby: "On the basis of your doctor recommending you should go to hospital, there is there, free, gratis, and for nothing"—because the payment is largely a matter of form—"a bed in one of the best maternity hospitals not only in this city but in the world, expert medical attention, trained nurses to wait on you and, what is more important, if the birth is very difficult, all the possible resources of science to save yourself and the baby" I think you will find a lot of women going to hospital even in preference to a nursing home. That has to do with the problem we are dealing with so far as the postponement is concerned.

As I said earlier, I felt somewhat disappointed listening to Deputy Dr. Ryan, because I frankly felt that if there was any case to be made for the full implementation of the Act on 1st August we would have heard it from him. I do not think we have had that case made. The point I am concerned with, and which I think he was justified in making is this, and I think the Minister should consider it and answer it. If it is necessary to pass this Bill and take power to (1) continue the Public Assistance Act and (2) to give the Minister power to deal with certain sections on a step-to-step basis, at what point do the postponed sections come into operation? That is important, because I doubt if the Labour Party or myself are prepared to commit ourselves to an indefinite postponement. If we do not get a definite date, which may be difficult, I think it should be clearly understood that it should not be long until we get an answer to the question. It may be a matter of months or some time next year, but there should not be a very long delay, because we are not prepared to take the position and to pursue the course that, to my mind, seemed to have been pursued for quite a period by the predecessor to the present Minister, that is to see the Act going on the Statute Book and wait for some miracle to happen to operate it.

Deputy Dr. Ryan took exception to the length of the speech made by the Minister. He suggested that if the Minister had come into the House, like a little boy who picked up a strange toy and did not know what to do with it, and explained that he was in a difficulty and said to the House: "Be good enough to agree to postpone it for a month or two," possibly the Opposition might have been very kindly and said: "Certainly we will give you a few weeks to look it up" I do not know what the Minister's experience is, but I know very well what would happen in this House if he said that—there would not be many pieces hanging together by now. We cannot have it both ways. If we are going to try and deal with the Act on the basis that we have all got a common concern to see it operating, and if the Minister, as a new Minister, finds himself in a difficult position with a need for time to get his hands on the situation and fully understand all that is involved, and we feel that he is entitled to that time, then quite clearly it would be fair to give it to him. It is not fair to suggest that he should walk into the trap of coming in asking for time and finding himself beset right, left and centre with an onslaught, not only in regard to his complete inability and inefficiency to operate the Act, but with the very definite suggestion that he was merely trying to fool the House and delay putting the Act into operation on the plea that he was not familiar with what was to be done.

I think he has pursued the only course, namely, giving as complete a review of the position as he can, placing before the House not only the viewpoint of the National Health Council, the viewpoint of the local authorities, and the advice tendered to him by his officials, but also taking his courage in his hands, because quite clearly that does arise in so far as the political background to this discussion is concerned, and explaining to the House very definitely the two alternatives: (1) that we should operate the Act completely on 1st August and, if confusion and chaos result, then we stand back and say: "That cannot be helped; at least we have kept our word." The Act is then in operation; he has not changed the date from 1st August and, if anything has gone wrong, it is not our fault, it is the fault of the doctors who cannot come to an agreement, it is the fault of the voluntary hospitals, it is the fault of the local authorities who only printed forms, and who were not concerned that they had to operate the Act and, therefore, we have to be content with the matter. Or we can take the other course of having some real concern for the people for whom the Act is intended, whether we be right or wrong at the moment in regard to a revaluation of the situation, to accept that there can be different viewpoints as to how we operate it.

I have heard different viewpoints expressed. I have heard Deputies say that in their particular local authority area they are completely ready to operate the Act in all its phases. At the same time, I have heard other Deputies say that in regard to their local authority area nothing had been done except to have forms printed. If we have got a clash of opinions between Deputies who are members of local authorities and members of the same political Parties as to the preparations for operating the Act in particular areas, does it not seem wise and reasonable that we should take a little more time, not make any drastic or permanent interference with the Act itself, but make provision by which we can look at the situation a little closer, bearing in mind that we are now in the second week of July and if the Act was to operate on 1st August that is less than three weeks away, giving little time to repair any defects which exist, or to check one opinion against another—that we take a little more time on the clear understanding, and I think on the basis of the statement the Minister has made in this House, that as far as he is concerned and, irrespective of the personal viewpoints he has expressed previously, so long as he is Minister he feels charged with the responsibility of carrying out the Act in its full provisions as on the Statute Book without any diminution or reduction or worsening; and that, if that statement is made publicly and at the same time he makes an appeal to this House, as he has done on the basis of the official advice given to him in the Department and on the basis of the reports he has received from the local authorities and his own conclusions from his own examination of the situation, that he would be given this facility to place the different sections more in order of priority subject to his final commitment that he will operate the Act, I think that is a fair and reasonable proposition?

Mr. D.J. O'Sullivan

The Minister has agreed to do that.

Mr. Briscoe

Why not tell us what is in it now? It would make the discussion much easier. The paragraph withheld is of vital importance. The fact that it is not disclosed is misleading to everybody, including the Labour Party.

Mr. Davin

We have our representatives there—probably more reliable than the Deputy's.

Mr. Briscoe

Will Deputy Davin wait until I develop my argument? First of all, with regard to reliability, a portion of the document was quoted here to-day and I have asked that the full document be put on the records of the House.

Mr. M.J. O'Higgins

Did the Deputy read the White Paper?

Mr. Briscoe

The White Paper only contains an extract. We are not children.

Mr. O'Leary

The Deputy is behaving like a child.

Mr. Briscoe

I would appeal to Deputy O'Leary to keep quiet because I am very serious in this matter. Deputy Larkin, speaking on behalf of himself and the Labour Party, made a suggestion in the final part of his speech with which we all agree. We do not ask the Minister to say that it is because of lack of information, lack of experience and so forth that he is prevented from implementing the Act on 1st August next. What Deputy Dr. Ryan asked, and what I am now asking is: Is the Minister prepared to say now that he can give an approximate date upon which the full Act will be implemented or are we to take it that the time limit is, as he himself said, until sufficient hospital accommodation is available?

I am sorry Deputy Larkin has left the House, because I am sure he would agree with what I propose to say now. Assuming we had the facilities in Dublin and assuming these facilities were not available in other parts of the country, is it just that they should be withheld from the people of Dublin because someone in some other part of the country cannot get the same facilities? The Act empowers the Minister to implement certain sections wholly or partly and even, for good reasons, to postpone them in order to give an opportunity of preparing for them. I emphatically state that it is unjust to deprive certain people of the facilities of this Act because those facilities do not exist elsewhere.

Deputy Larkin referred to what he described as the two voices with which officials spoke. The officials advised Deputy Dr. Ryan that this Act could be operated by the 1st July. The officials advised the present Minister that it cannot be operated for the time being. Deputy Larkin is neither innocent nor simple. Both those advices can be quite correct. They are not in conflict. One can operate the Act in certain parts of the country. One cannot operate it in other parts.

Mr. D.J. O'Sullivan

Is the Deputy advocating a few more borders?

Mr. Briscoe

I am glad the Parliamentary Secretary has asked that question. What is being done now by the inter-Party Government is that the sick and the suffering in areas where the facilities exist will be denied those facilities because a border might be created between Dublin or Cork and other parts of the country. That is the answer to that.

Mr. M.J. O'Higgins

That is utter nonsense and the Deputy knows that.

Mr. Briscoe

Deputy O'Higgins has been guilty of publicly uttering more nonsense than any public man I know, and when he is challenged to answer, he never does answer.

Mr. M.J. O'Higgins

I never compete with the Deputy in that.

The Deputy should deal with the Bill and not with Deputy Larkin.

Mr. M.J. O'Higgins

What I think the Minister for Social Welfare is trying to make clear is that the Minister for Health did not make a statement to the effect that the officials gave conflicting advice.

Mr. Briscoe

It is funny when the members of the inter-Party Government can be so confused with each other. It is a simple thing. Deputy Dr. Ryan stated categorically that he was advised by the officials that this Health Bill could be implemented by the beginning of July but that because he wanted to be more than careful he added on a month. The present Minister for Health was asked to-day by Deputy Larkin whether he had been advised by his officials that the Act could not be implemented by the 1st August, and the Minister for Health answered: "Yes", that he had been so advised by his officials. Deputy Larkin referred to this conflicting advice and said that he could not understand it. I hope it is clear now that this did happen, and that that is the position.

What I was pointing out was that if we are all seriously concerned and interested in the development of better health services for all our people, then we should bring these health service improvements as soon as possible to our people, wherever facilities are available or can be made available. They should not be denied to a single individual in any part of the country simply because a similar facility may not be available somewhere else.

I make that proposition, first of all, as an argument against anybody supporting a postponement of the date. Deputy Larkin and Deputy Dr. Ryan asked for an approximate date. Deputy Dr. Ryan stated that, if the Minister for any reason, was prepared to say that he hoped to be able to bring the Act into operation within a reasonable period, even, say, the 1st January next, we on this side of the House, on such an undertaking, would be prepared to facilitate the Government in getting the Bill through all its stages. Deputy Larkin also asked for a date. His attitude was that, if it is not implemented soon, those on the Labour benches will soon start asking questions about it in the House. That will not be of much help to the people for whom this legislation was designed.

Mr. O'Leary

Could the Deputy say how many local authorities have made any provision for it?

What about Limerick? They would not pay the rates.

Mr. J.J. Collins

That is not so.

Mr. Briscoe

The Dublin Board of Assistance do not say that they cannot implement it but that they have no facilities. They say they have no knowledge of the payment requirements. These are the objections to this Health Act from the local authorities, all of whom have discussed this for months and months.

They can go on strike.

Mr. Briscoe

They are on strike— that is the trouble. The trouble is the medical profession are on strike against this Act. They say in that document that because additional facilities have been given to people up to as high as the £500 a year income group their incomes have fallen and this is what they want. I do not know whether the Labour Party all know what is going on or whether those who do know what is going on know all that is going on. I am afraid they do not and I am afraid they are making a very grave mistake against themselves in standing for a postponement of the Health Act. They were party to a long-drawn-out battle in this House in an attempt to bring about better health services for our people.

The Minister gave us calculations and I would like to put on record my answer to the Minister's calculations as one of his reasons why the maternity side of this Act cannot be implemented at the moment. He told us that in Dublin something like 16,000 births occur each year and of that number 6,000 are under the heading of those that would qualify from the board of assistance. We have in the City of Dublin 220 beds available in certain hospitals and 117 private hospital beds, making a total of 337. The Minister forgot, of course, to include the 80 beds that will become available in a few weeks' time at St. Kevin's, but we will deal with the number of points quoted. The Minister said that if you were to average 25 births per bed each year you could figure out how many beds you would require in the City of Dublin if all of those went to hospitals. Let us deal with the 6,000 first. These are public assistance cases and let us assume they all go to hospital and do not have their babies at home. If we have the 220 beds available in Dublin we could barely deal with that number, but then the Minister went on and said because of the excessive demand for beds the period of time which the mother was allowed to spend in hospital was reduced in some cases to ten days and he actually said, in the case of Holles Street, to four or six days. If that is the case we would not need extra beds. I happen to be a governor of a maternity hospital—a very big one—and we have considered this problem regarding the shortage of beds over many years. We have examined it and we know exactly what takes place. The desire of the medical profession is that a woman having her first baby should go to hospital, and if they find it is a normal case with no complications, when she is expecting her second baby if the facilities at home and the circumstances are such as to make it suitable, she can have her second baby in her own home with all the attention from the hospital that is given on an outdoor basis. That reduces the number of beds required.

We also felt it would be better to be able to let the mothers rest for a longer period than is possible at the moment and we started to acquire property and equip it—not as first-class nursing homes—but as additional accommodation for those of the maternity cases which could not be described as serious or requiring constant attention. This can be done very rapidly and reasonably and if by implementing the maternity section of the Health Act it was found necessary to have accommodation—the accommodation I am referring to is birth accommodation for normal healthy people with normal healthy babies— you could have it in very quick time and in a matter of six months you could acquire sufficient houses with sufficient beds and sufficient help to attend to them without any grave inconvenience. We have discussed that on a number of occasions and we have had in fact considerable correspondence with the Department that preceded the Department of Health in this connection.

I cannot speak for the Coombe or for Holles Street but I certainly know from the point of view of what goes on in the hospital of which I am a governor.

Again I have to refer to the fact that if the Minister were to point out to us that his Department still has difficulties, which is a fact, because of the almost violent resistance of the Medical Association to the operation of this Act and that he is trying his best to get them to come to an agreement with him, whereas his predecessor had failed, we would have some sympathy with him. If this Medical Association as a whole realises that now the Minister is accepting the principle of this Act and that he has an unanimous Dáil behind him in attempting to implement it, we would get somewhere. Remember that when Deputy Dr. Ryan was trying to negotiate and was, if you like, fighting the medical profession, there were quite a number of people, who were then on this side of the House, who were totally opposed to the Health Act.

Every time one makes a statement here of truth or fact we are told it is not quite like that. The Corporation told the Minister, unless you arrange conferences soon we will be unable to operate this on 1st August and if you do not arrange these conferences soon you will have to postpone the date and not have us in trouble. That does not say that they do not want to work it. I want that to be clear on the records of this House and clearly understood by the Deputies who represent Dublin in the Dáil, because every one of them knows that these benefits under the Health Act are seriously wanted in Dublin. I meet some of my constituents every day, as I am sure the other Deputies who represent Dublin do, and I guarantee that every one of them has been asked: "Why are we not getting the maternity benefits". The £600 income level man could not understand why he was not getting it while other people were getting it. It should be explained to them that those who are on public assistance get this maternity benefit at the moment and that if it were implemented on August 1st the rest would get it. It is not going to be implemented now. There is a great deal of dissatisfaction about it.

The Minister said he was now accepting, in principle, this Health Act, but he used an escape phrase, that he was going to operate it in all its phases except in so far as it may be in certain parts considered to be in conflict with ethics. What they are I do not know. Does the Minister mean the ethical side from the medical point of view?

Mr. T.F. O'Higgins

If the Deputy does not know I cannot help him.

Mr. Briscoe

Perhaps the Minister will make it clear. Certainly that will be something which will be used afterwards and we will be told: "I told you at the time that that is what I based it on". I know that the Irish Medical Association or its official representatives are very hostile to the Act and will be very happy and will say, like the leading Dublin surgeon said at a recent meeting of the Medical Council: "The election is on. Fianna Fáil will be beaten and when they are gone, gone with them will be the Health Act". That is the view of the medical profession. I hope Labour will not be disappointed; I am sure they will be. They are doing a very dangerous thing in agreeing to the postponement of the Health Act.

Dr. Esmonde

We are this evening discussing health legislation because the 1953 Act was forced through both Houses of the Oireachtas by the Fianna Fáil Party and those associated with them. At that time, from the Fine Gael benches we pointed out that we had not the hospital accommodation to deal with an Act as wide and as ambitious as this, nor had the Minister any agreement with those who were to work the Act. In spite of that, the Act was passed. The Minister for Health when he took office—I wish him the best of luck in his office; it is a difficult one, but he is an able man and I am sure he will be a fine Minister for Health—found what we suspected, that no arrangements whatsoever had been made to deal with the many problems that arose as the result of this ambitious legislation. The Irish people require fresh health legislation and they have been waiting for a considerable period for legislation that would be effective. But for many years I cannot see that it will be possible for this country to implement the 1953 Act. I have listened to speeches from across the House and I should like to say that in my opinion there has been a good deal of muddled thinking. I heard Deputy Briscoe stating that Dublin is waiting for the legislation. I accept the fact that Dublin is waiting for health legislation, but what Dublin wants is health legislation that will be of some benefit to the Dublin people, some practical legislation. They do not want this sort of stuff on paper which produces nothing.

I will deal first of all with the maternity section. The Minister told us that there are 16,000 births per annum in Dublin. I do not think that any Deputy will deny that the hospital accommodation available is 337 maternity beds. The ex-Minister, Deputy Ryan, agreed that the hospitals are full. If we do not change this legislation it means that everybody in Ireland is entitled under the Act to equal rights. Deputy Dr. Ryan says that the hospitals are full. We agree with that. In case some Deputies are doubtful about that, I should like to give some statistics in regard to the National Maternity Hospital, one of the leading maternity hospitals in Dublin. That hospital has 142 maternity beds; 31 of these are used for ante-natal work; 103 are used for post labour; eight are used for isolation. These are the statistics for 1952, which are the latest available. They admitted 5,220 cases and the deliveries numbered 4,638. I should like to add that these maternity hospitals in Dublin are not only dealing with Dublin cases but with cases all over Ireland. They are up-to-date hospitals, having the latest equipment and facilities available. They have to keep beds available to deal with emergency cases which may come in from all over the country. The hospitals are already full. It was stated this afternoon that these hospitals are unable to keep the maternity patients for the specified period, which is ten days. The average case has to be shifted sometimes after six days and sometimes after eight days. That is the position in the City of Dublin. Yet Deputies opposite are crying out for the implementation of these health services. Then I come to my own constituency of Wexford. The population of Wexford is approximately 91,000. There are 21 maternity beds available for the County Wexford for a population of 90,000 people.

Mr. McQuillan

How many of the 90,000 would be having babies?

Dr. Esmonde

It is suggested that we should implement this Act. There has not been one extra bed provided in Wexford or, as far as I am aware, in Dublin, except in St. Kevin's Hospital, since the discussion on health legislation started. So much for maternity work.

The other services are the specialist services. We will offer free specialist services to a large body of our people all over the country. I presume that Deputies will accept that a doctor in practice must know something about these things. I have had to wait recently for three months to get a patient into a hospital in Wexford for a very simple, but very necessary, operation. I admit it was not a case of an acute emergency, but the operation was essential for the health of the patient. I was not the only doctor who was waiting three months; all over Wexford there are other doctors waiting three and even four months. My patient came from what is commonly called the lower income group.

We are now proposing to open these services freely to all sections of the population. That is what the Act offers and the Minister had no alternative but to do what he did to-day in all the circumstances of the situation. It would be impossible to implement the Act, and right well the Deputies opposite know that. They know that perfectly well and they are standing up and arguing to save their own faces. We told them long ago that this Act was unworkable.

Mr. Killilea

The Minister has not said that at all.

Dr. Esmonde

Not one argument has been produced this afternoon to show that there has been any increase in hospitals or in the facilities available.

Mr. McGrath

The Deputy is at least consistent anyway.

Dr. Esmonde

The Minister in the course of his remarks pointed out that the danger in the Health Act of 1953 was that all sections of the community would have equal rights—in other words, equal rights to treatment and to facilities in hospitals. Is not the one thing we all want to see in this country equal rights for all our citizens? The sooner we get away from the poor law mentality, the poorhouse mentality, the red ticket and the white ticket mentality, the better for this country and the sooner we stop this degrading business of segregating our people on the basis that one man has £5 a week and another man has £7 a week and the man with the £7 a week is a different type of human being from the other, the better. We all in this House, I hope, want to see the stage where there are equal rights for all our people not only in regard to health but in regard to education and all the other provisions.

A mystery that I cannot solve is that the Minister says there is a danger that there will be equal rights for what are known as the public assistance groups—and I have to call them that because that is the term used to describe them—and for the middle income groups to take advantage of our hospital and institutional services. At present, where are these other people being treated that the Minister fears will rush the present facilities? In what hospitals or institutions are they being treated at present? Is not it a fact that, although our hospitals are crowded at the moment, cases are dealt with? Is it the Minister's fear that there will be an on-rush to these hospitals now to take up the available beds and that the man with £500 a year and the farmer whose valuation is £50 will rush into the hospitals and, through influence on the local county council, throw the public assistance group patient out of the bed and say: "Get away. I am paying more than you are"? Is that the Minister's suggestion?

We are on an interesting point and I am sure it is something that will worry those people inside this House and outside it who have always maintained that the biggest snag in the Health Act is the load it will put on the rates.

There was a regional conference in Sligo a couple of years ago to discuss the Health Act. There was no trouble at all. It was considered very desirable but the question was why could not it be put on the Central Fund, why should the rates have to pay for it? After a while, when it began to sink into the minds of public representatives in the western counties, they found it would be of benefit to the farmer with a valuation of less than £50. There is a total of 370,000 holdings in Ireland. Almost 300,000 are under £10 valuation and, of that number, 110,000 of these holdings are in the province of Connaught and the three other congested counties. Were not Connaught and the three other Gaeltacht counties going to benefit under the 1953 Health Act? Let us see what is taking place now. Unless they come within the category of the public assistance group, all the small farmers in the West of Ireland are to be deprived of the benefits of the 1953 Health Act. While that is going on, we find that those who were formerly catered for by the Department of Social Welfare, insured workers, are being transferred to the Department of Health and that no charge will be made for these insured workers for hospital treatment provided their income is under £600. Consequently, the rates in these western counties will now bear the burden of paying for the insured worker while the small farmer, who is not in the public assistance group, will have to pay his rates to provide the services for the insured worker. I do not for a second want to be taken as being against the insured worker getting the hospital treatment.

Mr. D. Larkin

You are on the wrong track.

Mr. McQuillan

I want to see that the small farmer in the West of Ireland is include in the legislation. He does not happen to be organised and to have funds and trade unions behind him and he is dependent on the T.D.s to look after his interests. That is why he will be forgotten and that is why he is forgotten. It is a pity we have not the same opportunity to organise there as the trade unions have. If we had, there would be many new faces in this House.

All the Ministers who introduced Estimates said: "We had not time to examine the administration of the Department." Each one of them pointed out that the Estimate was prepared by his predecessor and that he knew nothing about it whatever, that he was only getting into the run of the Department. The one Department that anything seemed to have been known about or that any study was made of immediately is the Department of Health. Could not the Minister say, if he has not had time to go into the full details and implications of the Health Act: "Give me authority to postpone the implementation of this Act until August, 1955. Give me 12 months clear"? Could not he say that plainly to this House so that we could then have further discussion and, if it was decided then to make changes, we would know what was going to happen and would be prepared to take a stand?

The position is that once this goes through it cannot come up again for discussion on the basis on which we are attacking it here to-night. It will mean that the Minister's argument that facilities are not available can be used as an excuse to postpone well after the lifetime of this Dáil the implementation of this Act and we cannot blame the Minister as an individual and as a member of his own Party. That is what is troubling me.

Another Deputy has pointed out that when the benefits for people suffering from T.B. were given and when the big drive was initiated for tackling T.B. in this country, if the same mentality had prevailed as seems to prevail now in relation to health we in Roscommon would be still waiting for the building of a sanatorium in Merlin Park, people would still be waiting for beds all over Ireland and people would be dying fast of this scourge. There was no waiting at that time. There was a cutting of the red tape. All the facilities were not available at that time, but because there was an urgent need, an energetic drive was made and the Minister had the privilege of reading to this House the improvement that has been achieved and the decrease that has taken place in the death rate from T.B.

It is all a matter of how we look at it. If we come into this House with our minds in favour of useful legislation to promote the health of the people and under Acts that have already been accepted by the people, then we could get this Health Act to work. I want to say this to the Minister for Health: I do not say for a second that Deputy Dr. Esmonde who spoke has the agreement of the Minister for his statements here. If I felt that, I think there would be no hope with regard to future health legislation.

Towards the end of his speech the Minister pointed out that he was accepting in principle the 1953 Health Act. I would like, when he is replying to this debate, if he would tell us how long the postponement is going to be? Can he give us a fair idea of when he is going to implement it? If he cannot do that, give a fixed time or a flat date for the coming into operation of the services for all parts of country, the least he can do is to tell us when he can find alternative means to enable those local authorities who are now able and willing to work the Health Act to go about it immediately.

Seosamh Ó Cinnéide

Tá brón orm nár chuala mé an chaint a rinne an Dochtúir Esmonde ar an mBille seo. I am sorry I did not hear the official Fine Gael view of this Bill from Deputy Dr. Esmonde. It should be very interesting but from the remarks dropped by Deputy McQuillan, I do not think it was very helpful towards the implementation of any part of this Bill.

In the memorandum to this Bill in paragraph 5 it says:—

"In regard to the services provided for in Section 15 (Hospital and Specialist Services) and Sections 16 and 17 (Maternity and Infant Services) the Government are satisfied that in the absence of (1) the necessary agreements with the professions and hospitals concerned, (2) adequate financial provision and administrative arrangements on the part of many health authorities, and (3) necessary facilities otherwise (e.g., hospital and other institutional accommodation and specialist personnel), it will not be possible to bring into operation for the present all the services contemplated in the sections for all the classes enumerated and that to attempt to do so on 1st August next, as provided in the Regulations, would cause confusion which would result in serious hardship for the classes—particularly the lower income group—already entitled to corresponding services. These are the classes least able to bear such hardship."

I do not want to argue too much but I am just as persistent as the Minister that the Medical Association in Britain vetoed it but the British Government put it into effect. I have relatives of my own over there and they are better Christians than I am and good Catholics and they are delighted with the Health Act. Their children are seen to and looked after and they have nothing but the highest of praise for the British health services and the sooner those services are in operation here the better.

I want to come to the point made by Deputy McQuillan. What makes me intervene in this discussion is that I represent the small farmers in my constituency. The statistical experts agree that £1 p.l.v. represents an income of £12 and taking the agricultural community, will any of the Labour members who are so glib in supporting the postponement of this Health Bill, put themselves in the position of the small farmers of £10 valuation which would mean that they would have to live on an income of £120 a year and try to raise a family? They would not have even the wages of an ordinary road worker. Are there any of us who sit on these benches or on the Labour, Fine Gael or other benches, who have not been pestered week after week with bills from hospitals, specialists and anaesthetists, brought by those unfortunate people who form a large cadre in our population? As Deputy McQuillan pointed out according to the Statistical Abstract there are some 337,000 farmers and of these 223,000 are on £20 p.l.v. or less than that. They would have an income of £240 a year. Deputy McQuillan is aware and every Deputy in the area that there is not a meeting of Roscommon County Council of Westmeath County Council, or of Longford County Council but that some unfortunate man comes to them saying: “I have a bill for ten guineas” or “I have a bill for £17 10s.” Then, one has to plead with the manager to reduce it. These people are now definitely being debarred from the benefits of the Health Act unless the Minister can give us an indication of the particular date on which certain sections of the Act, now postponed, will come into operation.

We are supposed to be one of the richest counties. This country is poor, as a whole, and in the County of Westmeath there are 3,189 small farmers who are not employed on roads or anywhere else and have valuations from £4 up to £20, and they are excluded. In County Longford in the same category there are 3,967 small farmers of from £4 to £20 valuation.

They are nobody's baby: they are not organised. The mentality to-day is to have the big estates again and to let the small farmers be absorbed with groups of cottages around these big estates. It is because the Fianna Fáil Party represent that type of individual that we are 65 strong in these benches, and it is because we will continue to represent them that we will come back with a majority over all in the next election. We are going to see that these people will not be denied the services they are entitled to under the Health Act, 1953.

A case can be made for valuations of £20 to £50, but whatever may be said about postponing the extension of the benefits of the Act to that category, which is included in the Health Act, 1953, there is no defence for excluding the men of £20 valuation and under.

Deputy McQuillan referred to an insurance scheme and surely it is pertinent to refer to it here, because the Leader of the Labour Party ten days before the election when asked about the Health Act said he believed in an insurance scheme. Imagine going to these people who have, maybe, three sets of pigs in a year and nothing else, and trying to collect insurance from them. Surely that is an Alice-in-Wonderland idea: it could not be done in a country like this. And now the operation of the Health Act is to be postponed.

I take the Minister on the value of the statement he made here to-day and I know that in my constituency he has behind him the people who voted against any money being given for the health services this year. They entered a direct negative but we voted against it and carried our view.

So far as my county is concerned, we are anxious and willing to put the health services into operation. These are the particular points I wanted to make this evening. I again emphasise that it is the small farmers who have no free boots, who have not even a cow, who have no free milk and who have no other source of employment, that we should try to assist and keep in the country. They are people such as are described in the story of Knocknagow, people of the type of Matt the Thresher. Unfortunately they are people the majority of whose sons and daughters have to emigrate because there is very little work for them. If we are to keep them on the land, we must see to it that they have the social amenities that the trade unionist has. He has his charter of liberty in his insurance card. He has got that guarantee of citizenship; he is protected from want and every hardship. Now it is time that this Assembly, representing I would say over 1,000,000 of these people, should see that they get the health services which they require. I put it to the Minister with all due respect that he should specify the date on which this Act will come fully into operation, and that where it is a question of the health of our people—of fathers, mothers and children—the lives of these people are far more important than all the doctors in the world.

Mr. James Tully

If the subject under discussion were not so serious, it would be amusing to listen to the efforts made by some Deputies to tell the House that they represent the small farmers of the country. Having regard to some of the legislation passed and some of the things that they have done in the last few years, I do not think that it can be said that their actions in the past bore out what they say this evening.

Mr. McGrath

Tell us some of them.

Mr. James Tully

I come from a country district and I, too, claim to represent the small farmers even though I am a trade union official, and even though organised people support me. I do not think that because I am a trade union official and because organised labour supports me, that is any reason why I should not claim to represent the small farmer and why they should not trust me also. I would be very glad to see the Health Act fully implemented. We, of the Labour Party, feel sure that it will be implemented in the very near future. We can assure those who are offering us advice to-night that we shall see that it will be implemented at the earliest opportunity.

It was very funny to hear Deputy Briscoe tell us that the medical profession are on strike and then saying that the medical profession would have to implement the scheme. Does he suggest that the proper time for a business to expand is when all the employees or all the people working that business are on strike? That is actually what he was suggesting. I am sure it would be difficult enough even with the goodwill of the medical profession, to work this scheme. It can be worked and it must be worked despite what Deputy Esmonde said but we cannot possibly expect that to happen while there is no agreement whatever made with the medical profession. Before the former Minister for Health went out of office, he did not worry very much whether that agreement was made. He did not worry whether the doctors were prepared to stand on their toes on the 1st August or whether they would go on strike.

I do not know whether some of the Deputies speaking for certain counties can say in earnest whether these counties were prepared to put the Act into operation fully on the 1st August. I feel sure that most counties and local authorities are very anxious—as Christians they should be very anxious —to improve the health services of the country.

I know that I was in the county hospital in Meath three or four days ago— I can say, in fairness to the medical staff there, that they are doing their very best—and the beds were heads to points. More patients than you would imagine could be fitted into that hospital were being accommodated there, but where the extra number that would most likely come in after the 1st August, if the Act were implemented then, were going to be fitted in was a mystery to me. I think it is very wise of the Minister to postpone the full implementation of the Health Act rather than have the state of chaos which would almost certainly result in these counties where proper provision was not made for the implementation of the Act.

I am afraid there is no use in the Fianna Fáil Party trying to put the onus on the Labour Party for what has happened. I think they, and particularly the former Minister for Health, must bear their full share of the responsibility, because if the former Minister did his job properly there would be no need for letters to be written from the Dublin Corporation, a few weeks before the Act should come into operation, asking for a full discussion as to how things should be done. All these things should have been done in advance. There was no excuse whatever for leaving it until the eleventh hour, because by doing that I believe the chance of a smooth change over from the present conditions to the new conditions of the Health Act were gravely imperilled. I believe that the Health Act must be implemented, and implemented soon, but in fairness to the present Minister I must say that when he found the position as he did find it, it was only right that he should be given an opportunity to set things right before rushing in and doing something which would injure the health of the community rather than improve it.

Mr. McGrath

The interest that Fine Gael have in the Health Bill must be apparent to anybody up in the gallery or down here in the Chamber. We had the Minister himself sitting on his "lonesome" all through the evening and—I do not blame him for going out now—we have no Fine Gael member at all in the House at the present moment. We had practically the same condition of affairs during the long weary months of obstruction of the Health Act when it was before the House as a Bill. As I say, I do not blame the Minister for going out a short time ago, because he has been here all the time on his own for a considerable period this evening. He had only one Deputy behind him for well over an hour.

In the same way during the passage of the Health Act, we had three Fine Gael members present in the House watching their turn and doing their best to obstruct its passage—Deputy Esmonde, Deputy Mulcahy and Deputy MacEoin. They got up one after another to obstruct the Bill.

Mr. O'Leary

As you are doing now with the present Bill.

Mr. McGrath

Now the Minister says that he has accepted the Act. Of course, he is accepting the Act, because if the Labour Party are going to support the Government to pass the Bill now before the House, the Health Act will never come into operation. The Bill which we are now discussing will mean the abandonment of the Health Act. There is no such thing in this Bill as the provision of a precise date on which the Act will come into operation. It is simply put forward on the Kathleen Mavourneen system: "It may be for years and it may be for ever." In my opinion its postponement is more likely to be for ever. I have had experience of three and a quarter years of inter-Party Government before where Deputy Norton, the then Minister for Social Welfare, was always talking of his Social Welfare Bill but, until they were going out of office, he never made an attempt to put it through the House. In the same way the present Health Act will never be implemented. The excuse given by the Minister was the flimsiest I ever heard in my life. I put the question to him when he was concluding his opening statement: "What position would we be in now if the legislation brought into this House in 1947 was not implemented?" Would he have been able to read out on his Estimate yesterday about the reduction in the deaths from T.B.? Does he not know that only for the courage of Dr. Noel Browne, when the inter-Party Government came in, in working the Act brought in by Deputy Dr. Ryan there would have been many more graves filled in this country and that the people would not be in the position in which they are now of knowing when they are going into hospital with T.B. that practically every one of them will be cured? Dr. Noel Browne said that he would give the benefit of that Act to as many people as he could.

That is what we want now, to give the benefit to as many people as we can through this Health Act. The Minister admitted that everybody who was sick or was in need of medical assistance was able to get accommodation. We do not want people to continue coming to us as local representatives begging us to get their hospital and doctors' bills reduced. In many cases people have to raise loans to pay these bills. An insured person may have a wife and children and he has to try and pay for them. They are not included in the insurance scheme. Many trade unionists come to me to try and get their bills reduced. When an insured person goes beyond the six weeks' treatment in hospital provided for, he will not get the benefit under the insurance scheme unless he comes out of hospital and then goes back again. I know people who left hospital and who were definitely unfit to come out, but they wanted to be readmitted in order to come under the insurance scheme. These people and their children will continue to suffer.

As to the local authority hospitals, in St. Finbarr's Hospital in Cork if a person goes there to be treated and afterwards says he cannot pay, the home assistance officer will go to his employer and to his children's employers to find out what they are earning. The Labour Party wants that to continue and will vote for it to continue despite all their protestations here during the passing of the Health Act. They said it was not good enough. Up to this the representatives of the Labour Party on the voluntary hospitals supported us against Fine Gael in approving of the 1953 Act. But now, apparently, in order to keep some members in the Cabinet they are going to swallow this Bill, hook, line and sinker. They did that before. These people who talked about the poor man being as well entitled to health services as the rich man, during the election in Cork and elsewhere said that there were to be free health services for everybody, for the people who could afford to pay and the people who could not afford to pay. They are now going back on their promises. I would not mind if we were told that at some date in the near future there would be an attempt made to implement the Act. This is simply abandoning the principal feature of the Act, the provision of hospitalisation for our people. It is abandoning that completely and the Labour Party know it and they are swallowing it.

Deputy Tully stated that the Minister should come to an agreement with the doctors first. I am sure the Labour Deputies know of the attempts that were made to come to an agreement with the doctors in regard to the 1953 Act. Are we going to wait until we come to an agreement with the doctors, until there are beds available for everybody, and until the last bed is provided? That is what I gathered from the Minister's statement at any rate; that he was not prepared to take advantage of the beds that are there, that he was not prepared to give the people who are occupying them, or who will be occupying them in the near future, the benefit of the Health Act. He is only going to do it when there is a bed available for everybody who might get sick. If that is his attitude, is it not clear that this Act will never be implemented? Do the Labour Party not know in their hearts that it would never be implemented? Why do they not say: "We will give you six months or even 12 months"?

Mr. O'Leary

You did not do it in 20 years.

Mr. McGrath

We did more than anyone else. There was no money better spent in this country than the money spent on health services. People's lives were saved. Even if the people in Dublin did not appreciate it, the people in Cork and elsewhere appreciated the work done by Dr. Noel Browne. It is a disgrace to the people of this country that he was not returned again to the Dáil after the work that he did. Every Labour member in Cork knows what he did.

An Ceann Comhairle

What Dr. Browne did or did not do does not arise on this Bill.

Mr. McGrath

The Minister stated that there were not enough maternity beds in Dublin or elsewhere. What does he think will happen if he does not implement the maternity sections of the Act and give the people an opportunity of obtaining the benefits and choosing the doctors they want, even if they have to be attended in their own homes? Does he think the people are not going to have children? The children will be born anyway. Would it not be well that these people should get the treatment which the Labour Party were always spouting about. Would it not be well that they should get that treatment whether at home or in hospital and let us go on providing the beds as quickly as we can? We have provided 50 extra maternity beds in Cork within the last few years.

The Minister said that nothing had been done to implement the Act, that the former Minister did not go around to meet the people concerned. The Minister went to every local authority in the country. He sent representatives of his Department to the voluntary hospitals and we had conferences with them. He did everything in his power, as he said, until the election came along. What has been done by the present Government or what are they going to do? They are going to abandon completely these sections which they mentioned. The Labour Party know that and they are going to vote for it and let the people of this country die for want of the services which could be provided for them.

Mr. Maguire

The discussion on this Bill has been rather confusing, at least to one who is not so well versed as Deputies who took part in the previous discussions relating to this matter. We hear now that the anxiety of all Parties to provide a good and satisfactory Health Act to meet the requirements of the community has had an unsatisfactory kind of reaction.

It has led to what is sometimes called mal-de-tête or headache. Responsible Ministers who took this problem seriously in hands in the last eight or ten years have got a very poor reward for the efforts they made. They got everything but a satisfactory solution. It appears that this will continue longer. This evening the Minister stated that there was not enough hospitals to deal with the number of patients who were likely to make application for such service. That in itself is a bit disconcerting. It also indicates something very seriously wrong in the general administrative powers of Government Departments for not making the necessary provision long ago.

This Health Act has been under discussion for so many years that I cannot understand why any responsible department under any Government would fail in their duty to put before the local authorities all the information required for the administration of their part of the Act in carrying out the scheme. Yet the Minister this evening read out a list of public bodies to whom he had made reference to deal with the Act which is to come into operation on the 1st of August. Some of these bodies put forward the explanation that they did not know what way their duties were to be carried out. I do not believe that that information was withheld. It would, indeed, be a serious reflection on the ordinary elementary intelligence of those responsible in the Department not to advise the people in the country responsible for the carrying out of the details of this scheme. It must be held that either the officers in the Department were at fault or else the officials in the country were at fault. Strange to say, some of the local authorities did declare their willingness and their readiness to operate such a scheme. That showed that either they must have special advice which other county council bodies did not receive or that they had more intelligence in advance and went along the road. That statement by the Minister is very conflicting and is not convincing. It is a matter that should be cleared up in order to make sure that there is efficiency and co-ordination between the different parties in this State who endeavour to carry through a national plan regarding health or any other scheme.

If the present Minister is satisfied that we have not enough hospitals to deal with the number of applicants under this new Act, then must we infer that we have to wait until new hospitals are built and new accommodation provided? Any of us who have any knowledge of hospitalisation and the building of hospitals know that it is a very tedious and slow programme. In my part of the country we have sought the erection of a much-needed hospital and it was only at the end of 20 years that the job was started. It was a few years later before it was completed.

If the Minister wants to be convincing he should tell us when the date is fixed and the volume of work to be carried out before he can implement the scheme in its entirely. After all the years of building hospitals, in my part of the country in the last few months the Minister's Department seriously considered closing a hospital. We were practically told that the hospital was to be closed and demolished. Now the Minister admits that we have not got enough hospitals in the country. Where is the intelligent working in his own Department of which he is now the head if we are told we have too many hospitals and a few weeks later it is discovered and announced in this House that we are unable to put through this necessary Health Act because we have not got enough hospitals? Surely the Minister has enough evidence from the statement he made here that his Department needs some regulating and some co-ordination that will give efficient work and satisfy the public not for a few months of the year but consistently? Their plan should be to regulate and regularise the hospital requirements in the State and not to be saying they will build a hospital this year with so many beds to accommodate so many people and discover at the end of the year that they should have extended the hospital and provided more accommodation and beds. The whole thing is disconcerting.

Surely there should be some working agreement arrived at between those responsible for carrying out the operation of the health scheme—the doctors, nurses, chemists, dentists and others? If a period of one, six, or 12 months was suggested in order to bring about a desirable understanding between all these interested parties, then the Minister would be entitled to ask for a postponement in order to get the matter decided.

Hospital accommodation should be made available in the country to a sufficient degree to enable people to be treated without their having to come up to Dublin hospitals. Proper housing conditions should be provided. Proper food should be provided and we should try to eliminate the necessity for hospitals. Prevention is better than cure. Give us better housing conditions. Give us enough wages to feed our families sufficiently well. Let us give our children nutritious food. Lectures should be given to the various organisations in country districts and facilities for lectures from competent nurses and doctors should be given to the Countrywomen's Association. We should endeavour by all means to educate our people. We should provide them with the means of feeding themselves properly and building up strong healthy children.

Let us get rid of the idea of hospitalisation. It is a decadent outlook. We should prevent the necessity for hospitalisation and the only way of doing that is to feed our children properly and provide families with a proper wage to enable them to do it.

If we do that and give them suitable lectures on ideal living conditions in the home I believe we shall get better results than by spending large sums of money on the erection of new hospitals and the improvement of existing ones.

One of the evils which we suffer in regard to the matter of hospitalisation is the cry we frequently hear in rural areas: "Send the patient to Dublin." That, in turn, involves an expansion of the hospital facilities there. The real test of the state of health of our people is the frequency or infrequency with which they have occasion to consult a doctor. In my view, money should be spent on providing infants with the very best start in life from a health point of view and it should be hardly necessary for me to stress the importance of good home care. They are the methods which I would advise to help to bring about a strong and robust nation, and I should postpone Health Acts and suspend the expansion of hospitals in order to direct money towards that work. When I make these remarks I should like it to be understood that I am just an ordinary observer of conditions up and down the country. I am convinced that the State will get far greater benefits at less expense by building up a virile race than by expending hospitals and that sort of thing.

There are some sections in the Health Act of 1953 and, in my view, there is no necessity for delay in implementing them. We are all only too well aware that there are many disabled persons who have been disabled since birth or who became disabled through illness and these persons are forced to live at home and depend on their families to attend to them as they are unable to attend to themselves.

No provision is made for such people although they themselves are very conscious of the fact that they are a burden on their families and, in many cases, their parents are not able to attend fully to their requirements and that creates a double hardship, a hardship on the disabled person and a hardship on the parents or families because they are not able to do the things for the disabled person that they would like to do. Why delay treatment for that section of the community which, I feel, has been more neglected than any other section. The Minister should state that he is prepared to put that into operation, as an extension of hospitals is not necessary to enable such work to be done. If it is not possible to start it immediately, the Minister should tell the House a definite date on which that particular section of the Health Act will be put into operation.

People were led to believe that on the 1st August, 1954, certain sections of this Act would be put into operation. The public have been deceived for the past nine or ten years in their expectation of the implementation of a Health Act. Successive Governments were most vigorous in pushing through health legislation and yet, again and again, its enactment has been deferred. Can it be that the health services would be too costly for our country? Indeed, it may be that the delay is nobody's fault. If money is the trouble, the Government should be honest and tell the people that they are not able to finance the scheme to the extent planned and stop deluding sick people who, month after month, are awaiting the relief which they pray for and which they need so badly. Let us tell them once and for all that we cannot provide these services to the extent we would like because we have not the means to do so and let us stop playing politics with the ill and the needy because, as far as I can see, that is the danger.

Dr. Hillery

The last speaker's desire for a virile race which would be able to do without health services of any kind sounds like the dream of several Ministers for Health who have grown grey hairs in trying to get an adequate health service for our people. Like health services, the medical profession itself has grown to meet the needs of the people at large. It is doubtful if, in our time, we shall achieve such a virile race as can do without these services. It is that active consciousness of the need for health services for all our people that most members approach this present Bill.

Paragraph 5 of the Explanatory Memorandum which was circulated with the Bill suggests that it is necessary to postpone Sections 15, 16 and 17 of the Health Act, 1953. These sections provided for hospital and specialist services and maternity and child welfare services for those sections of the community which are in need of them at the moment, namely, the middle income group in the main.

The present Minister is and has been an unrepentant opponent of the Health Act of 1953 and, indeed, of any progressive legislation. Before the last Dáil was dissolved, and since then, he carefully kept himself to the front of those people who opposed this progressive legislation. It is natural, therfore, that when this Minister introduces to the House a Bill which would postpone indefinitely the implementation of the enactment of 1953, we should suspect that this postponement is a first step towards abandoning into the vague future the services for which people on this side of the House and the Labour Party at one time voted together because they thought they were essential to the people. It is for that reason that I will ask the Minister now the same question as has been asked by other members, and especially by Deputy Larkin. If the Minister intends this to be merely a postponement, will he now name a date or, failing a date, will he name a certain set of conditions which must exist before he will implement the Act of 1953? Deputy Larkin says he must get that answer and that he will ask parliamentary questions in order to get that answer.

Deputy Larkin knows as well as I know that parliamentary questions can very easily be answered, laughed at and jeered at—especially when they are pertinent—and that a short storm will see the end of the embarrassment to the Minister concerned. Deputy Larkin knows that if we are depending on parliamentary questions to the Minister to urge him to name definitely the date of implementation we are facing a time of vague answers such as we have been accustomed to from the Leader of the Coalition about ideal medical services but a complete shunning of practical medical services.

Deputy Larkin has one chance of getting an answer to his question and that is by asking here and now for a definite statement in regard to the date of commencement of the implementation of the Health Act of 1953 and, if he does not get it, to vote against this Bill. That is the line I am taking. If the Minister gives a definite date for the commencement of the 1953 Act, I shall be satisfied. If the former Minister could make an Order for the commencement of certain sections of that Act, he must have been advised that it was possible to do so. If, at this time, the present Minister finds it impossible to implement the Act on the date appointed, surely he should be able to predict, from the same source of advice, a rough date on which the provisions of the Act could commence to operate. He should know, roughly, if we can expect the implementation of these sections within six or 12 months. I should like, especially since we are dealing with the Fine Gael Party, to have something more definite than a promise. I would like a definite enactment stating the time, and I am sure that Deputy Larkin would feel far less uncomfortable than he seemed to appear if he got that answer this evening and did not have to wait for future questions.

There are three main objections here to the implementation of the sections of the Act. One of them is that the necessary agreement with the professions has not yet been reached. The Minister must get it into his head now that if he waits to implement health legislation until he has agreement from the medical profession he can wait for ever. It is throwing away, not alone his power but his responsibility as Minister. It is washing his hands of his responsibility, if he waits until he gets agreement from the medical profession to implement the Act. They do not want the Act. They told me that it would never be enacted. Some of the members told me that with the change of Government this would not be enacted. If the Minister thinks that we will accept his statement that it cannot be implemented without their agreement it is tantamount to saying that it will not be implemented at all, because the medical profession in the country will be opposed to such legislation as the Health Act, 1953.

Mr. T.F. O'Higgins

Would the Deputy tell me the alternative?

Dr. Hillery

The alternative to what?

Mr. T.F. O'Higgins

To getting the doctors to agree.

Mr. Killilea

In that case it is not going to come into operation at all.

An Leas-Cheann Comhairle

Dr. Hillery.

Dr. Hillery

It must be obvious to the Minister or to any man working in this country that you do not have to deal with a particular section to get agreement to implement the Health Act.

Another objection stated here is that the necessary personnel are not available. I can assure the Minister that waiting in London and other parts of England at this very moment there are hundreds of highly qualified young Irishmen longing to get back here. He will not be short of personnel if he advertises for them. The same thing holds in any branch of the service he goes to.

The main argument put up against the implementation of the Act is the argument which was put up the first day against the legislation. It was argued that the Fine Gael Party were opposed to the legislation because there were not enough beds. There was not enough accommodation. That is the argument we have to-day, it is the argument you will have in a year's time and in ten years' time. You will always have that argument. Implied in it is something which I cannot accept, that there are people in the country at the moment not getting these services. It is implied also that if you leave the present accommodation open to the middle income group they will so flood it out that people in the lower income group will suffer. If the people in the middle income group at the moment are doing without services, and if these services were made available to them, they have every bit as much right to the services as the people in the lower income group.

There are two forms of injustice. It is an injustice to give a man medical services if he can afford them while at the same time not to give them to a man who cannot afford them; but it is equally an injustice to give medical services to what they call the red ticket persons and deny them to farmers or other middle income group people. If the Minister and his supporters in the Labour Party and other places think that it is saving trouble to preclude these middle income people from attending a hospital they are putting a means test on it.

It is a means test in reverse—the man who has a certain amount of money cannot get service, and the man who has no money can get it. I suggest to the Minister that it would be far more just to allow all those people to have access to the hospitals and let the surgeons and people in charge of the hospitals assess their cases. Let the test be a medical test. Let there be a waiting list and let there be delay, but let the surgeon or whoever is in charge assess each case, pick cases sent in for treatment and let them have treatment according to their medical needs, not according to their lack of money or to the amount of money they have.

It is just as wrong to say that the man without money must get services and let the man who has some money do without them as it would be to let medical services be given to people with money and let the destitute go without. If we want justice at all we should give everybody an equal chance and leave our services, such as they are, open to everybody.

I do not believe altogether that we have not the accommodation, particularly in relation to Sections 16 and 17. In County Clare at any rate our obstetric arrangements are such that between domiciliary midwifery and hospital midwifery the patients are so divided that the hospital beds go to those who find it necessary to go to hospital, and nobody in my experience has been refused admission to hospital in Clare in an obstetrical emergency. At the same time, as far as I am aware, very few of the people from the county go anywhere outside the county for obstetrical care. If the Minister makes these services free it will not increase the number of people asking for the services. It will not increase the congestion in the hospitals. There is absolutely no argument so far as rural districts such as ours are concerned in favour of postponing it. Most of the speakers concerned themselves with the City of Dublin and the position of the maternity hospitals here—the few beds available. Nobody has yet adduced any evidence that we can expect an increased number of beds from any expansion of the hospitals. If we are to wait for an increased number of beds we can revert to the time when we were waiting for an increased number of beds for tuberculosis services.

You will not get satisfaction of needs until you make the needs felt. I think the Minister could only hope to get a real push ahead with hospital accommodation development when he stresses, or lets society stress, the absolute need for a rapid expansion in the accommodation available. You will not get further building efforts in private or public hospitals, or the public to appreciate the need for building, until you show the public the absolute need by allowing people to be turned away from hospitals if necessary or allowing them to wait a long time for the hospital. It is only then that you will get real pressure behind any building drive. Waiting until you have accommodation is absolute nonsense, and the people will not respond to any pleas you make, but they will not be long responding to demands by the public, and demands will come if you find the public having to wait for a long time for their hospital accommodation.

Mr. T.F. O'Higgins

A wonderful approach.

Mr. J. Larkin

If we start to do it that way you will not get hospitals quickly.

A Deputy

That is what you are going to do now.

Dr. Hillery

To get a properly organised obstetrical service does not need an elaborate system of hospitals, clinics and beds. All it wants is an intelligent use of the beds available. If this Bill was in operation I am sure the Minister could have his Department so arranged that the hospital beds would be used for those in need of them. In spite of Deputy Larkin's opinion I believe that much midwifery can be carried on in the patient's own home, and certainly should be while we have not hospital accommodation. I think that certainly all normal midwifery could be carried on, with any properly organised service, with a properly selected personnel, and that abnormal cases requiring specialist obstetrical aid could readily be picked out and sent to the pre-natal clinics at the hospitals.

We do not need extra beds if we use the beds we have intelligently. To use any accommodation intelligently we need a certain amount of centralised authority, and I suggest to the Minister that you will never get this centralised authority until you have a comprehensive Act in force.

The Minister being an opponent of the 1953 Act was the turning of the balance in this particular instance. I imagine that we are on the razor edge of an argument and the position may be sent one way or another by the pressure of the Minister in office. If the Minister wanted to implement the Act, there is nothing to stop him and more arguments could be adduced in favour of implementing it than of postponing it. I think the Minister is against the Act, as he was before he became Minister, and as his whole Party was, and that was demonstrated this evening by one of the main Fine Gael speakers. I am sure that Deputy Larkin would be far more uncomfortable if he were speaking now than when he spoke earlier, because Deputy Esmonde showed that the Fine Gael attitude to the Act was not one of postponing it but of definite antipathy to it and a desire to get away from the practical application of what we all desire and to move once more up into the clouds where they existed for three years in opposition, talking about ideals which we all want to see achieved but which we know could never be achieved. I would forgive the Minister, as would most other people, if he got away from these pipedreams and settled down to what is practicable and possible. We will all support him in getting a decent service for our people. We do not want dreams; we want practical measures.

Mr. O'Leary

I am a member of a local authority, the Fianna Fáil members of which proposed a postponement of the implementation of the Health Act. Deputy Allen and a sister of the ex-Minister for Health proposed, when the matter came before the general purposes committee, that it be postponed and no provision was made by Wexford County Council for it. We all know at the moment there is not a bed available in the county, even if the Health Act were put into force tomorrow.

You did nothing, and, when you voted for the 1952 Budget to starve the young people, you were not doing a service to the people.

Mr. Cunningham

You voted for it last week.

Mr. O'Leary

In conclusion, I congratulate the Minister on his appointment. I wish him well in his office, as it is a very responsible job. The health of a nation lies with the Minister for Health.

Mr. Cunningham

After the Minister had been speaking for 45 minutes he said he was speaking in generalities. That is his own statement. Now, in order to postpone indefinitely an important Act of Parliament, we would expect the Minister to give us facts and figures, especially figures; but after speaking for 45 minutes he said he was speaking in generalities. In the second half of his opening speech on the Second Reading he got down to figures but they were for maternity beds here in Dublin. In the main, that is the only figure given. If there were a shortage of hospitals or other shortages which would prevent the coming into operation of the Health Act on the 1st August, he should have given us definite information, instead of making an apology half-way through his speech that he was speaking in generalities. Of course, when we have a very unsound case to make, we are all inclined to beat about the bush and to speak in generalities.

The concern of Fianna Fáil was, first of all, for the public assistance class and, secondly, for the middle income groups. Those were the main people catered for by the 1953 Act. At the present time we have the public assistance class getting free medical treatment, free hospital treatment and free specialised treatment.

Now, let us take the middle income group. Although the ceiling is £600, that group commences—as Deputy O'Leary and all of us should remember —at a very low figure. Even road workers with little over £4 a week and farm labourers are being refused certain services on the grounds that they do not come under the public assistance class as their income is too high.

We have also to consider the small farmers. It is all very well to talk about the farmer of £50 valuation. Deputy Costello, now Taoiseach, said during the passage of the Health Act in 1953 that the £50 valuation farmers were driving around in Chrysler cars and that those were the people for whom Fianna Fáil was providing a free medical service. We must remember, again, the bottom of that scale. I know very many small farmers who have to pay, and pay through the nose, for medical services.

That second class which would be eligible for benefits is now getting medical treatment. If a farmer becomes ill and has to go to hospital, he goes to hospital. If a worker who is earning £6 a week or a small shopkeeper whose income is £6 a week becomes ill and is ordered to hospital by a doctor, he goes to hospital. There are many other such people. At the moment as in the past, if hospital treatment is necessary those people get it. But they pay for it and they pay dearly for it. That is what the Fianna Fáil 1953 Health Act provided for. It provided that those people who are now getting the services and who in the past got the services—and who went into debt and borrowed to pay for them—would get those services free from the 1st August of this year. Is there anything wrong with that? Is it necessary for Fine Gael or any other Party to pretend they are working for the betterment of that class and for the betterment of the poorer class? It is not genuine. The Minister's speech was most unreal. As Deputy Hillery said, the best chance we have of getting a hospitalisation drive and of getting local authorities to make money available for the erection of hospitals, is to implement the Health Act, so as to get an idea of how many people will be availing of the services under it.

There are some questions I would like to ask the Minister and that my constituents would like me to ask him. First of all, if there is a local authority that in the next six months says, and proves by figures, to the Minister that it is in a position on the 1st August or three months after that to put into operation the 1953 Health Act, will he give that local authority permission to go ahead; or will he say: "You must mark time, you must wait until everybody else is ready, until the slowest soldier in the group has got into line." If that is going to be the position, it is a most unreal and most unsatisfactory position. The Minister said that one-third of the population belonged to the public assistance classes. Of course, that is not so. I think the public assistance class is defined by each local authority; at least in effect that is what it amounts to. The category is measured by the local authority.

Mr. T.F. O'Higgins

I can assure the Deputy that the one-third is the basis upon which Deputy Dr. Ryan brought in his Bill.

Mr. Cunningham

Anyhow, I do not think it is a proper basis. I grant you it may be in the city.

Mr. T.F. O'Higgins

It is not in the city.

Mr. Cunningham

Mr. J. Brennan

The accommodation which exists now will be just as adequate for the implementation of the Health Act as it is to meet the requirements of the present services. For example, as regards maternity cases there can be no postponements waiting on the Minister to bring in a free mother and child service. Why not put the free medical services that we are providing under the Health Act into operation at once as regards these cases?

The question was raised as to whether there were sufficient beds. I feel that is entirely irrelevent in so far as the implementation of that section of the Act is concerned. No one will believe for a moment that the operation of the Act is being postponed until we have better facilities in the matter of hospitalisation. What the people believe is that this proposal is the first step towards a complete abandonment of the Health Act. That Act was opposed very strongly in the Dáil by the Fine Gael people when it was introduced by Deputy Dr. Ryan under a Fianna Fáil Government. Deputy Dr. Hillery dealt very fully with that aspect of the question and said that the reasons given by the Minister for not putting the Health Act into operation were absolute nonsense. He pointed out that if the Minister was to wait until he got agreement with the doctors he would wait for ever and that the same was true with regard to buildings. Deputy Larkin made an interjection which I thought was a poor viewpoint to take. Are we to take it that it is better to let people die and do nothing until the buildings are provided?

I think it is a sad reflection on our present medical services for the Minister to say that chaos would be created if all these sections were to be implemented on the 1st August next. The House, I think, should be prepared to take a firm stand on this and realise that it is master of the situation, that it has the last word in making provision for any scheme of medical services. The House should not wait until some section of the community, some of the professions tell us why and when we should move. If we wait until the Irish Medical Association tell us they are ready and are satisfied with any Bill that is brought in here, then I am afraid we shall see many Governments in this House before any finality is reached.

I had no hope whatever that the Fine Gael Party would be prepared to implement the Health Act, but I did believe that the Labour section of the Coalition would have sufficient influence with the Government to ensure that there would be no delay, and that if any changes were to take place they would be improvements as we were told during the election campaign. In the Dáil the Labour Party told us that the Health Bill when it was going through did not go far enough. I never heard the Labour Party at that time refer to the lack of accommodation or of other facilities which might hold up the implementation of the Act. Now, they concur with their Fine Gael colleagues and tell us that it is right to postpone the bringing into operation of that Act on the 1st August. I think that the Minister in his opening speech did give the assurance that he was going to implement the Act in its entirety as it stands, but no attempt was made to indicate when that would be done. Deputy Dr. Esmonde assured us that the Act was unworkable.

Mr. T.F. O'Higgins

What I think he said was that the services envisaged by the Act were.

Mr. J. Brennan

He said that, until agreement was got with the Irish Medical Association, the Act could not be implemented by this House. Some Deputies appear to be rather peeved that we should take up this line with regard to an Act which we brought in and were prepared to implement on the 1st August. I think that the line of argument that we are taking up is perfectly fair. The people of the country want us to take up that line and to expose what is actually happening here, although different excuses may be put before the House.

The Minister read to the House replies which he had received from local authorities. I wonder were these, in fact, replies given by local authorities or were they just letters received by the Minister from county managers or the secretaries to county councils. Although I am a member, I have no recollection whatever of anything of the kind coming before the Donegal County Council. I do remember, however, that at a meeting of the council we made adequate provision in our estimates to meet charges arising out of the implementation of the Act on the 1st August. It is not correct to say that the local authorities were not ready to implement the different sections of the Act.

Deputy Dr. Esmonde said that he was entirely opposed to State control of medicine. I remember his addressing a gathering, which I also addressed myself, at a by-election meeting in Galway. He was pointing out what an expensive thing this Act would be for the farmers and said that Deputy Brennan's Party wished to take their money to spend it for them, while his Party preferred to leave their money to them and let them spend it for themselves. He said that they were opposed to any Health Act. That, of course, is the mentality of the Fine Gael Party towards this Act. They have succeeded very adroitly in putting that excuse before the House and in getting the Labour people to agree with it. They have succeeded in that in so far as they have got the blessing of all the members of the Labour Party who have remained in the House for the debate and who have spoken. They seem to believe that the people throughout the country will swallow the pill in the same way. I move the adjournment of the debate.

Debate adjourned.

Dáil Éireann debate - Wednesday, 7 Jul 1954

Health Bill, 1954—Second Stage.

Dáil Éireann debate -
Wednesday, 7 Jul 1954