I merely want the Minister to explain what the position is.
Committee on Finance. - Health Bill, 1954—Committee Stage.
Question proposed: "That Section 1 stand part of the Bill."
The purpose of the section is to ensure that, on and after the passing of the Bill, an insured worker who at the moment is entitled to hospital services without a charge shall, until such time as may be determined by the Minister, continue to get such hospital services without any charge. It is to maintain in relation to insured workers the existing position.
The Minister in bringing in this Bill to postpone the operation of the Act in certain respects intends to bring in insured people for hospital benefits. If he had not decided to do that, insured people would continue to receive their hospital benefits under the Social Welfare Act. The Minister has not given any reason so far as I know why he thought fit to deal with this class of people. They could have been left as they are under the Social Welfare Act until such time as it was possible in the Minister's view to bring the various classes in under Section 15 of the Health Act, 1953. It would appear to me that an easy way to deal with the matter would be to leave them as they are until such time as the Minister decides to operate Section 15 of the Health Act of 1953.
That was considered as an alternative, but had I done so I would have no answer to a charge which might be made against me in this House that the Health Act was being abandoned. Of course, as I have already explained here, that is not the purpose of the Bill. For that reason, this section was introduced.
Is there any advantage in putting half the charge on the local authority?
I suggest the Deputy should ask the Deputy who is sitting beside him. That principle is enshrined in the Act.
The Minister is in possession. The principle enshrined in the Act was to bring in all these people. That question arose on some stage of the Health Bill, 1953. My explanation at the time was that, under the Bill, not only were we bringing in the insured people but also their wives and families and then they would be in the same position, naturally, as those under £600 a year who are not insured and who get equal treatment. But this is picking out a particular sub-section of a class and bringing them in for no apparent reason except to make a saving of half the cost to the Exchequer and putting that half on the local authorities. If the Minister is prepared to leave the greater part of this Act aside, there is no reason why he should not leave this aside also. To pick out this particular sub-section of a class and bring them into the Act and make special arrangements for them would appear to me to be for one reason only and that is a saving to the Exchequer.
No. That is one of the difficulties that one encounters when discussing on paper legislative proposals completely divorced from reality. The Deputy says, in effect: "We thought it would be a good thing to charge insured workers 6/- a day because we were giving the services to their families." That is a good debating point but, in fact, the families of most insured workers in the country already qualify for free hospital and specialist treatment. They will continue to get it under the Health Act, as amended by this Bill. What the Deputy was doing in the Health Act was trying to save some of the cost by charging insured workers £2 2s. a week and trying to cover that up by saying, in effect: "For that I am treating your wife and children free"—the wives and children already being entitled to free treatment.
Where?
Under the public assistance code.
That is a very good one, indeed.
The Deputy smiles at that. Does the Deputy suggest that the wife of an insured worker or the family of an insured worker does not qualify for free hospital and medical treatment?
If they do, he qualifies.
Many insured workers do qualify.
That is right. If they do, he qualifies also.
That is getting into larger territory now. The purpose of this section is to remove that charge during whatever period may be necessary to enable me to examine the whole situation and bring the necessary services into operation under the Act.
The Minister says that the family of an insured worker gets free treatment. In the area which I know, the wages of a road worker are £4 10s. per week. In my county, at any rate, they do not get free treatment and I am sure that that obtains in the whole of rural Ireland. The contention the Minister has put before the House —that the families of insured workers get free treatment in the hospitals in the country—is not correct. They are charged.
I cannot understand the reasoning of the Minister in this matter. I wonder if Deputy Larkin would help us here: he should know something about it. My understanding of the situation is that the Health Act of 1953 brought in for medical services certain groups in addition to those on assistance—those up to or under, if you like, the £600 a year income group. We know that there exists a situation where there are insured workers. Some of these insured workers may, in case of illness, be able to qualify under what is called the "assistance class". There are others, again, who have incomes not, as Deputy Kennedy says, of £4 10s. a week but higher incomes—possibly on the verge of £600—and their families could not possibly qualify for assistance. I think the Minister agrees that that is the position. What is being done? We are transferring the insured workers from the Department of Social Welfare to the Department of Health and, in so doing, half of the cost hitherto borne by the State will now be put on the backs of the taxpayers.
I should like to remind the Minister that, in the local authority of which I happen to be a member, his supporters and colleagues—the Coalition group— are all out to put back as a charge on the national Exchequer many of the charges which the local authority now has to bear. It seems to me to be very amusing that those who stand for that policy are ready to support a change of this kind which will put an additional charge on the ratepayers.
What we are concerned with—and I think the Labour Deputies support us on this—is that the family of an insured worker who is not on what one would call the level of assistance class, but who is under the £600 a year income, should have the benefit of the Act.
That is not on this section.
The Minister is bringing in under this section——
I am removing a charge of 6/- a day under this section —nothing else.
I do not want to be confused on this. The Minister admits that this section deals with the insured worker and it will bring about the transfer of the charge from the Department of Social Welfare to the Department of Health, plus——
This section?
We are on Section 1.
Yes.
Deputy Dr. Ryan asked the Minister to explain Section I. He made it clear that, as he understood it, while, first of all, the Act brings the insured worker under the Department of Health and removes him from the Department of Social Welfare, this section removes what was envisaged in the 1953 Act—the charge of 6/- a day.
Will the Deputy allow me for a moment? The section, as the Deputy will see, is an amendment of Section 15 of the main Act.
Yes.
Section 15 of the main Act is the section which imposes on each health authority an obligation in accordance with regulations to provide institutional and specialist services for a number of people. In sub-section (3) it is provided that,
"Institutional services shall be made available without charge to the persons specified in sub-section (2) of Section 14"
—those are the present public assistance groups—
"and to such other persons as may be determined by the health authority."
In other words under Section 15 of the Act an obligation was on the health authority to provide in accordance with regulations, say, for example, for five groups of people, and the first group they could not charge.
The assistance group?
Yes. Any of the other four groups they could charge according to their own decision.
And the means of those people.
This is the clause that would have deleted that. The purpose of the amendment is to say in relation to the insured workers who are in the other groups—except the public assistance group—that, until such date as may be fixed by the Minister by Order, in effect there may not be charged the 6/- a day to any insured worker who, in accordance with the present conditions, qualifies for hospital treatment; so that in effect the section does not deal with anything except the removal of the 6/- a day charge for the time being.
On the insured worker?
Yes.
That is what I am saying. He is now going to get treatment for himself only, but the cost of it, by the removal of this, is going to be borne fifty-fifty by the State and by the local authority. Is not that the position?
Part of the cost. The cost is £5 12s.
Part of the cost—two guineas a week—will be borne, fifty-fifty, I take it——
£5 12s.
The £5 12s. will be borne fifty-fifty. What is happening here is that under the 1953 Act it was envisaged that this type of insured worker to whom I am referring, who would be earning less than £600 a year, would have qualified for himself, his wife and any other member of his family for health services subject to a maximum charge. Now this section, the first section of the Bill, proposes to bring him in from social welfare into the operation of this amended Health Act.
No. He is brought in by the section itself, by the Health Act.
He is brought in by the Health Act. He is now being left in the Health Act and everything else is wiped out. Now he is going to get the same treatment as he got before for himself only. He is not going to be asked to pay the 6/- a day maximum charge, but his wife and his children, because he is in the class above the assistance class and below the £600 maximum, will have to pay—he will have to pay for them to a private practitioner. How can any Deputy of the Labour Party stand for that? I am asking Deputy Larkin what answer can he give to the type of person whom he specifically represents in this House. Surely to goodness, it would be far better for us, even if we should abandon all the rest, to at least bring some help to that type of person—the diligent, industrious individual who is in employment, who is in benefit, who is, because of his ability and his industry, above the assistance level, who is going to be denied for his family and his wife the benefits——
Denied what?
For his wife and family.
But surely the wife could be charged for treatment also under your Act.
You are going to charge 6/- a day.
Yes. In other words, the insured worker, if both were in, could be charged four guineas a week
There seems to be some kind of a depression in the mind of the Minister for Health.
I get very depressed when I listen to the Deputy.
He seems to think that when the wife gets sick the husband is going to get sick, so it will cost twice as much. The whole approach to this Bill is that if you once have a satisfactory and adequate, genuine, humane Health Act, everybody is going to get sick on August 1st, and if you do not pass it they will remain healthy.
If this Bill is going to be thrown out, everybody will be sick.
As far as anybody can try to interpret what is in the Minister's mind, it is his fear that the hospitals will be rushed, there will be queues a mile long, and the poor public assistance individual will be crushed in the queue and will not get the service to which he is at present entitled. That is the attitude. This particular section, the first in the Bill, is something that I cannot appreciate at all as being acceptable to the Labour Party. You have the insured worker who has under £600 a year income but is above the level that would qualify him to be considered as an assistance case, and his wife and family are being denied the assistance that the Health Act was bringing to them. In addition to, and on top of that again, the approach is that it is the local authorities who make half the charge. Because of this transfer now of the insured worker himself from social welfare to health it has to be borne by the local authority.
To my mind it is a very simple issue. I think that it is again part and parcel of, and fits in with, the whole scheme of things, that we are not going to have any progressive legislation in the lifetime of this Dáil in connection with health matters, but that this particular operation of social welfare is being taken out of their hands and put into what might be regarded as the proper place for it, the health section, and that is all that has been accomplished. But there is no benefit to the individual and there is, as compared to the present position, an additional burden on the ratepayers. We have that from the people who are always criticising local authority rates, and that from the Party that recognises through its members on those authorities, that the vast bulk of our payments in the local authorities are statutory payments, and this is another of them. We will not be able to do anything about it.
I am opposing this particular section, and I would like to hear Deputy Denis Larkin explain to me even, if he does not want to explain to the industrial workers, how he can be satisfied with this section.
The Minister is trying to get over most of his difficulties by enlarging the public assistance class. We had it here last week in the Dáil. He said that half the population of Dublin was included in the public assistance class. He said that of the population of the country as a whole one-third were in the public assistance class. I should like to know from the Minister if he asked local authorities what they regarded as the public assistance class. In Donegal, we have, first, a large number of small farmers; secondly, we have road workers; and thirdly, we have agricultural labourers. The small farmers are not insured workers and insured workers, in the main, are composed of agricultural and farm workers. In Donegal these people are not regarded as coming within the public assistance class, so that, in Donegal, at least the public assistance class——
Donegal is the only bad county with regard to this.
——forms a very small part of the population, and by giving these facilities to insured workers, by transferring them to the Health Department and asking the local authority to contribute half the cost of hospital expenses, the Minister is not catering for the wives and families of the insured workers at all, because they are not, as he thinks, in the public assistance class.
They are.
I want to get this clear because the Minister has confused the issue. All insured people are not in the public assistance class and it is very confusing to make the point that they are. I am sure there are many insured workers earning a fairly decent wage who would resent being put down as being in the public assistance class. We must keep the two things distinct in our minds. A person may be insured but he may or may not be in the public assistance class. If he is, his family are also in it and therefore we are not concerned with him in this section. What we are concerned with in the section is the position of the insured worker not in the public assistance class and the Minister stultifies his own Bill by saying that they are all in that class. We are dealing with the insured worker who is not in the public assistance class. If he is not in it, neither are his wife and family, and this amendment brings insured workers under the Health Act. It gives them the same benefit or privileges as they have at the moment under the Social Welfare Act, but it does not in any way provide for his wife and family. His wife, it is true, if she came under the Health Act when it does come in, could be charged, if the health authorities so decided, 6/- a day, but until the Act comes in, she could be charged more than that—as much as the authority thinks she can pay and, as well as that, she could be charged a fee for the performance of an operation by a surgeon, so that there is no use in trying to argue that the families of these people will be as well off as they would be under the Health Act, even if this section is passed. We want to be very clear on that before we decide that the section is good.
I should like to know also why the phrase "until such date as may be fixed by the Minister by Order" is inserted here. Evidently the Minister does not contemplate making this a permanent arrangement. He probably has in mind that, when everybody in the classes specified in Section 15 come under the Act, this Order may be dropped. If that is his intention, I cannot find any fault with it, because I had contemplated doing the same, but if his intention is other than that, I should like to know what the purpose of putting in these words was.
I take it that the Minister will accept himself as an authority on certain figures.
No, I certainly do not.
The Minister at column 1323 of the Dáil Debates of 7th July last referred to insured workers and said:—
"In Dublin, the fraction would perhaps be nearer one-half than one-third so far as insured workers are concerned."
That is, half the insured workers would be in what is called the assistance class. The Minister went on to say:—
"The figure of 450,000, covered under the National Health Insurance Acts, is incorporated in the Social Welfare Act."
In other words, the Minister admits that there are 450,000 insured workers and he says that, in Dublin, 50 per cent. of these would be in the assistance class and the other 50 per cent.——
I think the figure of 450,000 referred to the number of insured workers who are eligible now for hospital services. The total figure for insured persons is something around 750,000.
At column 1323, Deputy MacBride asked:—
"Could the Minister, before passing from that, give the numbers covered in the two classes mentioned, the public assistance classes and insured persons?"
The Minister replied:—
"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."
That is an error.
I was quoting the Minister as an authority and I am now told that that is an error. Perhaps the Minister would correct it.
The end of that sentence should read: "so far as public assistance is concerned." It is perfectly clear from the next sentence. The sentence should read:—
"In Dublin, the fraction would perhaps be nearer one-half than one-third, so far as public assistance is concerned."
It is clear from the preceding and following sentences.
The figure of 450,000 which the Minister says is incorporated in the Social Welfare Act is a little over half the total of 750,000 insured workers. There is a little more confusion there which the Minister might perhaps deal with, but it does not get away from the fact that, whether that statement of the Minister is now to be regarded as a misprint or not, there is a section of insured workers whose families are being deprived of the benefits of this Health Act. The tragedy of the situation is that, while this Bill is being discussed here, those who should show the greatest interest in it are conspicuous by their absence. Not a single member of the Labour Party—Minister, Parliamentary Secretary or Deputy—is here for the discussion.
Or Clann na Talmhan or Clann na Poblachta.
Clann na Poblachta are represented.
Yes, there is one— 33? per cent.
It is a great tragedy that this Bill should be going through the House section by section, without any assistance from those who should be nearest to it, those who say they represent the working class. Here we are struggling to bring assistance to that class and we get no explanation from them, not to mention assistance.
Many Deputies who represent rural areas know that I was one of the Deputies for Dublin City to whom they came when they had problems such as have been explained by Deputy McQuillan, the problem of people coming up from the country for particular specialist treatment in Dublin, who, when the bills were sent down to the country, went to their Deputies and said: "Will you, for goodness' sake, get in touch with somebody in Dublin and try to get this bill reduced."
Notice taken that 20 members were not present; House counted and, 20 members being present,
On a point of order. The Deputy is travelling far from the section. The only question in the section is whether it is right to remove a possible charge of 6/- a day on an insured worker.
I believe the Deputy is travelling too far and I gave him a great deal of latitude. I cannot allow Second Reading speeches on every section.
Let us come back to the single line on the road I am travelling. This amendment is removing the 6/- a day that may be charged on an insured worker when he goes into hospital but as a result of that, part of the charge will be borne from another source. Up to this there was no charge on the local authority for the hospitalisation of insured workers but now half of the charge is to be borne by the local authority. I hope Deputy Alfred Byrne will realise that we are now going against his policy. His policy is to try to get the Exchequer to bear a greater part of the statutory charges which the corporation has to pay.
Is that set out in Section 1?
There is nothing about that in the section.
It arises from it.
I cannot find any reference to it in the section.
The Minister explained the section to me.
I am not responsible for what the Minister said, although he said what he wanted to say very clearly. However, I cannot find in the section where it fixes the charges or where the charges are to be met from. Deputies cannot travel over the whole Bill on every section. The matter to which the Deputy referred may be in some other section but it is certainly not in Section 1.
Section 1 deals with Section 15 of the main Act. Section 15 is being amended by this Bill and Section 15 deals with the charge.
It does not. It deals with the charge of 6/- a day.
It does.
It deals with classes.
I have to rule that the charges are not in Section 1 of this Bill.
The classes of people entitled to benefit are.
I am afraid it is getting a bit too technical for me.
I know the Bill is technical but the difficulty is that the Chair cannot allow a Second Reading speech.
I think Section 1 deals with the charge.
It deals with the 6/- a day charge.
It does not deal with the charge on local authorities. The point Deputy Briscoe is making is whether it is to come from the Exchequer or from the local authority.
If this section is agreed to, the local authority will pay half.
Will the Chair accept that that is the position? The immediate effect of the passing of this section is to transfer the charge by way of half to the local authority, because that arises from the whole matter.
The imposition of the charge on local authorities, as Deputy Dr. Ryan is aware, is proposed, not in this Health Bill or in the Health Act but in the Health (Financial Provisions) Act of 1947. It is in another Act altogether and it is in no way involved in any of these sections or in the Health Act of 1953.
Section 15 of the Health Act of 1953 lays it down that the health authority can charge in certain cases. Section 1 of this Bill enables the Minister to relieve the insured person of paying anything towards that charge. Of course, the health authority will have to pay the total charge for the treatment of that person and will only be recouped to the extent of 50 per cent. If the section was not put in, if the insured person was left where he is under the Social Welfare Act, the Minister for Finance would have to pay the whole lot. Therefore, Deputy Briscoe's argument seems to be relevant, that if we pass this section we are, in fact, saddling local authorities with half the cost of treating the insured people.
But that is not provided in this section. The only question in this section is whether it is right to remove a charge of 6/- a day.
The 1947 Act has been quoted by Deputy O'Higgins and we all know that all progressive health legislation emanates from the 1947 Act.
It has not emanated far.
Tuberculosis treatment is another development from that Act. Deputy Dr. Ryan has clearly understood what is in my mind. You have insured workers at present whose hospitalisation and treatment is borne by the State exclusively. By remitting this charge of 6/- from the insured worker, in giving it over to the health section you are at the same time transferring the charge in full from the Exchequer, the health section will pay half of it and the local authority will pay the other half. It is to that that I am drawing the attention of the single other member of the Dublin Corporation who is here. Apart from the other argument I used—of an individual and his family circumstances and so forth—I think that is improper. If the Minister wants to postpone the Act he should leave the insured worker where he is until he is able to implement it in the manner he wishes. To use this postponement of the vital sections of the Health Act to put a further charge on the Dublin Corporation is something that I protest against.
I want to make the same protest. This will put a burden on the Cork Corporation also if they have to pay 50 per cent. of the insured person's hospital expenses. We are aware that the 1953 Act would make the local authorities pay that; but the insured member, and every other person who came under the provisions, was getting the health services under the 1953 Act. They are being deprived of them now and as well as that they are being asked to pay half of the expenses of insured members.
As Deputy Briscoe has mentioned me, I would like to say that I was one of those who advocated that the Exchequer should accept some of the burdens on the Dublin ratepayers. I put that case forward to his Minister and his Party dozens of times and they trampled on me as well as on the citizens of Dublin.
Who is trampling on you now?
Section 1 agreed to, Deputies Briscoe and McGrath to be recorded as dissenting.
SECTION 2.
I move amendment No. 1:—
To add to the section a new sub-section as follows:—
( ) Notwithstanding anything contained in this Act or in any of the regulations which may be made pursuant to this Act the persons who but for the provisions of this Act would be entitled to the services provided by or pursuant to the provisions of Section 25 of the Health Act, 1953, shall be the persons referred to in sub-section (1) of Section 15 of the Health Act, 1953.
The effect of the amendment is that, notwithstanding the passage of Section 2 of this Bill, in regard to those who would under the 1953 Act have chosen their own hospital—that is, availed of the provisions of Section 25 of that Act—the Act will come into operation on the 1st August.
I am afraid that in order to make my points in regard to this amendment I must refer to an argument that was put up before, that we have not got proper hospital accommodation, and to other arguments that were used in the postponement of the Act of 1953. Naturally, anybody opposing this amendment would use the arguments the Minister used in postponing the Act in general and I am, therefore, forced to refer back to some extent to the question of hospital accommodation and to some other matters that were raised of that kind. For many years past—in fact, I think I can say to any person interested in accuracy, back to 1932—hospitals have been built and provided every year. There was no great provision made, I admit, before 1932—in fact, no provision at all.
Except the provision of money.
There were no beds provided anywhere from 1922 to 1932.
Do not forget that the whole financial structure springs from before 1932.
I do not know what point the Minister wants to make there. I think it cannot be controverted that nothing was done in the way of providing hospitals before 1932. We were left here with the poorhouse infirmaries as we had them when the British left this country and no attempt was made to improve them. It was only after 1932 that an attempt was made to improve the hospital accommodation in this country.
In columns 1329-30, the Minister said last week:—
"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."
Down further, in column 1333, he said that no extra bed was provided.
I would not go back further than the last three years—my term of office. I want to point out to the Dáil that during those three years I saw very many hospital beds made available. I myself had the privilege of opening new hospitals during that time. I agreed, as Minister, to the additional accommodation being made to several hospitals in the country and sanctioned the reconstruction of hospitals and the building of new ones. It is true, of course, that the new hospitals which were sanctioned during that period are probably not ready yet, though some of them which I would like to mention will not be long until they are ready.
I cannot see the importance, the vital importance given by the Minister in his speech, to the point that beds should have been provided within a specified period, that is, between the passing of the Act of 1953 and All Fool's Day. I think these are the dates on which he laid emphasis in talking about the lack of accommodation, when he repeated so often that nothing, good, bad or indifferent, was done. Anyone with a bit of sense—I think the Minister has sense, but does not try to use it when it does not suit him —must know that to bring an Act into operation you do not build hospitals in the period from the time it is passed until you bring it into operation. The hospitals are already built.
I mentioned here before that, unfortunately, I have not a very good memory for exact figures. I did not bring departmental documents out with me—which perhaps would be expected of me by certain people. However, I remember this figure and feel I am right in it—that over the last seven years since the Department of Health was established, something like 9,000 beds were added on in this country. That is a very big number. If any of us can throw his memory back to seven years ago, he will admit that there was no great wait for a bed except perhaps in the case of T.B. In other words, the bed accommodation was almost adequate at that time. Still, these 9,000 beds have been added. Some of them, I admit, are for T.B. I agree with the Minister, and admit what he says is true, that at present all beds are occupied, both in the county hospitals and in the voluntary hospitals; but it is equally true that nobody in this country is refused hospital accommodation if they need it. As a matter of fact, in the discussion here on the Bill last week not one of the Deputies who supported the Minister in postponing the Act of 1953 claimed that there was a waiting period in our hospitals, not one of them claimed that people had to queue up.
The only case which was made, as Deputy Briscoe pointed out, was that some people believe that if the Health Act is brought into operation more people will look for hospital accommodation. I do not think that will happen. I do not admit that will happen. There might be some slight encouragement to people who are now deferring what they regard as the "evil day" to go ahead with treatment; but that will not mean an increase in bed occupancy because if people go to hospital early on they get out all the more quickly. If they leave things too long, there is bound to be a long stay in hospital, and from that point of view beds are occupied longer than they need be.
The complaint from people is not that they are not getting hospital accommodation; it is that they are not able to meet the bills. It is that which has deterred people in certain cases— perhaps not very many, but I know of some myself—from going into hospital; they felt they could not meet the bill. The important principle as far as Sections 15 and 25 are concerned is that provision is made in relation to charges rather than in relation to hospital accommodation.
What is the present position? I have tried to give a brief résumé of the historical situation over the last 22, or seven, years, as the case may be. Let us take the position at the moment. In the month of May, a cancer hospital was opened in Dublin. So far as I recollect, it has 150 beds. The effect of the opening of that hospital should be that beds will be made available in the ordinary general hospitals which, up to this, were given to cancer cases. It must be obvious to everybody that, if cancer is removed from the general hospitals, to that extent a void will be created in the general hospitals; in other words, beds will be available for other patients.
Only a few weeks ago a new surgical hospital was opened at St. Kevin's. I do not know how many beds there are, but I think it is 100 to 120. There is a new urological hospital being built by the Meath Hospital. It will add 120 beds. Before I left the Department I was told that hospital would be available in the not far distant future. I would say early next year at the latest. Also sanctioned by me before I left the Department were additions to the City of Dublin Hospital, Baggot Street, to Steevens' Hospital and to the Mater Hospital. The accommodation I have mentioned adds up to a fair number of beds in the general hospitals and those are beds additional to the accommodation already available. As well as that, sanction has been conveyed to both St. Vincent's and St. Laurence's to build new hospitals. They will take some years but they will come along in time. So much for Dublin.
Additional beds are being provided in the Mercy Hospital in Cork. Limerick Regional Hospital, a large hospital with almost 300 beds, will be available before the end of this year. There are additions being made to many county hospitals at the moment. Many new district and county hospitals are being built and will be available at varying dates between now and two or three years hence.
A very big hospital, the Galway Regional Hospital, is nearing completion and should be ready some time next year. Apart from that, three regional sanatoria are being built, two of which will be ready by the end of the year. The other is almost completed. That will relieve the position in relation to the general hospitals and in relation to the many temporary hospitals that are now being used for T.B. patients, because these patients will be taken out of these temporary hospitals and sent to the regional hospitals. These temporary sanatoria will then revert to their former position as district or cottage hospitals and will be available for either maternity cases or for general medical and surgical cases.
Also on the list are two substantial hospitals. There is the Mallow County Hospital which was built before the war and taken over by the military during the war and taken over as a sanatorium when the emergency ceased. Now that the Cork Regional Sanatorium has been completed that temporary sanatorium will be vacated and handed back to the county as a general medical and surgical hospital.
Here in Dublin, Rialto, which is part of St. Kevin's, will be handed back as a general medical and surgical hospital as soon as the Dublin Regional Sanatorium is finished. In Rialto there are about 200 beds. Again, orthopaedic hospitals are being built and one has actually been completed in Galway. One is nearing completion in Cork at Gurranebraher and could be used partially at the moment if there was urgent necessity for it. These orthopaedic will relieve the pressure on the general hospitals because the orthopaedic cases will be taken out and more accommodation will be available in the general hospitals.
Taking all these together, it is obvious that within the next six months there will be a very substantial addition to the number of beds available for ordinary surgical and medical cases and a person with a will to operate it should have no great difficulty in setting the Act in motion in so far as medical and surgical cases are concerned. If they look at the returns from the Department of Health for some years back, Deputies will find that in no year was there so much spent on the building of hospitals as in the year 1953. Up to last year all the money spent on hospital building came out of the Hospital Sweeps fund. From last year the Exchequer has been contributing a large amount. The figure spent in 1953 may be exceeded by 1954, or it may not. At any rate these two will be the biggest years since hospital building commenced, so there can be no doubt that hospital accommodation is being provided.
If that is the position, and I assert it is the position, what is the point then in the Minister coming in here and saying no hospital was built between October, 1953, and All Fools' Day, 1954? Possibly it did not happen that a hospital was opened during that time, though I am almost sure that a hospital was opened. I think extra beds were made available in St. Kevin's and shortly after that extra beds were made available in the cancer hospital. The provision of hospital accommodation is going on all the time and I have not the slightest doubt that beds are available had the Minister a mind to go ahead with the implementation of the Act. That being so, I do not see how there could be any very strong objection to operating Section 25.
Section 25 of the Health Act of 1953 gives to a person the right to choose his own hospital. If he does that and comes within the classes that are laid down in sub-section (2) of Section 15, he will be entitled to a subvention from the health authority. The subvention would be the amount that would be payable to a general hospital by the local authority, less £2 2s. a week. At the present time, the amount payable is £5 12s. If you deduct £2 2s. from that you get £3 10s., so that anyone entitled to avail of the provisions of Section 25 could choose his own hospital and get £3 10s. from the health authority to help him pay his way.
I must say that I cannot see why the section could not be operated. It does not interfere in any way with hospital accommodation. These people have to choose their own hospital and have to make their own arrangements. If, therefore, we are thinking only of the public assistance classes and of the priority that is due to them, the hospital must look after them. First of all, it can only agree to take a person in under Section 25 if the other people are already provided for. Therefore, we are not interfering in any way with the priority which is due to the public assistance classes. We are not running any risk that the hospital will not be available. At least, it is not our affair if you like, because the person himself must choose the hospital, and it is only putting Section 25 into operation as far as these people are concerned. I think the Dáil would agree that that can be done. I also have amendments dealing with Sections 15 and 16 of the 1953 Act, but I do not think it would be appropriate to talk on them now.
Perhaps the Deputy would like to discuss them all together.
I do not mean to repeat most of the arguments that I have already made, but there is some additional information that I want to give later with regard to maternity beds. I may be as anxious to get holidays as anybody else, but I would like to have the other case discussed as it should be. Therefore, I am leaving my submissions, or my arguments, in support of this amendment as I have made them for the moment until we hear what views other Deputies may have.
I should like to follow on the lines of Deputy Dr. Ryan, and to give the House some factual, and, I would suggest, surprising additional information. The Minister, speaking at column 1322 on the 7th inst., referred to the machinery in operation in Dublin for the care of the sick poor. He said that a rate of 1/- in the £ in Dublin produced an annual sum of £120,000. If the cost is to be reckoned at about £5 12s. per week, does that mean that the number of people who can get treatment in a year will be in or about 24,425? The point that I am coming to is that the bed accommodation that would be required for the servicing of our assistance cases in the City of Dublin would be 400 beds per year. These would have to be kept in mind as being specifically needed for these people.
I asked the Minister to-day a few question. I asked him, first of all, if he could tell me the number of hospitals that had been started and completed in each of the years since 1932. At this point, I should like to ask if it is not a fact that health attention for our assistance classes arose out of our 1939 Act, and that from then on we heard nothing very much about inability to meet the hospital and medical requirements of these assistance classes?
The details given in answer to my questions to-day will appear on the records of the House. They are not as comprehensive, as full or complete, or in the way that I wanted them. Deputy Dr. Ryan himself will probably be surprised to know that in the period 1932 to 1948, there were 51 hospitals or institutions built—county hospitals, district hospitals, fever hospitals, mental hospitals, maternity hospitals, children's hospitals, sanatoria, and so forth. I am not going to read out the full list because I do not want to waste the time of the House. I would suggest to Deputies that they should read these returns. From 1948 to 1951, the hospitalisation building programme was continued, and 19 were built. From 1951 to 1954, there were seven more built. As regards major reconstructions or extensions—the Minister said in his answer that he was not dealing with them all because there were so many small ones—there were 17 carried out in the period 1932 to 1948; 26 in the period 1948 to 1951, and 21 in the period 1951 to 1954. You have there that magnificent record of the building of hospitals, thereby making provision for the health and treatment of our people. That is something that was unknown, unheard of or that was unthought of up to 1932.
Where did the money come from?
Where does the money come from for anything?
Are we going to take the line of saying that we must do this or must not do that by making money our standard?
The Deputy might at least be fair to those who introduced the sweepstakes and originally sponsored the Hospitals Trust Fund.
That was on a free vote of the House. It was not a Party vote.
It was a Government proposal.
The Minister is historically wrong. It was not a Government proposal. It was a Private Members' Bill.
Which was adopted by the Government.
It was a Private Members' Bill supported by the free vote of the House.
It was called a white elephant first.
I think you had better leave that out. That is a ridiculous interjection.
What would you expect?
Perhaps the Deputy will be impressed if I tell him that I asked the Minister to-day, by way of parliamentary question, to tell us how many hospital bed in this country in 1932 and how the number increased year by year up to the present. Of course, the Minister is a good politician and the answer and the way he framed it are significant. I did not get the information that way but I had to get some information.
On a point of order. Could I ask the Deputy how many people are sleeping in the corridors in the hospitals of Galway City? I know what I am talking about.
They would be all sleeping in the open if the Deputy's Party had their way.
They would be sleeping in Glasnevin and elsewhere.
You are a great bunch.
Would Deputy Coogan cease interrupting, please? Deputy Briscoe on the amendment.
I asked that question. I am sure that even Deputy Dr. Ryan, who is so close to this problem, would be surprised at the achievements of the Fianna Fáil Government in connection with hospitalisation. We have to-day over 50,000 hospital beds in the country, 40,000 of which, or over 40,000, are for acute cases only and do not include chronic cases. That means that if we were to give people one week in a hospital, we have 2,000,000 bed weeks in the year. We are still building and still going on and yet it is suggested that our amendments should be rejected on the grounds that we have not sufficient accommodation. I shall put the question down again to the Minister and a series of questions. I shall ask how many beds had we in 1932. I shall ask it every week when the Dáil reassembles to get the figure of the growth of bed accommodation and then the Deputy from Galway will realise how many more would have been crawling in corridors but for our provision.
Come down to Galway and we will show you a few things.
You are not telling him to keep away from it.
He would not be accepted there.
I have got very great friends in Galway.
Very few.
He will be at the races very soon. Would you like a tip?
I wonder what he would be selling.
I neither buy nor sell. I accept the hospitality of my friends.
Would Deputy Briscoe speak to the amendment?
If these personal interjections are made I do not think I can let them go unanswered. I must come back to Dublin. I have said that, for the requirements of assistance cases— I am talking of cases other than maternity cases because we have another amendment dealing with maternity cases—if there are 800 beds required to meet the assistance cases in the City of Dublin and if you added to that the 50 per cent. additional of the population that would come in by the implementation of our Act, you would require possibly another 200 to 300 beds. I do not know if the Minister is prepared to argue the matter on the specific availability of beds or not. I say he has no answer whatever to the situation. As far as the City of Dublin is concerned, there is no lack of facilities. I would like to challenge the Minister on this. Deputy Alfred Byrne knows that we have already partially implemented portions of the Health Act which are now being put aside. Are we to be faced with the position of having to refuse the assistance we are now giving to our needy people in the City of Dublin, when this amending Bill becomes an Act, superseding what we are doing? I want the Minister to check on that. When the Health Act was going through the House and was passed, we anticipated and we said we would not let the people wait. We gave additional facilities and additional services and we are now being debarred from doing that. Deputy the Lord Mayor probably will bear the burden of most of the protests when it comes to be felt.
Would the Deputy indicate what service he has in mind?
The Minister can make his inquiries.
The Deputy made a statement here.
He will be surcharged.
Yes. I said we had partially implemented portions of the Health Act. We have been much ahead of other local authorities.
The Deputy made a statement here. I am asking him would he indicate what services he was referring to.
I challenge the Minister to make the inquiries to find out.
Bluster.
No. It is your job. It is your job to tell us to stop doing what we are doing.
I challenge the Deputy to name any services.
And to surcharge us for doing it.
You will be surcharged.
I challenge the Deputy.
I do not mind facing that surcharge. If we are to be surcharged for saving lives, it will be a very new situation.
That little trick does not work here. If the Deputy wants to say something of a serious kind he should be in a position to prove it.
I am quite serious in saying that the Minister cannot under any circumstances whatever adduce a single iota of evidence to the effect that the Dublin Corporation is neither willing nor able to carry out everything that is suggested in these amendments. Secondly I say—and this will come up again—the approaches made by the Dublin Corporation to the Department of Health, the letter they wrote on 24th May and the letter they wrote on 28th June, to which the Minister referred but gave no date, dealt with nothing but technical matters, conferences for the purpose of implementing technical matters in the operation of the Act, not the physical difficulties.
I know what it is to sit in the Minister's place all day. If the Minister would like a half hour's adjournment we would be quite agreeable.
That is very kind of the Deputy. I would. I am not asking the Deputy to commit himself but could he give me any indication as to how long the debate will continue after that?
I do not know.
Give us some concession and we will make it short for you.
I am afraid the debate will not finish to-night. I may be wrong. I do not know.
Business suspended at 7.10 p.m. and resumed at 8 p.m.
I referred earlier to the answer I got to-day to the question about bed accommodation, and I mentioned before that we have approximately 50,000 beds to cover all classes of chronic cases; and deducting the chronic cases and deducting the vast bulk of bed accommodation for mental cases, we still have over 30,000 beds for all others, the ordinary hospitalisation cases, medical and surgical, eye and ear, skin and cancer, maternity, observation, T.B. pulmonary and T.B. non-pulmonary, V.D. and children's hospitals, mental defectives, convalescents, rheumatism, and so on. I might point out, in connection with that, the tremendous development in hospitals generally, the building of hospitals, the additions to and reconstructions of existing hospitals and voluntary hospitals and the number of hospitals in the course of construction which would by the end of this year or next year add a considerable amount of accommodation apart from what is generally known as the well-attended side of hospitals, the outdoor clinic side, which treats the vast bulk of cases that go to hospital, apart from those who have to go into hospital for operations and for ailments of various kinds. I cannot see why this amendment should be objected to. It is inherent, of course, in what I regard as a deliberate definite policy of defeating the 1953 Health Act.
I have said before that the cost to the local authorities of implementing the full Act, and particularly in implementing this amendment will not be in any event unreasonable in any way. The previous discussion we had on Section 1 in any case, adds to the burden of local authorities payments not hitherto required of them, and does not give any additional benefits in medical treatment. My colleague in the Dublin Corporation, Deputy O'Higgins, who is always suggesting that he wants rates to come down is now going to vote for a section here where rates are being increased by the transfer of payments from the Exchequer to the backs of the ratepayers. But we are not concerned by what was conveyed to me by way of an interjection from Fine Gael—"Where are we going to get the money?" This Health Act was not opposed on the grounds of cost. I think all sides of the House would prefer to see assistance being given to our citizens—and particularly to those of them, not quite the sick poor but the lower income group—in every way and I do not think that anybody from any side of the House would question it purely on the basis of cost, because, after all, it does provide a considerable amount of money for every possible aspect of life to help the people generally, so that I do not think the interjection is of any consequence and I do not think it represents the point of view of even the Fine Gael Benches. But I do say this: We want the most up-to-date, progressive health legislation. We want to see the State do its part in helping to maintain the health of the people. We build houses in large numbers to house our people properly, to protect them from the effects of bad houses; we are eliminating T.B. as fast as we possibly can; we make provision at great cost to the State for education and so forth, but on this particular thing there seems to be an objection and a different attitude altogether.
At a later stage, possibly on the third amendment down here to-day, we will be able to deal in more detail with the question of the money side of it in so far as it concerns the State. But so far as it concerns those who will be operating the Act, I ask the Deputies of the House to read the answers given to questions to-day in connection with hospitalisation and bed accommodation and I think every one of us can be proud of the fact that since 1932 tremendous strides were made so that we can now see in our lifetime hospitalisation as it is needed fully supplied. I think that is a great achievement.
I think also that from the point of view of bed accommodation—taking those already in existence and those which will be coming along in the next few years—nobody can quarrel with the fullest use being made of these beds for the betterment of our people. As I said before, the Party that should be closest to the problem and that should know more about this, I think, from the workers' point of view, from the mass-population point of view in the cities, anyway, surely should be the representatives of the Labour Party. This is a form of legislation which to my mind, if they profess to be in any way of a socialist turn of mind, should be something that they should approve of as they did when they opposed the opposition to it when Fianna Fáil was in office. Why we cannot get the support of the Labour Party in our consistent attitude in respect of this matter. I do not understand.
I come back to the note on which I started on this matter. When in 1939, legislation was passed to enable the State to deal with the question of giving medical services to the public assistance classes we did not have then, no more than we have now—in fact we had less then—the facilities to implement it. As I said before, very few years passed when we were able to implement it fully and I doubt that many people to-day can find fault with the facilities that are available to the people. In the same way, our opposition to this Bill and these amendments are an effort to do something to keep the Act alive.
I cannot understand the Minister's point of view. He says he accepts the Bill in principle and wants to have it fully implemented. Here is an amendment that we say cannot in any way disturb him from the point of view of difficulties. We argued on the first section of the Bill a particular item that has gone by the board. We are arguing now on another section of the Bill and we shall be arguing on a further one. I have deliberately not discussed the maternity side of the question because that can be dealt with separately. I know that I shall not get the support of Fine Gael but I should like those who feel that they cannot face the situation and who have absented themselves from this House, to read the debates. I hope that at some later stage they will press the Minister, even behind the scenes, not to remove all possibility of being able to retrieve the position. By adopting the Bill in its present form and rejecting these amendments, the House in my opinion will ensure that the 1953 Act can never be resurrected from the position in which it will be put by the passing of this Bill.
I disagree with the statement of my colleague Deputy Briscoe that the Labour Party have any special grace or that they represent the working man better than we do. When any question of political advantage arises, they forget all about the working man. We believe that a stitch in time saves nine. The Minister in his Second Reading speech spoke about the line-up of particular classes coming under Section 15 of the Act as beneficiaries. These particular classes go into hospital in case of serious illness. I know of no case that is denied a bed at present where the illness is urgent.
There is always contact with extern institutions. A particular number of extern institutions are on the list of every county hospital, and where the case is urgent and cannot be dealt with by the local county surgeon, it is sent to an extern institution. Then there are liaison arrangements providing for the transfer of a case from one county hospital in which there may be a surplus to another county hospital. Our anxiety to see that the 1953 Act will be implemented arises from a desire to ensure that the people will not lack these facilities. We want to have them taken out of the public assistance group. We want to see their spirit of sturdy independence preserved. We do not want to keep them from going to hospital until they are at death's door.
The Minister referred to charges to patients with property up to a certain valuation but the House and the Minister should bear in mind that there is even a big general practitioner bill and a big chemist's bill to be paid before ever there is a question of hospital treatment and the Health Act does not interfere with that. What we are concerned with is that the people set out in Section 15 should get the facilities, by right as ratepayers, that certain people in the public assistance category and in the insured workers category get at present. We are putting up the contention, and justifiably from our experience, that there is no dearth of beds and that no case will be left waiting if the necessary representations are made about it.
Deputy Dr. Ryan in his statement here referred to the growing availability of beds. When I asked the Minister when Blanchardstown Sanatorium would become available, he said about the end of the year. So far as I know there will be 500 or 600 beds available there. That will mean that in my own county some 60 odd beds will be released for further patients, in addition to those which will become available by reason of the new addition to the county hospital and the reconstruction of the Athlone hospital which will be carried out in the coming year. There is therefore no justification for the implementation of Section 2 of this Bill. The amendment proposed by Deputy Dr. Ryan is a reasonable amendment to that section and it should be accepted by the Minister.
The main argument which the Minister put up here was the alleged lack of accommodation in hospitals and the fact that no attempt was made to make any arrangements for carrying out the 1953 Act. He said some little thing was done before the elections. I can assure the Minister that his predecessor went round to different parts of the country with his officials. At one conference in Cork, he met members of the Cork Corporation, the Cork County Council, the Waterford Corporation, the Waterford County Council, the different managers and the representatives of some other counties as well. At the time he asked for, and got, their views on the Act. He sent his officials around to the different local authorities and to the voluntary hospitals, and in most cases got agreement in regard to the working of the Act. I have here a letter which I came across this morning, from the Department of Health to the South Charitable Infirmary, Cork——
On a point of order, the amendment is an amendment which deals with the choice of hospital section. It does appear to me that the Deputy is dealing with the whole principle of the Bill. We are discussing a proposed amendment in relation to Section 25 of the Principal Act which deals merely with the choice of hospital.
It appears to me that Deputy McGrath is dealing with institutional services.
Every Deputy I have listened to has dealt with the same matters and this is the first time that the Minister has objected.
I did not want to be unfair to Deputy Briscoe.
But you want to be unfair to me.
I could not be unfair to you.
May I ask why the Minister should want to be unfair to me if he was not unfair to Deputy Briscoe?
Deputy Briscoe was making a reasonable contribution. I know the Deputy.
I think that remark should not be allowed. It ill becomes a Minister of State——
I was referring to the Deputy's previous contributions to this debate which were a disgrace to the Deputy.
Is the Minister going to be allowed to say that my contributions were a disgrace and get away with it?
That is a matter for the Minister. I cannot decide as between the Minister and the Deputy.
It is a matter to which I am drawing the attention of the Chair. I want to point out as Deputy Briscoe, Deputy Dr. Ryan and Deputy Kennedy pointed out, that the accommodation was there and that the arrangements were made. There is no reason why this part of the Bill should be abandoned, because "abandoned" is the word for it, not "postponed". There is no reason why people should be deprived of the benefits that are available and there is no reason why the people at present in hospital or who are about to go into hospital should be deprived of those benefits. I think the conduct of the Party opposite which has been missing from this House for the whole of the week— the Labour Party—is disgraceful to the people who voted for them.
I want to say that as many facilities are there as were there for the introduction of any Act brought into this House. I know that the people on that side of the House have no experience of bringing in any major Act for the good of the people. They can hardly understand how it could be worked or commenced. They have no experience of it.
I cannot understand why the people who could avail of these services are being deprived of them. As I said before, there were not sufficient beds available for T.B. patients, yet the legislation was implemented. Everybody knows that the number of beds in hospitals increased every year since Fianna Fáil came into power in 1932. I hope it will continue to increase. It is simply to sabotage the 1953 Health Act that this Bill is brought in.
Question put.
The Committee divided: Tá, 56; Níl, 70.
Tá
- Allen, Denis.
- Bartley, Gerald.
- Beegan, Patrick.
- Blaney, Neil.
- Boland, Gerald.
- Brady, Seán.
- Breen, Dan.
- Brennan, Joseph.
- Brennan, Paudge.
- Breslin, Cormac.
- Briscoe, Robert.
- Burke, Patrick J.
- Butler, Bernard.
- Calleary, Phelim A.
- Carter, Frank.
- Childers, Erskine H.
- Colley, Harry.
- Collins, James J.
- Cotter, Edward.
- Crowley, Honor M.
- Crowley, Tadhg.
- Cunningham, Liam.
- Davern, Michael J.
- Derrig, Thomas.
- de Valera, Eamon.
- de Valera, Vivion.
- Egan, Nicholas.
- Fanning, John.
- Flanagan, Seán.
- Flynn, John.
- Flynn, Stephen.
- Geoghegan, John.
- Gogan, Richard.
- Harris, Thomas.
- Hilliard, Michael.
- Kelly, Edward.
- Kennedy, Michael J.
- Kill lea, Mark.
- Lahiffe, Robert.
- Lynch, Celia.
- Lynch, Jack.
- McGrath, Patrick.
- McQuillan, John.
- Maher, Peadar.
- Moher, John W.
- Mooney, Patrick.
- Moran, Michael.
- Moylan, Seán.
- Ó Briain, Donnchadh.
- O'Malley, Donough.
- Ormonde, John.
- Ryan, James.
- Ryan, Mary B.
- Sheridan, Michael.
- Smith, Patrick.
- Traynor, Oscar.
Níl
- Barrett, Stephen D.
- Barry, Anthony.
- Barry, Richard.
- Beirne, John.
- Belton, Jack.
- Blowick, Joseph.
- Burke, James J.
- Byrne, Alfred.
- Byrne, Thomas.
- Carew, John.
- Casey, Seán.
- Coburn, George.
- Collins, Seán.
- Connor, Johnny.
- Coogan, Fintan.
- Corish, Brendan.
- Cosgrave, Liam.
- Costello, Declan.
- Costello, John.
- Crowe, Patrick.
- Davin, William.
- Deering, Mark.
- Desmond, Daniel.
- Dillon, James M.
- Dockrell, Henry P.
- Donegan, Patrick S.
- Murphy, William.
- Norton, William.
- O'Carroll, Maureen.
- O'Donnell, Patrick.
- O'Donovan, John.
- O'Hara, Thomas.
- O'Higgins, Michael J.
- O'Higgins, Thomas F.
- O'Reilly, Patrick.
- Donnellan, Michael.
- Doyle, Peadar S.
- Dunne, Seán.
- Esmonde, Anthony C.
- Fagan, Charles.
- Finlay, Thomas A.
- Finucane, Patrick.
- Giles, Patrick.
- Glynn, Brendan M.
- Hession, James M.
- Hughes, Joseph.
- Kenny, Henry.
- Keyes, Michael.
- Kyne, Thomas A.
- Larkin, James.
- Leary, Johnny.
- Lindsay, Patrick J.
- McAuliffe, Patrick.
- MacBride, Seán.
- MacEoin, Seán.
- McGilligan, Patrick.
- McMenamin, Daniel.
- Manley, Timothy.
- Morrissey, Dan.
- Mulcahy, Richard.
- Murphy, Michael P.
- O'Sullivan, Denis J.
- Palmer, Patrick W.
- Pattison, James P.
- Reynolds, Mary.
- Rooney, Eamonn.
- Spring, Dan.
- Sweetman, Gerard.
- Tully, James.
- Tully, John.
Tellers:—Tá: Deputies Ó Briain and Hilliard; Níl: Deputies Doyle and Spring.
Progress reported; the Committee to sit again.
Question declared lost; amendment negatived.
I move amendment No. 2:—
To add to the section a new sub-section as follows:—
( ) In any case where any of the women referred to in sub-section (1) of Section 16 of the Health Act, 1953, are at any time on or after the 1st day of August, 1954, receiving medical, surgical, midwifery or specialist services in respect of motherhood made available by a health authority then notwithstanding any regulations made pursuant to this section in every such case the provisions of sub-sections (3) to (5) inclusive of Section 16 of the Health Act, 1953, shall apply.
Section 16 of the Health Act of 1953 deals with medical care for mothers. It puts an obligation on the health authority to make available, without charge, medical, surgical, midwifery, hospital and specialist services for attendance to the health of women (being women specified in sub-section (2) of this section in respect of motherhood. They of course, the same group as we have been speaking about already in that section which has been mentioned so often, Section 15. The effect of this amendment, if passed, would be that the health authority would not be obliged to provide the services but would be obliged to give the benefits of the section to all those women who find themselves in hospital or receiving a service of this kind from the health authority. Further, it would give them the benefits of sub-sections (3) to (5) of Section 16 of the Health Act of 1953.
This amendment is parallel, if you like, to the amendment we have already put before the House, and which has been defeated, except that it refers to women only and to maternity.
The only objections that the Minister made to the application of these sections when he was bringing in this amending Bill were, first, that there was not sufficient hospital accommodation and that the necessary preparations, therefore, were not made; and, secondly, that being the case, that those women who were in the public assistance class, who now have priority, would no longer enjoy that priority and therefore might be squeezed out. If this amendment were agreed to the local authority would still, until the sections are properly brought into operation, be bound to give priority to those in the public assistance class, and that objection therefore——
Could I interrupt the Deputy? The amendment, as it is on the Order Paper—I do not know whether it is international or not— excludes hospital service.
That was not my intention, I must say.
Is it intended to be "hospital, surgical"——
I think that as the original section was drafted——
I was wondering if it was omitted deliberately. The section says "medical, surgical, midwifery, hospital and specialist".
My recollection—certainly my intention was to copy down the first sub-section and I do not like to say that the office was responsible. Perhaps through an oversight I was responsible.
I do not mind. I will take it that the Deputy intends to include "hospital".
Yes, I am arguing on that basis if the Minister will accept that. If the amendment were passed it could not be argued that the public assistance classes would be in any way at a disadvantage, because they would still enjoy the priority that is there for them at the moment. The effect of the amendment, therefore, would be that those women who are actually receiving medical, surgical or obstetrical service, whether at home or in hospital, and who would come under Section 16 if it were in operation would enjoy the benefits of that section without having a priority, the reason for that being that the Minister had argued that there was a danger if that priority was removed.
I did speak on the last section with regard to hospital accommodation, but I purposely omitted to deal with one section of that, that is, with regard to maternity accommodation. I would like to resume as far as that is concerned. The Minister spoke a good deal here last week in his two speeches with regard to overcrowding, as it were, of the maternity hospitals here in Dublin. It is well just to take these hospitals first for the moment. There are three maternity hospitals in Dublin—in order of seniority—the Rotunda, the Coombe and the National Maternity Hospital in Holles Street. The Rotunda and the Coombe look after a very large number of cases, but it is traditional with them to look after a large number of their cases, as they call it, "on the district"—in other words, in their own homes; so that while we might talk of the number of beds in the Rotunda or in the Coombe Hospital that does not in any way give you an idea of the number of women that they look after, because they do send out their medical staffs to the district to look after the women in their own homes and in that way they look after a very large number indeed. It will be seen that if there was even a larger number to look after it would be easy to extend this service. There would not be any great difficulty in the Rotunda or the Coombe in giving more service on the district than they are giving, that is, to look after the women in their own homes.
Holles Street, however, which is a hospital that came into being much later than the others, has had a different tradition, inasmuch as it looks after most of its cases in the hospital and has never built up to any great extent that type of service on the district that the other hospitals have. It may be said, as it was by Deputy Larkin when he graced this House with his presence, that it would be better if women were looked after in hospital, but I think that if anybody will examine the records of the three Dublin maternity hospitals he will find that the service that is given, based on the test of mortality, is as good in the Rotunda and the Coombe as it is in Holles Street. In other words, those two hospitals, even though they have to look after a great number of women in their own homes, have been just as successful in their work as Holles Street has been. We can take it, therefore, that if we want to extend our maternity service in this country it can be done in the woman's home just as well—practically as well, anyway—in the normal case, of course, as it can in hospital. There are, as we all know, many cases that must be sent to hospital, but that proportion is small and we would have quite sufficient beds to deal with them.
The Minister in speaking about this last week said that in the provision of maternity beds nothing was done good, bad, or indifferent. My recollection is— I have had to explain here several times that I did not keep figures or records of what had been sanctioned when I was there and I have only my recollection to go on—that an extension of the number of beds has been sanctioned or at least on the point of sanction for both the Rotunda and Holles Street. That number, of course, is small. It does not mean very much. The Coombe is building a new hospital. That will take a few years building. St. Kevin's, however, is providing an 80-bed unit, and that should be ready in the very near future, certainly before the end of this year.
It was also said by the Minister that no arrangements were made with these hospitals. I would like to direct the Minister's attention to a letter which was received by the Department, by me, somewhere between the middle and the end of May—a joint letter from the three maternity hospitals in Dublin. The three hospitals at a meeting had considered what they would do with regard to the operation of the Health Act, and they wrote a letter to the Department telling what they were prepared to do. They were prepared to operate the Health Act—on certain conditions, of course; and I think that no Minister looking at those conditions would say that they were all unreasonable. He might not altogether agree with them. I personally would like to modify them if I was dealing with them myself, but on the other hand, another Minister might regard them as reasonable and say that they should be accepted. I am certain of this, however—that a Minister who was sincerely anxious to operate the Act as far as maternity is concerned would see in that letter from these three maternity hospitals, certainly, if not a scheme he would be prepared to accept, at any rate a scheme he could discuss with those hospitals and come to an agreement in a very short time. In that meeting of the three hospitals before they sent this letter the professional staffs were represented, and they were prepared to agree to the terms laid down in it. As I say, an agreement could be reached that would make it possible to have the Act operated.
There were Deputies in this House who spoke on the Second Reading, who had supported the Health Act, 1953, but who were impressed by the Minister's plea for delay. I would say to those Deputies if they were genuinely impressed with the necessity for the 1953 Act—I would say to them in absentia, perhaps it will be conveyed to them—that if they ask the Minister to have a look at this letter they will say to him: “Well, that was a fair basis and could have been pursued”; and in fact I think that if they looked at it in any impartial way they would say to the Minister: “This postponing Bill was not necessary when that letter was before you.” I might be asked what did I do about it when I received that letter. As I say, I would have liked to have modified the terms made by these hospitals, but I realised very shortly after receiving it, if not at the time I received it, that I would not be Minister.
I, therefore, was not going to queer the pitch for a new Minister by writing back and saying: "If you alter your proposal in regard to so-and-so, I will agree." I thought it only fair to let the new Minister deal with the letter as he thought fit. He might ask for amendments in the scheme put up for which I would not ask, and, on the other hand, he might not ask for some of the amendments for which I would ask. It was, therefore, left to the new Minister to deal with. I say, therefore, very emphatically and very sincerely that the Minister could get an immediate agreement with the voluntary maternity hospitals on the basis of that letter from these three maternity hospitals, and that we could operate in this city a maternity scheme under Section 16.
In addition, as I have already said, there will be 80 beds coming into commission in St. Kevin's, and they will certainly be sufficient to put Section 16 into operation. Outside Dublin, 50 beds were added in Cork not so long ago—perhaps a year ago—in St. Finbarr's, and there are 50 others being provided. I do not know how long they will take to be ready, but, even if they take a considerable time, we have at any rate 50 additional beds in a city of the size of Cork in recent times and they should be sufficient to operate the maternity scheme so far as it goes in Section 16. Throughout the country, many additions have been made in the form of maternity beds to county hospitals and there is, of course, a maternity hospital sanctioned for Limerick, but it will not be available for some time.
Those who argue against the feasibility of operating the 1953 Act always appear to assume that when this Act comes into operation every woman will be going into hospital to have her baby. There is no such intention. Even in the regulations made, there were laid down very clearly the conditions that would apply to the woman who had her baby at home and the woman who would go to hospital, and it is intended that it is her own doctor who will decide whether she will stay at home or go to hospital. He must take into consideration not only medical but social conditions. He must take into consideration the type of home she has and whether it is a sanitary place for a woman to give birth to a baby. According to figures supplied by the Minister to Deputy Briscoe, we appear to have in this State at the moment somewhere about 1,800 maternity beds. If they are each able to provide for 25 women in the year, we would have two-thirds of all births in this country in hospital. That is probably more than we require, and, in many of the other well-hospitalised countries, they have not more than that. No case could be made that we have not got enough maternity beds to carry the section out.
The object of the Act under this heading was to enable a woman to employ her own doctor and that doctor would then decide whether she would have her confinement in her own home or in hospital. The doctor would, in the ordinary way, advise her to have her baby at home, if it were going to be a normal birth, and, if it were not, he would certainly advise hospital treatment. In the ordinary way, however, as I say, she would be induced to stay at home by the financial arrangements. She would get a free doctor, a free nurse and even a free maternity pack—the equipment and dressings supplied by a hospital, if she went into hospital—so that every inducement would be offered to her to stay at home. I do not believe there would be any lack of beds to operate Section 16.
I want to make it clear, therefore, that I still believe that Section 16 could have been operated. I still believe that the number of beds were, and are, sufficient. We are as well hospitalised as practically any other country in the world, so far as maternity beds are concerned, and a case cannot be made on that basis against the operation of Section 16. As I have already mentioned, the Dublin maternity hospitals, with their technical and medical staffs, were prepared to operate the Act on a certain basis.
It was a basis to which the Minister could agree or ask for further discussions and have it put into operation without any great delay. If the Minister is prepared to produce that communication from these three maternity hospitals and if any fair-minded person in the Dáil or elsewhere who believes in the efficacy and urgency of the 1953 Act says: "Even so, I think the delay is necessary", that would be his opinion and I would not find fault with it, though I would not agree with it; but I contend that the beds are there.
Even if the Minister contends that we are still somewhat short of beds and that there is a danger that those in the public assistance group may be squeezed out and may lose the priority they now have, by accepting the amendment, no harm is done to these people. You merely apply the section to those outside the public assistance group who may and will be getting treatment at the time of maternity. One of the objects of putting the section in was to encourage women to employ a doctor during childbirth. I am sure that Deputies are well aware that many women in this country have their babies with the aid of a midwife and without a doctor. Our maternity mortality, although by no means appalling, is too high and we want to bring it down, and one of the objects of Section 16 was to encourage women to employ a doctor during that very critical time and in that way to reduce the maternity mortality. There will be that advantage also in accepting the amendment and I urge the House to look with favour on it and try to induce the Minister to accept it.
The Minister has stated time and again in connection with the Bill in general, and I am sure he would say the same thing with regard to this amendment, that he is not postponing the Health Act of 1953, but merely bringing in its provisions step by step according as facilities are available for the various categories. I wonder does the Minister take the line that all local authorities must be in exactly the same position to implement Section 16 of that Act. If that is the case, my information is that a number of local authorities are not quite as up to the mark as others and is it fair on the Minister's part to force these local authorities, which are at present in a position to implement fully Section 16, to mark time and to deprive the people of the facilities available to them under that Act, until such time as other local authorities have made the necessary arrangements?
I support this amendment which Deputy Dr. Ryan introduced because I am familiar with the situation as it is in my own constituency. I can assure the Minister and the House that the local authority of which I happen to be a member is prepared to operate fully Section 16 of the 1953 Health Act from the date as set out. Our local authority looked ahead when the 1953 Act was going through the House. We felt it was the duty of the local authority to ensure that all preparations would be made to carry out the particular sections of that Act and we were especially anxious to provide the necessary services under the mother and child section. At the present time our county surgeon has just completed a special refresher course in London on gynaecology in order to be able to implement Section 16 of the 1953 Health Act. We have our county physician who is there available to do the obstetrics.
Although the Minister's argument is that accommodation and beds are not available, I want to assure him that this is not so in Roscommon. Our local authority can cater for all cases at the present time. I understood him to say here the other night that since the passing of the 1953 Health Act no additional beds had been provided for maternity cases. In the last few months Roscommon County Council has provided 14 additional beds, and that in a very small local authority like Roscommon is a tremendous achievement. If we work it out on the basis that each bed can cater for 25 maternity cases in the year, that is a provision for 350 new maternity cases made in the last few months in my county.
I would like to pay a tribute at this stage to our officials and staff on the local authority for the foresight they had and the enthusiasm they put into-their work because they were anxious to see that this particular section of the Health Act, 1953, would be implemented. One of the most important things we must all have for the success of any measure is enthusiasm and the desire to see it work. We have a typical example of the enthusiasm and efficiency of a staff shown in a local authority whereby they have now made the necessary arrangements to put into operation completely Section 16 in connection with mother and child welfare.
I would suggest to the Minister, if he finds himself in a difficulty as far as accommodation is concerned in some local authority areas, that he should not penalise those areas which have shown initiative and have taken the necessary steps to enable the 1953 Health Act to be implemented. I would, therefore, ask him to ensure that, if he does not find this particular amendment acceptable, he will make provision that those local authorities which are in a position to implement Section 16 which deals with maternity care for mothers and infants up to six weeks would be allowed to implement that particular section.
I take it the Minister will permit me to argue on his figures in connection with births in the City of Dublin that he gave us when introducing his Bill. He stated that the total number of births in the City of Dublin would be around 16,000 per year. Of those 16,000, 6,000 would be connected with what is now known— and which I hope soon will be forgotten—as the assistance classes. We all admit that the average requirements for a bed for a maternity case would be approximately on the basis of two cases per month. The Minister also said that to deal with the 6,000 assistance cases we required somewhere between 220 and 240 beds.
The income group to which Section 16 refers brings in an additional number of our population and, taking the Minister's figures again, it would mean that another 3,000 cases would have to be catered for, not more. If an additional 3,000 patients have to be catered for in Dublin, taking the figure of the bed requirements, it would mean you would require an additional 110 beds. We have 220 to 240 beds; we will have an additional 80 beds within the next few months in St. Kevin's, so that you have almost all of your bed requirements.
Another aspect of this matter with which I wish to deal is in connection with our maternity hospitals.
Deputy Dr. Ryan referred to a letter written to the Department of Health by our three maternity hospitals as a result of consultations amongst themselves and their staffs. I ask the Minister now if he is prepared to read that letter to the House. If he does not read it to the House I will publish it. I happen to be a governor of one of those hospitals and I know what the contents of that letter are. There is no dispute in the hospitals about the carrying out of Section 16 of the Act. There is no statement that the facilities are not there. They made certain requests which Deputy Dr. Ryan said, as Minister, he might have asked them to modify but which he felt might even be acceptable to the present Minister; but from the point of view of applying the services there is absolutely no doubt that it could be done and no reason at all to take the line that Section 16 should be removed from the 1953 Act.
Deputy Dr. Ryan talked about the way the Coombe and the Rotunda hospitals operate, as distinct from Holles Street Hospital. In any discussions I heard, when in attendance at board meetings, in connection with this particular development, it was welcomed, for this reason, and I referred to it briefly on the Second Stage of the Bill. It is desirable, in the opinion of the Medical Board, that every woman having her first baby should come into hospital; and on the basis of the experience they have of the mother in giving birth to the child, they know whether in the case of a second, third or fourth baby such baby can be born at home, provided the home circumstances are also suitable.
Apart from that, there are cases where mothers require certain additional convalescence and there are cases where babies require additional attention in their initial stage. They do not come out like machine-made articles: every case has to be judged on its own. It was quite easy to contemplate the taking over of a couple of buildings and adding the necessary accommodation requirements for what might be called convalescence or post-birth circumstances where there was no danger or no problem. In any event, the great number of cases that are attended to in their own homes at present must be dealt with in the way Deputy Dr. Ryan indicated. I think we are fast reaching the state of affairs when, in particular, in the case of the first baby it is essential that the birth take place under the control of a qualified practitioner, a doctor.
I have asked the Minister is he prepared to read the letter from those hospitals, is he prepared to take the House into his confidence; and I challenge him, if he does not do so, that he is withholding the contents of that letter for the simple reason that he knows what we on these benches say happens to be correct, that Section 16 of the 1953 Act can be operated immediately, that there are no physical difficulties, that there are no objections, that there are only just the terms and conditions to be settled between those hospitals and the State.
The civil servants who are in the under-£600 a year income group may be very happy that they have been given a sop in the arrears of salary, but there has been taken away from them a very valuable benefit under this section of the Bill. If it is not implemented they will begin to regret it very soon, when their eyes are opened as to what is behind all this.
I know the Minister is not going to be drawn by me now with regard to this letter, but I say categorically to the Labour Benches that they ought to be very reluctant to oppose this amendment.
You read the letter.
I have not got it here. I am asking the Minister to read it. I am saying now to the Labour Benches, through the Chair, that there is a letter in existence from the maternity hospitals in Dublin which does not object to Section 16, which shows they are prepared to implement it and that it can be done. There is no excuse whatever for denying the public the benefit of Section 16. I say to the Labour Deputies that before they vote against this amendment they should ask the Minister, if he will not read the letter, to show it to them privately so that they can make up their minds as to whether they are being misled by not knowing the circumstances. I am making this categorical statement now and would welcome a denial if it is possible to deny it.
Deputy Larkin asks me to read the letter. Deputy Larkin was not born yesterday; he is a very experienced fencer in political arenas. What I said before I repeat, that the Minister has the letter, he will either show it to the Deputies or will produce it to the House—or he will not.
The Deputy said that before.
Deputy Larkin asked me why I would not read the letter and I am belatedly replying to that interjection. If the Minister does not read it I, as a governor of the hospital, will ask for a copy of the letter and I will publish it—with the statement that I had previously made the members of this House aware of the contents of the letter. I do not think anybody could be more clear and specific in supporting this amendment than I am at this moment.
I mentioned, on the Second Stage, that I could not understand the necessity for the taking away from the Health Act of Section 16. Deputy Alfred Byrne knows very well the services that both the Coombe Hospital and the Rotunda render to the people of the City of Dublin in the matter of births. He knows, possibly as well as anybody, the way these hospitals care for the people, take them in for treatment when necessary and send out the district persons to serve the districts. These two hospitals are quite willing to extend their operations to those who are in the under-£600-a-year income group.
Apart from the services, apart from the health side, which is the most important, there is also the money help to the people. There are grants inherent in this. There would be the £4 maternity grant, apart from the payment of the medical fees, the choice of doctor, and so forth. All these things come into it. In the case of an industrial worker who does not qualify for assistance, he gets a double grant, because he gets a grant under his ordinary circumstances, apart from the grant that would occur under Section 16.
I believe that, even at this late hour, even if it does not go to a division, if the Labour Party lift their little finger and say to the Minister: "Do not take this away from the people, whatever else you do", there will be no division and the Minister will agree. To that extent, I say to the Labour Party that those of them who are here have to bear on their shoulders the responsibility as to whether the people who are to benefit under Section 16 will benefit or not.
It is very interesting to hear Deputy Briscoe as an honest pleader appealing at this stage to the Labour Party to accept their responsibility in regard to the present Bill. I feel that if we had a little more honest pleading in respect of the present Bill from the members of his Party, both since the commencement of this discussion in the House last week and particularly before it was discussed in the House, we might be a little clearer on it. We had a discussion last week on Section 16 and we are aware of the statement made by the Minister in regard to what he said was a shortage of maternity beds. Deputy Briscoe now tells us there is a letter in existence, written by one of the maternity hospitals.
Written on behalf of all three.
That is better still. This letter was written on behalf of the three maternity hospitals, indicating quite clearly that they did not envisage any difficulty in carrying out fully the provisions of Section 16. Surely, for the sake of clarity, this letter should be produced. They have had a week in which to get that letter and produce it. Let the Minister read the letter, too. But let us note the addendum: if the letter is not read to-night, Deputy Briscoe will publish it.
I will get a copy.
But, by the time he publishes it, this debate will be over.
I will get a copy.
I am asking for it now.
There is the Minister, and it is he who is responsible.
But the Deputy is responsible for introducing the letter here to-night. He is a governor of one of the hospitals. We are merely trying to get a clear picture on this matter. From the first moment this debate was introduced the whole atmosphere has deliberately been bedevilled and turned into a political cockpit so that, even when we get a statement, such as the statement Deputy Briscoe made to-night—I have great respect for Deputy Briscoe and 99 times out of 100 I would immediately accept any statement he makes —I have considerable doubts. Why does the Deputy not produce the letter?
Ask the Minister.
Do not pass the buck.
Do not put the responsibility on my shoulders.
If you are the governor of one of the hospitals——
If we have the third person, it will be better.
Agreed, but I did not introduce the letter. So far as this amendment is concerned, we are again getting the usual cloudy debate. The section in the Bill is for the purpose of giving power to the Minister to make certain regulations under which an order of priority can be established in relation to certain sections. Deputy Dr. Ryan proposes an amendment to that. I am not quite clear as to what he has in mind. Perhaps he, or the Minister, will clarify the point for us. One thing is quite definite: so far as the amendment is concerned it has nothing whatever to do with hospital beds and it is no use building up a case for the amendment on the proposition of either Deputy Briscoe or Deputy McQuillan that in the particular hospital or local authority area there are maternity beds available, because the amendment refers only to medical, surgical, midwifery and specialist services. It is noticeable that in so far as Section 16 is concerned the word "hospital" is left out of the amendment.
The Deputy said at the beginning that was an error.
I accept that. In so far as the amendment is concerned, its actual provisions seek to restore the application to the women covered by the section of sub-sections (3) to (5). Sub-section (3) deals with the question of payments and sub-section (4) deals with the question of making regulations. In that regard, the regulations include the responsibility of providing for a choice of doctor by means of agreement entered into with the medical practitioner who is prepared to enter into such an agreement with a local authority.
I recall that in last week's debate the Minister said he had hopes that in so far as that choice of doctor was concerned he would be able to implement it and make it available. Equally, I recall that in regard to that particular point in relation to choice of doctor in maternity cases, Deputy Dr. Ryan went to great lengths to point out what appeared to him to be the almost insuperable physical difficulties at this late stage in arriving at agreement which would make that choice available. That was a debating point because he then went on to say that if all these very great difficulties in relation to the provision of a choice of doctor could be overcome, then, equally well, the other difficulties in regard to the full implementation of the Act could also be overcome.
Listening to him when he outlined in some detail, with all his professional knowledge and his background as Minister for Health in the last Government, the difficulties that lie in the way of the present Minister being able to implement that choice of doctor, it seemed to me we should have some explanation as to whether in fact there is a reasonable opportunity of the Minister now being able to meet the requirements of sub-section (4), making the necessary regulations, including regulations providing for a choice of doctor. That is why I am not quite clear in relation to the purpose of the amendment except in so far as we are, apparently, dealing with this kind of political fencing which has been going on around this Bill since last week.
Quite clearly the purpose of this amendment, as with the others, is that if the main issue in regard to the deferment of the operative date from 1st August is not to be prevented by the Opposition, then they will do it by way of introducing a series of amendments which, if they are carried, will, in effect, take away all the benefit the Minister may feel he can secure in relation to the bringing into operation of the various sections of the Bill by creating such difficulties and so many back doors through which the various sections of persons qualified under the Act can claim, in some cases by dubious means, the benefit of the Act, not on the basis of qualification but on the basis that they have either secured medical attention already and by that established fact become entitled to the full benefit of the Act.
That peculiar approach is indicative of the course of the entire debate on this matter. If there is no ground for the postponement of any section of the Act, then it seems to me it would have been more preferable for the Fianna Fáil Party to stand firm on that issue of principle and fight it. If, on the other hand, there is a case to be made for the postponement of the operative date, then let us face up to that situation. As far as I can see, both in regard to the discussion on the Second Reading and in relation to these amendments, they want to have the best of both worlds. I am still somewhat puzzled as to the full implications of the amendment, and I hope that Deputy Dr. Ryan and the Minister will make clear what is in effect the benefit conferred by the amendment if one looks at it from the point of view of those who want to see the full section in operation. Alternatively, what are the difficulties which will be present in securing the introduction of the ordinary services under the Bill? Again, we have confusion because of the introduction of cross-issues in discussing Section 16 dealing with maternity cases and then discussing child welfare and the payment of maternity grants.
Section 16 deals with maternity cases and the provision of the various services. It might be helpful if we kept to that instead of broadening the debate by introducing other issues not covered by the particular section.
I want to say a few words in explanation. Deputy Larkin, having thrown in his lot with the Minister, is the most able advocate the Minister now has. Whatever one puts up, Deputy Larkin is able to knock it down; and he is prepared to go even further than the Minister now in his advocacy of the postponement of this Bill. Of course, I recognise his difficulties. The Labour Party has swallowed the anchor, as it were. The Deputy cannot now go back and say that he was wrong or made a mistake.
He stated that I said there would be great difficulty in introducing a choice of doctor. That is a most unfair interpretation of what I said. I have held all the time, and Deputy Larkin knows this, that the Act could be operated on 1st August. Deputy Larkin, however, professes to believe that the word of a person on this side of the House, who is most anxious to put the Act into operation, cannot be taken, but that we should take the word of a man on the other side of the House who talks all the time about the impracticability and impossibility of implementing the Act. Deputy Larkin is now prepared to do that. I am not, therefore, very hopeful of convincing Deputy Larkin by anything I may say because he has taken his stand.
I was arguing that the Minister said he would operate Section 16 for the lower income group. That means there must be a choice of doctor. I went on to say that, in my opinion, that was one of the most difficult things in the Act. Hospital accommodation, about which the Minister was arguing, was not a difficult matter and if the Minister was prepared to say that he could bring in that choice of doctor on 1st August next, then he could do nearly anything required under the Act. Because I argued in that way Deputy Larkin interprets me to the House as saying that the choice of doctor is almost impossible.
If the Minister is going to provide the choice of doctor for the lower income group there should not be much difficulty in providing it for everyone, because the panel is there and can be used. Deputy Larkin must see that if he wants to see it, but he does not want to see it. He wants to take his stand in arguing the thing to the bitter end, and he will stand by the Minister. Surely, Deputy Larkin or, in fact, a less intelligent person than Deputy Larkin, must see, that if you have a choice of doctor, which means that the local authorities must have a list of doctors in each area who are prepared to work the Act for the lower income group, there is not much trouble in saying to every other group: "There is the list for the choice of doctor." But Deputy Larkin has gone so far in supporting the Minister that he cannot see that. I have pointed out to him that the choice of doctor is there for the other groups as it is for the lower income group. We can, therefore, put that aside. There is no difficulty because the Minister has pointed out that he is going to bring in the choice of doctor. Deputy Larkin has shown plainly that he thinks that whatever the Minister says is right. Let him believe him in that, too, that he is going to bring in the choice of doctor.
The Deputy has asked us to produce the document. It is the Minister who has it. How can we produce it? If I had acted as Ministers did in 1951 and had taken documents out of the Department, I would have it, but I did not act that way. The document is there on the files.
Deputy Briscoe said that he was publishing it.
I said something different.
I am saying where the document is. I do not see any difficulty about publishing a document like that. If the Minister says there is a difficulty, let him show the document to Deputy Larkin, let Deputy Larkin be honest about it, and come back and say that he saw the document and that it did not make any difference as far as he was concerned. I think that when Deputy Larkin sees the document he will say to the Minister: "You misled us", and that it was not we who did it.
In reply to what Deputy Dr. Ryan has said as regards a misunderstanding about the document, there is no point in my opinion in seeing the document after the Bill has gone through.
It has not gone through yet.
I pointed out, when Deputy Briscoe referred to this letter, that I took it it was in the Department because he invited the Minister to read it. The letter was sent by the three maternity hospitals, and I take it that they have copies of it.
They have.
Deputy Briscoe knew that last week.
No, I did not. Do not assume things.
All that I want to get clear is this. We are told that there is a document in existence which will convince me that the Minister is wrong. I have pointed out that it was quite clear that, at least, in so far as Deputy Briscoe is concerned—it is possible that Deputy Dr. Ryan may have overlooked the letter—he must have known of that letter last week. If he was so concerned to enlighten the members on this side, why did he not—there was nothing to stop him— read the letter, and not wait until the Bill is passed to publicise it?
So far as Deputy Dr. Ryan's comments are concerned, I frankly do not accept what he says or what the Minister says, but I am greatly swayed by what the National Health Council says, the council which he appointed and which he now, apparently, repudiates. That is what concerns me.
Is that what convinces you?
I have regard to the fact that some of the members of the National Health Council were nominated by bodies with which I am associated. After their nomination they were appointed by Deputy Dr. Ryan, who was then Minister. I myself was one of those who paid particular attention to the inclusion of a provision for the establishment of a National Health Council under the Health Act. I did that when the Bill of 1953 was going through the House. I felt that, if a situation arose in the future, the existence of that council would be a particular guide for those looking for an unbiassed opinion from a council made up of different individuals. It is quite possible that if they arrived at a decision with a divided voice, one might be inclined to take one point of view or the other depending on the members of the council who had spoken for or against a particular motion.
I have not yet heard from Deputy Dr. Ryan a satisfactory explanation because of his attitude in respect to a unanimous decision by the National Health Council. They may be right or they may be wrong, but they have been dealing with this matter continuously since they were appointed. As I am one of those who attach considerable importance to the council, it seems to me more important to pay attention to what they have to say than what either Deputy Dr. Ryan or the Minister has to say. I do not know if there is anything wrong with that approach.
I have not changed my attitude with regard to the National Health Council. Deputy Dr. Ryan seems to have. On the occassion of the Second Reading debate, he indulged in some peculiar debating points. He tried not merely to undermine whatever authority or public confidence the National Health Council had, but in fact to make it what everybody was anxious it should not become, a part of political exchanges of a kind that go on around this House. The result is now that, in regard to the various Parties in this House, if we could have accepted the position, whatever may be our political views either in regard to the main Act or the present Bill, we could at least have taken guidance from this body which was brought into legal existence by Deputy Dr. Ryan's own Act with the support of many of us in this House. I have described how the council was formed. It provided at least a platform to which all of us could have had regard. Now the platform is undermined, and we are told that we cannot expect any guidance from it.
What was the verdict of the council?
I do not know because apparently whatever resolution or verdict it came to it is no longer to be accepted as being the verdict or viewpoint of an independent body. It is now to be regarded as some kind of a collection of individuals who will jump when the strings are pulled. If that was the kind of council that Deputy Dr. Ryan appointed when he was Minister, then, again, I think he is responsible. I understand that, whatever may be their individual views, they were appointed for their standing in the public life of this country, their professional knowledge and experience, their experience of public administration and of public health matters. Now, apparently they are such a collection of spineless individuals that the Minister may call them together and say to them: "Look, I want a recommendation to postpone so many sections of the Act," and they automatically act—and that is a council constituted to carry some responsibility.
With regard to the National Health Council, I do not want to have any misunderstanding. I said that the Minister had made up his mind to postpone the Act and that the Labour Party had agreed to that. Deputy Larkin now tries to give us the impression that he was swayed by the National Health Council, but the Labour Party had agreed to that before the National Health Council met. Deputy Larkin and the Labour Party did not know what the National Health Council was going to say at that time. At any rate, having got agreement from the Fine Gael Party and the Labour Party, the Minister went to the National Health Council on what, as I have said, he knew was a controversial political question— whether this Act should be operated or not. He went to that council to get their opinion, knowing or expecting what their opinion would be.
I said that that was dragging the council into politics. Deputy Larkin can twist that around and say that I set up a political body, if you like. When I set up that National Health Council I made it very clear. I was asked the question very distinctly had they any executive function and I said: "None whatever" that they were advisory; the Minister could listen to their advice and could take it or not take it as he saw fit. Is Deputy Larkin going to persuade us in this House, this sovereign Assembly, that we must do what the National Health Council advise us to do because Deputy Larkin is seeking a way out for the decision of the Labour Party but it was post factum, what he is quoting now. The Labour Party had agreed to this proposal and then they came along and gave their advice and now he quotes them as swaying him in his opinions. I did not use the words, “pulling strings”. It was the Minister who used them. I never said a word about pulling strings but the Minister said that when I was there I had the opportunity of pulling strings. I never used the expression until he used it first.
I said you were accusing me of having pulled strings.
I said the Minister went to the council; he made his case and expected to get a certain decision.
I did not make a case.
I said a very carefully worded resolution was put up by a representative of the Labour Party and that neither he nor anybody else there could have written it out after hearing the Minister. It was too cleverly done. It had, of course, we all know, the hand of Deputy Norton. We all know that. That is what I said, that the resolution was brought in in somebody's pocket. It was all arranged beforehand. I suppose the great majority of the National Health Council did not know of these things that were going on. They gave their opinion on hearing the Minister and that was that. Again, I say, they were dragged into politics by the Minister.
I want to intervene now because I do not think the last contribution made by Deputy Dr. Ryan is worthy of him or worthy of the position which he held. I think the Deputy has conveniently forgotten matters to which I referred on the conclusion of the Second Reading debate. I was not the Minister for Health on the 29th May. The Deputy was. On the 29th last May I did not even know I was going to be Minister for Health. The Deputy knew that he was Minister for Health. On the 29th May a resolution—unanimous resolution—was sent by the National Health Council to the Deputy as Minister, dealing with this particular subject that we are now discussing. The Deputy seems to have forgotten that resolution.
No. What has that got to do with it?
The resolution which came to my predecessor on the 29th May was:—
"The National Health Council, having further considered the maternity and child services regulations, passed the following resolution and directed that it be transmitted to the Minister for Health. The resolution is as follows:—
"Having regard to the complexity of the regulations, the absence of the necessary services and the importance of full and proper consideration by the council of the regulations in the interests of the people and the undetermined arrangements regarding hospitals and medical and nursing staffs, etc., the council gravely doubts whether the facilities which are required for the operation of the maternity and child services regulations are available or can be made available at the date of coming into operation of these regulations'."
That is a resolution containing an expression of opinion from the National Health Council, the advisory body to the Minister for Health and established by my predecessor, an opinion given by them before I became Minister for Health, while my predecessor was still in charge. Is it to be suggested that in some way that council in expressing that view were acting wrongly or mala fide or doing something that they were not perfectly entitled to do?
I do not think it comes well from any member of this House, and least of all from the Deputy who set up that council, whose duty it should be to respect them and their views, to come in here and, merely for the purpose of a short-time political advantage, to upbraid the council that have expressed a view that is not shared by him.
I, unlike the Deputy, have not had the long experience that he has had in the Department of Health. I am there a very short time. Unlike him, I am not a doctor. I am, therefore, merely, as a layman, acting on advice and I hope that for so long as I am there I will never shut my mind to advice from whatever source it may come. As a Minister for Health, being charged with the duty of carrying out health legislation, the first body to whom I must look for advice is the statutory advisory body established by my predecessor to advise me on health problems. Am I acting wrongly when I do that? Am I acting politically when I take into consideration a view freely expressed by a body not formed by me, over whom I can exercise no jurisdiction, put there by my predecessor to advise him as Minister for Health? In what circumstances can Deputy Dr. Ryan suggest that that is wrong when the National Health Council express, as they are bound to express, an opinion on important services for the health of the people? I think his contribution has been a disservice to that body.
The National Health Council comprises people who are profoundly opposed to the political views I share and which Deputy Larkin shares. It comprises men who are members of Deputy Dr. Ryan's own political Party who, so far as their politics are concerned, might, naturally, not be displeased at any political disadvantage that might come to me or to Deputy Larkin or to any other Deputy on this side of the House but they are men who have taken their position seriously and, taking it seriously, have given their opinion quite removed from politics, freely and unsolicited, as to the provision of these improved services for the people.
While I suppose these remarks may not be strictly apt with regard to the amendment, I feel, a Leas-Cheann Comhairle, it is right that the mild protest which I have uttered with regard to the remarks of Deputy Dr. Ryan in relation to the Health Council should be made because I think it is wrong that that body and their views should be bandied around in this debate in order to secure for a point of view in the debate a short time political advantage.
The facts are the National Health Council, before ever I became Minister, expressed a view which I have incorporated in a legislative proposal here. After I became Minister, they expressed that view also. If the Deputy thinks that because they expressed their view after I became Minister, it is to be disregarded, how can he reasonably say that the expression of the same view before I became Minister is also to be disregarded? I was just coming to the amendment itself. Frankly, I find it difficult to understand the purpose of this amendment. I appreciate, of course, that the Bill itself is a technical one to a certain extent and it is not possible for a Deputy, and indeed it is difficult enough for a Minister with the assistance of his Department, to express adequately what may be desired in the way of an amendment or a section, but at the same time, making all due allowances, I do find it difficult to understand what is proposed by this amendment.
The amendment says in effect that in case any woman of the various classes referred to in Section 15 of the Act which for this purpose is carried over in Section 16, happens to secure from a health authority the services set out in the section, then the health authority, in effect, should pay for and provide those services. I do not know how such a woman in relation to motherhood could have such services made available to her unless in fact the health authority was prepared to do so. I assume that what it was intended to say was that the maternity sections of the Health Act should go into effect on August 1st in relation to all the women originally envisaged in Section 15. I assume that is the intention, but that certainly is not what the amendment says.
Dealing with what I conceive to be the intention behind the amendment I would like to say this, and I do not care how it is misunderstood or played about by Deputies: I have not become Minister for Health, despite the views of Deputy McGrath, in order to cause people to be sick or to suffer; I have not become Minister for Health in order to take from the people of this country something my predecessor intended them to have. As I said before and I repeat it here, I am concerned as Minister for Health—and no matter who may doubt this they will find when I say it I mean it—to see established and provided in this country for our people even better health services than are contained in that Health Act, 1953, and I believe that, with the help and support of, certainly, the political Parties on this side of the House and I hope of the Opposition that that assurance will be carried into operation.
When I proposed this Bill to the House, the principle of which was accepted last week, I did not do so for the purpose of depriving anyone of anything; I did it for the purpose of enabling me to make my predecessor's Act work and for no other reason. I do not want to travel over all the ground covered in the debate last week and I think it is sufficient to say this— that health services can never be provided merely by passing an Act of Parliament.
If anyone thinks that that is the end of health provisions, then not only are they not doing their job but they are causing false hopes to arise in persons covered by the particular piece of legislation. A great deal more requires to be done. And in relation to all the services under the Health Act—and the maternity service is dealt with in this amendment—the question of accommodation arises; the question of agreements with the professions and hospitals arises, and different matters of that kind have to be taken into consideration. It may be easy for some Deputy to say: "Ah, accommodation —well, surely, we have enough beds there or we have enough beds here." I can see those as debating points, but they are only part of the problem that must face the Deputy of this House who is responsible to see that these services are provided—and that is myself.
On August 1st, were all these services to go into operation, naturally there must be medical men to provide the services. There are none at the moment. Deputy Dr. Ryan has mentioned the choice of doctor. You cannot have a choice until you have at least two doctors. At the moment there are none. You cannot have a choice of maternity hospital until you have at least two such hospitals. At the moment there are none willing to operate and enter into agreements necessary to carry out the provisions of Section 16. I, as the responsible Deputy of this House, have to secure to the best of my ability and in accordance with the obligation placed upon me by the Government and the House, the co-operation of the different bodies: I have got to ensure provision of necessary accommodation. That I intend to do. As I see it, it must be my concern to bring these services under this Act into operation in an orderly and rational manner. I cannot do it if efforts are made to extend the services in a haphazard way—by the back-door, if you like. That would completely prevent the orderly application of this Act that I regard as being essential. I cannot think well of any suggestion such as is contained in this amendment that a health authority should be compelled to adopt—if you like—any person outside the public assistance classes and other classes who happens to secure a hospital bed. That would place a premium on influence and wirepulling. I do not think it would be desirable. These other classes will be provided for uniformly and altogether just as soon as the necessary arrangements and the necessary accommodation is available for them.
Again, in relation to accommodation, I do not want to travel over the matters we discussed on the Second Reading because this amendment and other similar amendments are in effect amendments contrary to the principle of the Bill as adopted on the Second Reading.
Deputy Dr. Ryan and Deputy Briscoe referred to the question of maternity accommodation. It is true, as Deputy Dr. Ryan said and as I hope that additional maternity beds will be available in the future, but that does not meet my immediate problem. It is no good telling a woman who is now about to have a child that it is all right, that at the end of next year there will be a bed available for her. My concern must be, and will be so long as I am Minister for Health, to provide for the people in accordance with the facilities actually available at a particular time. My present problem in relation to different parts of the country is, as Deputy Briscoe mentioned in relation to this city, a very serious one indeed. I notice that Deputy Briscoe disregarded completely the situation that now confronts the National Maternity Hospital in Holles Street. That hospital provides accommodation in maternity and motherhood for women of the lower-income group. It has been doing its best to provide for all, but it has found it impossible to do so.
At the moment, as I said last week, the average stay for a woman of the lower-income group in Holles Street is something around five or six days. The minimum period advised, I am told, is ten or 11 days but just because there is not available for these women the accommodation that is necessary, they have to go into hospital, have the child, and be out in five or six days. Often—I have had reported to me actual instances of this—they are asked to leave and are put into a car or ambulance at four or five o'clock in the morning because another woman in labour has been brought to Holles Street and urgently requires a bed. Now there is no good in Deputy Briscoe, Deputy Dr. Ryan or anybody else talking about figures when those are the facts in relation to a hospital just not far from this particular building. Those are the facts at the moment, that the accommodation is not there, leaving aside the question of arrangements with other bodies.
Deputy Dr. Ryan is quite right in saying that the other maternity hospitals traditionally have provided services on the district for motherhood and maternity cases. That, of course, is so. At the moment some 3,400 cases per year are looked after on the districts by the Coombe and the Rotunda. Many of those women, in fact the vast majority, are in the lower income-group and they have been so looked after because it has not been possible to provide hospitalisation for them. Merely because that is the position, is not to be regarded as proof positive that accommodation is adequate. I hope to see, with the assistance of my Department, many of those cases dealt with in hospital in future.
Apart from anything else, while we have a housing problem in this city and while housing accommodation is not adequate or good, it is an appalling thing to think that over 3,000 births take place in perhaps not very suitable surroundings. I sincerely hope that Deputies will not regard the fact that domiciliary treatment is provided by two of the three hospitals as being proof that that is what is thought to be best. It is not.
May I just give the figures again for the information of the House? In Dublin City at the moment there are 200 public beds available. There are 117 private and semi-private beds. For public assistance cases alone at the moment, some 240 beds are required so that you might say that they are just able to stagger along. Actually the bed requirement is slightly higher than the births but with some difficulties in some places and with caring for a big number of births in the homes, they are able to carry on. Were I to operate Section 16, however, and apply the hospital right to the thousands and thousands of other women, the position would become chaotic. In Holles Street alone what would happen, were hundreds of other women to have the same right to go in there and to get beds? The average stay then, instead of being five or six days, would be much lower and there would be a fight in order to get a case into a bed. I do suggest to Deputies that they should appreciate that it is my concern. and that it will be my concern, to get these services into operation, but I am doing it in accordance with what I regard as being possible. I am doing it with due regard to what still has to be provided. I am doing it with the firm intention of providing better and better services for the people.
I do not regard this Health Act as being a good measure. I think that the theory behind it is not a sound one and, certainly so far as the principles in the Act are concerned, amendment may be necessary. I do not regard the services provided in the Health Act either as being the end-all of our provision for the people. I do wish to provide as quickly as possible far better services than are designed in the Health Act but my concern, as I said on Second Reading, is to get the Act as far as the services are concerned working as quickly as possible. To do that, I think the best way is to enable me to apply the Act gradually to the other classes in accordance with whatever arrangements may be made.
Deputy Dr. Ryan and Deputy Briscoe—I almost forgot to refer to this —mentioned the question of some letter. Now I never heard of any such letter until it was mentioned by Deputy Dr. Ryan. I wonder was the Deputy being absolutely frank with the House?
I wonder could he have been frank or was he merely making a debating point? Because if the letter to which I refer—I am sure it was written— meant anything it must have made an impression on his mind. If it made an impression on his mind, one would expect a reference would have been made to the letter last week and not this week. If there was any debating advantage or political advantage to be made with regard to that letter, would not one expect Deputy Dr. Ryan, when last week I spent some time referring to the problem of maternity beds in this city, to have said: "Wait a minute. Sure the hospitals are agreeing. They wrote me a letter only three or four weeks ago." But there was no reference by him at all to any letter. What has happened is that over the last week-end, I am sure, Deputy Briscoe, Deputy Dr. Ryan and the rest of them put their heads together and, perhaps, some friends said: "Do not forget that letter that was written away back. Refer to that in the debate. It is going to suggest the hospitals were going to agree."
I have not seen such a letter. I never heard of it until it was mentioned to-night but I have endeavoured, since it was referred to, to get some information with regard to it. Apparently, a letter was written some time ago to the Department when my predecessor was Minister. It is not clear whether that letter was written before the general election was announced or after but, in any event, the maternity hospitals raised a number of points in relation to the part they would have to play in the provision of these services and they asked for the views of my predecessor or the Department on these points. A letter in reply was duly sent and not a word has been heard since with regard to any——
What is the date of the letter in reply?
I have not seen it.
I want to see whether it was before or after the election.
If the letter, as he said it did, indicated no real trouble, well then why did he not get them to agree? If the letter were received, as he said it was, just when he was ceasing to be Minister for Health, then the position is that he made these maternity regulations without consulting these hospitals at all. Now, which is true? Either the letter was received by him before he made the regulations—before the election took place at all, in which event he could have concluded an agreement, which he did not, with the three hospitals, or the letter was written, as he says himself to-night, when he knew he was going to be succeeded by somebody else as Minister for Health. That means that he made these regulations and caused this whole situation without having consulted or received the views of the three maternity hospitals. I do not know which is correct but whichever is the true position it does not appear to be a very satisfactory situation.
As I will not intervene again, I would just like to refer to Deputy McQuillan. Deputy McQuillan referred to the position in Roscommon. I am certain what the Deputy says is correct in so far as accommodation is concerned but the Deputy will appreciate, I am sure, that the provisions of Section 16 cannot be operated anywhere without the co-operation of the doctors, midwives, chemists and so forth. Those are necessary preliminary arrangements and, of course, they have not been done and cannot be done in the time available to me.
The Deputy also said that the county surgeon had gone away to do a refresher course in gynaecology. That has nothing to do with Section 16. Although I am sure he is well up in gynaecology, it does not come in under this section.
I merely suggested that every effort was made by the local authority in order to be able to implement the Health Act.
I am sure that is so. That fact does not ease the particular problem I have mentioned. I do not think there is anything further I have to say with regard to the discussion on the amendment.
Just one question before the Minister sits down. Is it the poor or paying patients in Holles Street who are put out in the early hours of the morning?
We are discussing the question of public assistance.
I do not want to follow the Minister at this stage but there are just two points I would like to clear up. To begin with this letter. I had not the advantage of seeing Deputy Briscoe during the week-end. I must confess that the Minister took me by surprise because I did not think he would accuse me of withholding a communication. I was therefore, if you like, unprepared to deal with that point. Afterwards, I got up to speak and I recollected the communication from the maternity hospitals. We will leave it at that.
I did not upbraid the National Health Council. I had no intention of upbraiding them. I think the Minister will agree it is a wrong thing to go out from here that I ever did that.
I do think if the Deputy thinks over it that it was open to that interpretation.
I do not think so. I was upbraiding the Minister for the way he used the National Health Council.
If the National Health Council is usable they are not a very good body.
I was asked if I thought their opinion was bona fide. I think it was. As I said before, the Minister is only bound to listen to their advice. He is not bound to take it. I am not finding fault with the National Health Council but with the Minister for putting that particular question to them and the way it was done.
As I said before, I want to stop this here and now. I thought I put the Deputy correct on Second Reading. I did not suggest to the National Health Council anything. I told them my problem. If the Deputy consults some of his friends on the Health Council who were present and with whom I am sure he discussed this matter they will tell him I spoke to them for about three or four minutes and left them. I never suggested any advice or that they should suggest any particular course.
I must say that my deepest sympathy goes out to Deputy Larkin.
It is mutual, Deputy.
I really feel that when Deputy Larkin supported this Health Act he believed in it. I believe that, up to recently, he still believed in it. I cannot understand why he should not try to test to the full the suggestion which I made in regard to the allegation I made. Deputy Larkin stepped away from Section 16 of the Act and he got up to his knees in the National Health Council—and the Minister and he are prepared either to support or reject this particular amendment on what they described as an opinion expressed by the National Health Council. But Deputy Larkin did not tell the House that the National Health Council had offered that opinion as a result of their consultation with these maternity hospitals. He has not adduced even the slightest evidence that they did and he does not even now know whether they were in consultation with these maternity hospitals. The Minister side-stepped the letter——
You buried the letter.
I have not buried anything. I only produced the letter.
You have not.
We will come to it. The Deputy is skating as skilfully as he can on thin ice——
It has not broken under me.
Give us the letter.
I challenge the Minister to read the letter.
I have not got it. I never saw it.
The Minister has everything else to read except this particular letter. He has the communication from the Health Council——
I will have the letter later.
All right, we will rest on that and——
Certainly I will search for this letter.
The Minister will have a search for this letter. He knows about the reply to it because he made reference to the reply. He made suggestions about the date on which it was written yet, when he was asked what the date was he just did not know. I am speaking through the Chair, to the Labour members. Deputy Dr. Ryan stated that the Labour Party agreed to the introduction of this Bill before the Minister had any consultation or contact on this matter with the Health Council—and Deputy Larkin has not denied it. Therefore, all the talk about not being influenced by the speeches from these benches and the dishonesty of our approach is all nonsense. I think the word "dishonesty" is misused in this situation.
Would you believe me if I denied it?
I would, and I challenge the Deputy to deny it. I would believe the Deputy. Here is his opportunity to deny it. Deputy Larkin asked me if I would accept his word if he denies it. I have asked him to deny it and he does not do so.
I do deny it. Now, are you satisfied?
You deny what? I have witnessed to-night a performance by Deputy J. Larkin. I am asking him now whether he categorically denies that the Labour group agreed to the postponement of the implementation of this Health Act before the Minister went to the Health Council. Is that what he is denying? Very well, I will accept that but other people might repudiate it. I am accepting Deputy Larkin's word on that. It is about time he denied it. He did not deny it to Deputy Dr. Ryan.
The Minister talks about wanting to have this letter produced. I have said that if the Minister does not produce it I will see a copy of it. I am asking Deputy Larkin, in the interests of the persons whom Section 16 will serve, and not because I want to score a point on him, to ask the Minister to show him the letter. As Deputy Dr. Ryan has said, he can make up his mind behind the scenes. The Minister asks what is the use of telling a woman who is expecting a baby in six months' time that there will not be a bed for her within a year. That is the Minister's answer to the whole point. The question I should like to ask is whether a woman who is expecting a baby in six months' time will be better off without the knowledge that there is not a bed for her. The Minister then talks about the position of a certain hospital. There is a knock on the door in the middle of the night: an urgent case of a birth taking place: throw somebody out. As far as I know, the vast number of people who have normal births taking place in their homes make arrangements beforehand. They know the approximate date of the expected arrival and they make the necessary arrangements. They do not wait until something happens and then ring up for an ambulance.
It is not as predictable as all that.
If the Minister had a little bit of experience as a member of a local authority he might know more about the whole position. It is a great pity that Deputy J. Larkin did not remain longer on the Dublin Corporation, particularly when these health matters were being introduced. If he had remained he would have understood that many things can be done which are now being put on the long finger.
I am not concerned about scoring a point off Deputy Larkin and I am sure he is not concerned about scoring a point off me. As I say, I am terribly sorry for the position he had to adopt to-night. He did not know that this Bill would be introduced any more than we did until it was introduced. It came as a surprise to him but he accepted it. I am expected to believe that and I suppose the public are supposed to believe that.
I do not know what you believe.
I know what I believe. I say that, when the 1953 Health Act was going through this House, the Labour members poured scorn on it because it was not what they believed a proper Health Act should be—but nevertheless they were quite prepared to accept it as something on account. Their view was that it would lead somewhere and that it was better than nothing. Deputy Norton described it as meaning almost nothing. Apparently it meant quite a lot. To-morrow afternoon, I propose to press the Minister again to tell us whether or not he has got this letter which I have spoken of and then I shall make it my business to see whether I can get a copy of it from the body of which I happen to be a governor.
Hear, hear!
Then I shall read it to Deputy Larkin and send him a copy of it. If the Deputy was in any way serious in attempting to convince the members of this House or those people whom he represents that he is in earnest about these amendments, about the fate of the Health Act, about the fate of the people who will lose the benefits they stood to gain under it, he will take a different line with regard to this whole matter.
When speaking before, I said I am convinced that Section 16 of the Health Act can be implemented. The persons who have the facilities are willing to implement it, certain little terms and conditions to be agreed. Apparently there is not very much between what they asked and what the previous Minister was prepared to give them. But it can be done, and I think that it is a great shame to deny these things to the lower-income groups, that is to say, those in destitution, those on assistance and those under £600 income level. Deputy Larkin, I am sure, has been approached, as I have, and as Deputy Denis Larkin has, by a number of people who were expecting to benefit by Section 16. I move to report progress.