Health Authorities Bill, 1959—Second Stage.

I move that the Bill be now read a Second Time. The main object of the Bill is to rectify the existing arrangements for providing and administering the health services in the territories represented by the boroughs and counties of Dublin, Cork, Limerick and Waterford, respectively. These arrangements are complex and over-lapping; and, because of this, are a frequent source of avoidable annoyance and sometimes grave hardship to those for whose benefit the services are intended. They are in some measure a legacy from the past; a past which in the form of certain administrative anomalies has survived the great changes and developments in our health services which have taken place since World War II.

The House will recall that the changes in question originated with the Health Act, 1947. Not alone did this Act introduce notable developments in the preventive health services; it also designated county councils and county borough corporations as health authorities and conferred on them powers and functions in relation to health wider in scope than local authorities had had before. The 1953 Act continued this development and brought it to its present stage. By reason of these Acts the position today is that throughout the country— except, however, in Dublin, Cork and Waterford—the county council (and in Limerick county borough, the City Council) as health authority is responsible for all the general health services.

Unfortunately the conditions which existed when the Act of 1953 was under consideration made it, for the time being, impracticable to simplify administration in Dublin, Cork and Waterford. There were in each of these areas at that time a number of boards and other joint authorities, each of which had its separate staff and provided some, but not all, of the services. The task of introducing the provisions of the Act of 1953 over the whole State imposed a great burden on the staff of my Department and on the staffs of the local authorities concerned. The task would have been an impossible one, if, at the same time, an attempt had been made to merge the existing authorities within each of the areas concerned for the purpose of administering the new code. The fact that it has taken several years of almost constant consideration and continuing negotiation to produce anything like acceptable conditions for the mergers, confirms this view.

Moreover if the Act of 1953 had compelled the county councils and county borough corporations, for the areas to which the Bill relates, to provide, as health authorities, all the re-organised services, it would have entailed the splitting of several existing organisations. For example, the services provided in St. Finbarr's Hospital and other institutions by joint boards would have had to be divided between the Cork Corporation and Cork County Council; and similarly the hospital services in Waterford would have had to be apportioned between city and county, instead of being provided by joint boards.

Having regard to the new services and to the extensions in existing services which the local administrations were then being called upon to provide, it was decided, wisely, that any drastic administrative surgery in these four areas would, at that stage, be inadvisable. Accordingly, as a temporary measure, it was decided in 1953, that, while the health authorities in them were to be responsible for the services, it was to be arranged that the appropriate co-existing bodies should provide some of them on an agency basis. The instruments allocating the performance of functions to the bodies in question are most complicated and it has been by no means easy to administer them.

The question of unifying the administration of the health services in Dublin, Cork, Limerick and Waterford had, however, been under consideration before the 1953 Health Bill, and it has since been the subject of correspondence and discussion with the local authorities concerned. Thus these bodies have had the opportunity of considering unification exhaustively and of furnishing their views on the proposals in the Bill.

As well as unifying the health services in the four areas specified in it, the present Bill, if enacted, will merge the administration of the mental health services with that of the general health services. When I come to deal with Section 20, which has been drafted to provide for this, I hope to persuade the Dáil—if indeed persuasion is necessary —how very desirable such a merger is. In the meantime, however, before I outline the principal provisions in the Bill, I should like to direct the attention of the House to some figures. They show why any Minister for Health must be anxious to ensure that the best administrative organs which can be devised should now be established in the four areas to which they relate. They show too why the general body of taxpayers should be concerned to the same end.

The total expenditure on local authority health services is estimated at about £16½ million in the present year. Half of this, as the House is aware, is paid by the ratepayers, half by the Exchequer. Of the total expenditure of £16½ million, about £7½ million, representing nearly half the expenditure for the country as a whole, is spent in the Dublin, Cork, Limerick and Waterford areas. Half of this sum in turn, that is, £3¾ million, is paid by the general body of taxpayers throughout the State from the Health Services Grant which the Budget provides. In the face of these figures, it cannot be said that only the residents and ratepayers of the four areas where unification is to take place, have an interest in the financial aspects of my problem. The public generally are also largely and vitally concerned in it and should be as determined as I am to see that in the administration of the health services avoidable inefficiency and over-lapping should be prevented.

I may now proceed to refer to the salient provisions of the Bill. Those set out in Sections 2, 3, 4 and 5 are fundamental. These Sections respectively provide for the unification of the Health services in the areas of Dublin, Cork, Limerick and Waterford, and for the setting-up of a new health authority in each. In the case of Dublin, the authority will consist of nine members appointed by the County Council, fifteen members appointed by the Dublin Corporation and 3 members appointed by the Dún Laoghaire Corporation. But on all occasions when the operation of the Mental Treatment Acts is to be dealt with by the Dublin authority, three members of the Wicklow County Council, appointed for the purpose, will be entitled to attend the meetings of the authority and to participate in the discharge of that particular business. In the cases of Cork, Limerick and Waterford, a complication such as this does not exist; and the new bodies in such cases and for all purposes will be composed solely of members of the appropriate county council and county borough corporation. As in the case of Dublin, the members will be duly appointed by the parent bodies. It will be the duty of each of these new health authorities to provide, for the whole of its functional area, all the services at present made available therein by the existing local authorities.

Section 7 provides for the requisite transfer of health functions from the local authorities which heretofore have exercised them; and sets out the scope of the services covered thereby. They include the general hospital services, maternity and child health services, the tuberculosis service, dental services, the infectious disease service, the general medical service given by district medical officers, food hygiene, the control of the sale of food and drugs and the supervision of midwives in their practice. All of these services are necessary either for the protection of the general health of the community or to meet the needs of individual citizens who may happen to require medical, surgical, dental or other curative or preventive treatment. They are very comprehensive; they affect everyone in some degree; but they touch the vast majority of our people very closely in a great variety of ways. Their effectiveness depends in the main on close integration with each other.

Yet in the four areas with which the Bill deals, responsibility for them is at present divided among no fewer than nineteen authorities. In Dublin, there are seven such authorities; the Dublin Corporation, the County Council, the Dublin Board of Assistance, the Rathdown Board of Assistance, the Balrothery Board of Assistance, the Grangegorman Mental Hospital Board and the Dublin Fever Hospital Board. Each of these separate authorities is concerned with some only of the services. None is concerned with them all, nor is there any authority with general responsibility for their co-ordination. Similarly, in Cork, the Corporation, the County Council, the South Cork Board of Public Assistance, the Joint Mental Hospital Board and the Joint Sanatoria Board each operates services; but again there is no co-ordinating authority for the services as a whole. In Waterford, there are the County Council, the Board of Assistance, the Corporation, and the Joint Mental Hospital Board and in Limerick we have the County Council, the Corporation and the Joint Mental Hospital Board. Once again, in neither area is there a co-ordinator. It is self-evident that a multiplicity of authorities, separately administering services so closely related as those I have enumerated, must result in an irrational dispersion of function and responsibility which, as I hope to show, breeds confusion and inconvenience for the ordinary citizen. To remedy this the administration of the services must be integrated and simplified; and the readiest way of doing this is to set up the new authorities, unifying authorities, contemplated by the Bill.

But, before going further at this stage into this proposal, it would be convenient to explain now the reference in Section 7 of the Bill to the Public Assistance Act, 1939. No health service is now provided under the Act; it governs only the administration of home assistance. At present home assistance is provided and administered by public assistance authorities, including those Boards of Public Assistance which I have named and which will be dissolved under Section 7 of the Bill. With the abolition of these boards, it is necessary to make provision for the continuance of the home assistance service. As Minister for Health I would prefer that it should not be dealt with by the new authorities; but, on the other hand, if it is not handed over to them, it will be necessary to keep all the existing boards of assistance in being, to administer what is now a very minor service indeed. Accordingly the management of home assistance is one of the functions which will be transferred. The granting of allowances under the Blind Persons Act, 1920, is under the control of the Department of Social Welfare and is not a health service. It will still remain under the control of that Department but will, like home assistance, be administered through the new authorities. These Social Welfare functions, however, will constitute only a relatively insignificant part of their duties.

Reverting now to the prime purpose of the Bill, the Dáil may wish me to give some examples of the confusion, inconvenience, unjustified expense and positive hardship to individuals, which have been occasioned by the existing fragmentary administration of the health services over the whole area represented by the county borough of Dublin and the administrative county of Dublin (which includes, of course, the borough of Dún Laoghaire)—an area inhabited by over 700,000 persons. This I shall proceed to do, but please bear in mind that the cases which I mention are a few only of the great many which have come to my notice.

In Dublin, persons applying for, say, hospital services under the Health Act, 1953, make an application which is sent to the Corporation or the County Council, as appropriate. These services are available to what we designate as the lower and middle income groups and whether or not the applicant is within the eligible category is determined by the Corporation or County Council. This is relatively simple, but when it comes to the matter of charges for this service, complications arise. Those outside the lower income group may be charged up to ten shillings a day; those in that group are not to be charged anything at all. If, therefore, the patient feels that he is entitled to these services without charge, he must show that he is in the lower income group which is the class entitled to what is commonly referred to as the "Blue Card".

The grant of such cards, however, is not a matter for the Corporation or the County Council but for the Board of Assistance for the area in which the applicant lives. To prove his entitlement to the service free, therefore, he will first have to apply to the appropriate Board of Assistance—there are three of them in the Dublin area—for a "Blue Card" as evidence to support his application to the Corporation or the County Council. Ingenuity and compassionate administration can and have reduced the annoyance and hardship which can be caused by this complicated procedure; but they cannot provide an adequate substitute for having eligibility for all services determined by the one authority.

There are other complications and annoyance peculiar to the persons— and there are over 50,000 of these— who live in those suburbs of Dublin which are just inside or outside the city boundary. A case came to my notice recently of a lady who lives just within the city boundary in Churchtown, but convenient to the dispensary premises in Dundrum. Dundrum being in the county, these dispensary premises are owned by the Rathdown Board of Assistance. There is, however, sufficient co-operation between that body and the county council to allow of the use of the premises by the county council for poliomyelitis vaccination. The co-operation, though, does not extend far enough to have this service provided at a county council clinic session for city residents, so when this lady wished to have her children vaccinated against poliomyelitis, she had to bring them three times to the Dublin Corporation clinic at Crumlin. To get there from Churchtown is no inconsiderable journey, especially for a busy housewife.

The Crumlin clinic, on the other hand, is quite convenient to many persons resident in the administrative area of the county council; but because they are not in the city area, they cannot avail themselves of the services provided there. In the area near Crumlin, there is, in fact, a salient about half-a-mile square extending from the county into the city. The population of this salient is about 3,500, comparable with many of our smaller towns in Ireland. The housing development within the salient is essentially of the same type as in the surrounding district—working class and lower middle income houses—and, of course, those who occupy the houses in either area are likewise similarly circumstanced. Nevertheless the inhabitants of the county salient may have to travel considerable distances, if they wish to avail of the medical services. If, for example, one of them should need to attend a tuberculosis clinic, he or she, must go to that maintained by the county council in Long Lane, which is at the back of the Meath Hospital. Whereas if the administration were unified, the service could be given at the Crumlin clinic.

Another case which comes to my mind is that of a person resident in the city who, when visiting a house in Dún Laoghaire became suddenly ill and the gravity of his condition was such that he had to be removed for an urgent operation to a voluntary hospital in the Borough. He was entitled to General Hospital Services under the Health Act of 1953; and if he had been admitted to a city hospital, the Corporation, in the normal course, would have accepted full liability for the payment to the hospital. The Corporation, however, did not have an arrangement to accept such liability for patients admitted to the hospital in Dún Laoghaire. The luckless patient then had to pay a substantial bill for his treatment; for the Corporation, because of the fortuitous circumstances which had put him into the Dún Laoghaire hospital rather than into a city hospital, would not, in respect of his treatment, accept more than its limited liability under Section 25 of the 1953 Act. On the other hand, if this man had been resident in Dún Laoghaire or the County, the County Council would have paid all his hospital expenses.

Deputies in another connection recently have had occasion to study the zig-zag and, apparently, arbitrary course which the boundary between the administrative area of the Dublin Corporation and that of the Dublin County Council tends to follow. They will have noted how the county boundary runs through the suburbs of Dublin, not around them, and in many places divides communities which are essentially one. This has created difficulties for all concerned with the health services, whether as operators or beneficiaries, for which, I submit, there is neither rhyme nor reason.

For example, the boundary crosses Whitehall Road, Kimmage, at a point about one-third of the way along that road from Kimmage Road West to Whitehall Crossroads. The consequence is that persons living on one section of the road have to deal with quite a different set of health officers and to resort, when necessary, to quite different health institutions such as clinics, to persons living in the other. And yet they are very much alike in all their circumstances. They are alike in the fact that administrative boundaries notwithstanding, they are part of the same urbanised community.

This is true, of course, of not only those who live within the actual city boundary, but of a great many more who live in the administrative area of the county. Most of us may not realise how the population of these areas is actually distributed; that, for instance, the population which lives on the fringes of the city and the borough of Dún Laoghaire makes up more than half the total population of the county. A few figures bearing on this point may help us to appreciate why the existing administrative position is highly anomalous, at least so far as the health services are concerned.

In 1956 there were nearly 706,000 persons resident in the Dublin area. Of these 539,000 lived within the city boundary, 48,000 in Dún Laoghaire and 119,000 in the county. Of the last mentioned figure, more than half, that is about 62,000, resided in suburbs of the city or Dún Laoghaire. Thus of the 706,000 persons living in the city and county of Dublin, about 650,000 lived in definitely urbanised communities which are contiguous with each other. The remaining 56,000 must include a considerable number of persons living in rural areas so near to the city or Dún Laoghaire that their economic centre and the centre for them of public services of various kinds is in the city area. It is thought, in fact, that the population of the areas in the county which can be described as truly rural is only about 36,000 or 5 per cent. of the total population of the city, the county and the Borough of Dún Laoghaire. Having said this, I think I have, so far as Dublin is concerned, fully established the case for the proposed innovation.

In Cork there is a similar, though somewhat less striking situation. The population of Cork City, living within the administrative area of the city corporation, in 1956 was 80,000. The "census suburbs" for the city had then a population of over 34,000. If to these we add the contiguous rural areas, it would appear that there are at least 40,000 people, whose natural centre is Cork City, who work there and shop there and who are separated from it for the purposes of many health services.

The county population of 257,000 is, of course, much greater than that of the city; but included in that figure are, as I have said, at least those 40,000 persons detrimentally affected by not being able to avail themselves of the city health services. I think it is clear that all of these and very many more, whether resident in the City or County, will benefit by the enactment of the Bill.

The problems arising from having surburban populations cut off from city services do not materially arise in the cases of Limerick and Waterford. The main case for unification in these areas rests on the fact that the population in each case is too small to be saddled with the expense of more than one health authority.

In this connection I may point out that the population of Limerick City and County in 1956 was under 138,000; which is less than the population of Galway and not much more than that of Kerry, Mayo and Donegal. In each of these areas, health services are administered by a single authority. The population of Waterford City and County is even much smaller, being only 74,000 or less than that of many counties.

The major reason for setting up new health authorities in the four areas with which the Bill deals is to co-ordinate the health services in them, to improve those services, and to make them more readily available to the members of the public. But a further purpose is to achieve substantial economies in administration. Between the four areas, there are, as I have already mentioned, at present nineteen authorities concerned with the operation of health services. Each of these, in addition to its medical and nursing staffs, has its own secretarial, accounting and administrative staffs. In each area the several existing authorities are engaged on similar administrative work, perhaps, indeed, in relation to the same person at the same time.

With the establishment of one authority in place of the several which now operate in each area, we may expect that expenditure on this type of duplicated administrative work will be significantly reduced. Centralisation of the accounting and other procedures should also result in additional considerable economies.

The total expenditure on health services in the four areas is, as I have mentioned, about £7½ million. It will be clear that, with figures of this magnitude, it should not be difficult, by cutting out duplication, to save a sum ultimately running into five or, perhaps, six figures each year.

All these economies, I concede, will not be achieved immediately. Existing staffs, for instance, have certain rights, and it is not intended to deprive them of these. Staffs, of course, will have to be transferred to the new authorities, but all those affected will be dealt with fairly. It is apropos to mention that I have had some preliminary representations regarding the position of the Dublin Corporation clerical and administrative staff. Naturally, I shall consider these most carefully, between now and the Committee Stage of the Bill.

Since 1952, as I have already mentioned, there have been consultations with the rating authorities concerned with the proposals now before us. On the whole, I think I can say they have been satisfactory. Thus in the Dublin area, I am glad to say, the corporation, the county council and the Dún Laoghaire Corporation have signified their agreement with the scheme, subject to the costs being divided among them in a certain way. In Limerick, also, I understand that the local authorities' reservations similarly relate only to the same matter of costs. I trust that on this point the Bill, as drafted, will be satisfactory to these and the other authorities which it affects.

Section 11, in fact, has been drafted with such reservations, regarding the apportionment of costs, in mind. I have sent copies of the Bill to all the authorities concerned, and have indicated to them that I will be prepared to consider for the Committee Stage any amendments in detail which they may wish to suggest. May I say in relation to Dublin and Limerick that it is gratifying to see how all public authorities in these areas are ready to co-operate with each other to provide the best possible administration for their health services? It is evidence too that in this respect the desire for better administration is not a product of the Custom House alone.

In the remaining two areas, that is, Cork and Waterford, I am afraid that I cannot report that the local authorities in them are at one in favour of the proposals. But I trust that, as the Bill progresses and its provisions are better understood, the local authorities in both districts will fall into line with Dublin and Limerick.

Fears have been expressed by some of the members of the rating authorities that they will lose what have been described as "their present rights" to participate in the control of the health services. Section 10 of the Bill, I submit, should dispel all legitimate fears in this regard.

Under Section 10, local committees of a health authority can be appointed; and these may include even more members of the parent council than are on the authority itself. Moreover, each of the health authorities, as defined in paragraph 2 in the First Schedule to the Bill, will be so constituted as to ensure that each local electoral area in a county will be represented thereon by at least one member. Furthermore, where an appointing authority so decide, they may, in accordance with paragraph 6 of that Schedule, remove from office the members they have appointed to the Health Authority and appoint others in their stead.

Deputies no doubt will have noted the special provisions which are set out in the Second Schedule to the Bill in relation to the estimates of the new health authorities. These represent a noteworthy departure from the present position in regard to estimates, and are designed to give the rating authorities concerned a position of greater authority so far as expenditure proposed by these bodies is concerned.

As things are now, rating authorities are not informed, even in a preliminary way, by the existing subsidiary authorities of their estimates and demands until the latter are furnished in final form. Under the new procedure as laid down in the Schedule, provisional estimates will be prepared by the new health authority; and before that authority formally adopts them, the rating authorities concerned will be given an opportunity to examine them and to comment on them. This procedure should enable the rating authorities to influence and in some measure to control expenditure by the new health authorities.

The second purpose of the Bill, as I mentioned earlier, is to amalgamate the administration of the mental health service with that of the general health services. This service still remains separate from the other health services, there being a strict legal distinction between them. What it is proposed to do in this Bill is to abolish this distinction throughout the country.

In Dublin, Cork, Limerick and Waterford, the change is made easy by effecting it in conjunction with the wider proposals for those areas. In the case of seven other counties where the mental health service is administered direct by the county council, the effect of the proposals in the Bill will be that that council will continue to perform those functions, but in future as health authority. In the remaining areas, where there are joint mental hospital boards at present, these boards will be replaced by new boards appointed by the health authorities. After the enactment of this measure, therefore, the one and the same body of law will deal with the administration of both the mental health services and the general health services throughout the State.

Mental treatment, as I think everybody in the House is aware, at one time was almost entirely a matter of custodial care of the patients and there was, unfortunately, a social stigma attaching to any family which had been so luckless as to have had a member committed to a mental hospital. The last ten years or so, however, have seen important advances in the treatment of mental disease. Due to chemotherapy and other techniques, complete recovery in very many cases is now not unusual; and in others the distressing conditions caused by mental disorders have been greatly ameliorated. At the same time there has been a gradual change in the public attitude towards mental illness.

To foster and encourage this change of attitude, and to bring about more rapidly a situation in which mental illness will be regarded exactly in the same light as any other illness, I have included in the Bill proposals, as set out in Section 20, for merging the mental treatment services in the general body of health services. We must strive to end, once and for all, the idea that mental institutions are not hospitals, and that there is something inferior about the services which can be provided for mental patients.

The Mental Treatment Act of 1945 represented a considerable advance on the legislation which operated before it, but over the years since it was brought into operation, experience has shown that many changes in the code are necessary or at least desirable.

Because of the developments in treatment and care to which I have referred, there is, indeed, a need for a comprehensive review of the code. That review will, however, take time, and as an interim measure, I hope to introduce shortly an amending Bill to deal with the more urgently necessary changes. The present Bill, therefore, deals only with the changes in the legal and administrative spheres which I have mentioned.

Other provisions in the Bill may require elucidation. I have already referred to Sections 2 to 5 relating to the setting up of the Dublin, Cork, Limerick and Waterford Health Authorities, and to the constitution of these authorities as referred to in the First Schedule to the Bill.

These, as the House knows, are the principal sections of the Bill. Except for those relating to the mental health services, most of the remaining sections are consequential on the establishment of the new authorities.

Section 6, for instance, specifies the general powers of the authorities and provides that the members of each shall be members of the parent council. I think this is essential in view of the very considerable amount of money which the authorities will spend and the need to maintain control by publicly-elected members over the comprehensive services which they will provide.

I have dealt earlier with Section 7, which lists the functions which will be transferred to the new health authorities.

Section 8 will apply to the authorities the general body of the local government code which governs the activities of local authorities generally. I would, however, draw attention particularly to sub-section (1) of this section under which the County Management Acts will be applied to the new bodies.

This means that either the city or the county manager for the area will be designated to perform the executive functions for the authority. This is the normal practice for joint bodies, but, in relation to the Dublin health authority the sub-section should be read in conjunction with Section 17.

The local committees to be set up under Section 10 are, as I have mentioned, designed to meet the views put forward by some of the local authorities in the areas concerned. These committees can consist of as many members of the county council or corporation concerned as these bodies may desire.

In any county there may be up to three such committees. Their functions will be limited to certain services of a local nature, such as the dispensary medical service and the maternity and infant care service, which will be specified in the regulations. As respects these services, the local committees will have full power to obtain information from the county manager on their operation.

Section 11 deals with the method by which the expenses of the new health authorities will be met. They will be contributed by bodies appointing members in such proportions as they may agree upon or, in the absence of agreement, as may be determined by a person appointed by the Minister.

It has been necessary, in the Dublin area, to make a modification of this whereby, in the first year of the health authority's establishment, the Dún Laoghaire Borough Corporation as such will not make any direct contribution. The reason for this is that the corporation will not have budgeted for such a contribution in its rate for that year.

The Wicklow County Council will also bear its due proportion of the cost of the Dublin health authority for each year.

Until the various contributing authorities have reached agreement on the basis of allocation, or until this has otherwise been determined, the expenses of each health authority on health services will, under Section 12 of the Bill, be contributed in proportion to their expenditure in the local financial year immediately preceding that in which the authority is established.

The expenses of the authorities in the provision of home assistance will not be divided in accordance with the scheme which I have mentioned. It is specifically provided by Section 11 of the Bill that these expenses will be met on the basis of each contributing authority paying the cost of services provided for persons in its own area.

Section 13, in conjunction with the Second Schedule to the Bill, provides for the special procedure to which I have referred earlier for the examination by the rating authorities of the estimates of the new authorities.

Section 14 makes some technical adjustments in the channels through which the health services grant will be paid, but does not affect the total amount which will be paid from that grant nor the amount which will be paid to any of the areas affected by the Bill.

Under Section 15 of the Bill, it is proposed that in every area to which the Bill relates all the public authorities concerned with the administration of the health services, including boards of assistance and certain other bodies, will be dissolved and their functions taken over by the new authorities.

The property, offices, assets and liabilities of the bodies thus dissolved must be taken over also by the health authorities which replace them. The provisions of this section and the Third Schedule, which should be read with it, follow the usual pattern of legislation transferring functions from one body to another.

Among the public authorities affected by Section 15 is the Dublin Fever Hospital Board about which I should like to say a word. Like so many other aspects of medicine, the pattern in regard to infectious diseases has changed very materially in the past 20 years. Previously, it was necessary that the emphasis should be on the isolation and treatment of patients suffering from these diseases. Nowadays, the development of prophylactic procedures—immunisation and vaccination—has permitted the emphasis to be shifted to prevention, and the rôle of the fever hospital, while still important, has become a secondary one.

Accordingly, most of the county fever hospitals and all the fever sections in the general voluntary hospitals have been closed or diverted to other purposes.

Experience in recent years lends us to hope that, within the next decade, prophylaxis will be so effective, and so generally availed of, as to reduce still further the need for fever beds. It is likely, therefore, that inside that period, not alone will it be possible to close one of the two remaining fever hospitals in Dublin, but that even one of them will be too large for the number of patients involved.

It is important to ensure that any part of the existing fever accommodation which may become redundant will be used to the best advantage in the interests of the public. I feel, therefore, that this is the time to make provision for the transfer of the hospital at Cherry Orchard now administered by the Dublin Fever Hospital Board to the Health Authority.

In case Deputies may have forgotten the fact, I should make it clear that the Dublin Fever Hospital Board is a public authority. Unless there were some particular reason for doing so, there would be no logic in leaving this body outside the scope of the unification proposals any more than there would be for leaving out, say, the Rathdown Board of Assistance or the Balrothery Board of Assistance or the Dublin Board of Assistance. This was recognised from the time the proposals were first being developed in my Department in 1952 and the proposal in relation to the Dublin Fever Hospital Board has remained part of the scheme ever since. I am in full agreement with this.

I am satisfied that the prevention and treatment of infectious diseases are essentially matters for the local health authorities and have no doubt that the public interest will be served best by the proposal in the Bill. The Dublin Fever Hospital Board, to whom a copy of the text of the measure was sent, however, do not accept that view, so I have agreed to meet a deputation from it in the near future.

Section 16 deals with the officers of the Corporations and County Councils who are now engaged on services which will be transferred to the new authorities.

Section 17 makes special provision for a Chief Executive Officer of the Dublin Health Authority.

Because of the size of this authority and of the extensive scope of the services which it will provide, it is considered unrealistic to apply, in the ordinary way, the provisions of the County Management Acts under which the City Manager would become responsible for the executive functions in relation to the Health Authority.

At present, these functions in the Dublin area are delegated to a special Assistant City and County Manager. It is intended that they will remain with the City Manager in law but that they will, in practice, be delegated to the Chief Executive Officer.

The City Manager of Dublin, therefore, will thus retain overall responsibility; there will, however, be a clear cut line of authority through the Chief Executive Officer to the other officers of the authority. Where functions are delegated to any other officer of that authority, he will perform them under the supervision of the Chief Executive Officer.

Under Section 18, there will eventually be a single office of Chief Medical Officer for each of the four areas, instead of the separate city and county medical officers which there are at present. The advantages of this change, I think, are obvious and it would be quite illogical to do anything else in the context of the establishment of the new authorities. However, difficulty may arise at the beginning in bringing this provision into operation.

It is accordingly intended that, where there are at present holders of separate offices, they will be permitted to retain these offices until one of them becomes vacant. When this happens, Section 18 will be brought into operation in relation to the area concerned, and the person then holding the office will become Chief Medical Officer for the entire area. In fact, this should happen immediately on the establishment of the authority in the case of Cork and Dublin, as there are vacancies in those counties at present for County Medical Officers. Vacancies do not exist at the moment in the other areas, Limerick and Waterford, but under Section 19 an easy procedure is provided under which, if either the city or the county medical officer agrees, he can be transferred to another county.

The transfer of mental hospital functions to health authorities is effected by Section 20. The necessary adaptations of various references in the Mental Treatment Acts are made, and under sub-section (4), the Minister will be required, under powers which he already has, to set up the new Joint Mental Health Boards to which I have referred earlier. All the institutions at present operated under the Mental Treatment Act by local authorities will become subject to the law governing other health institutions.

On Section 21, I would just like to explain that the reserved functions of a local authority are those which can be performed only by the elected members and not by the Manager.

The miscellaneous amendments specified in Section 22 are such as are necessary or desirable in a number of enactments because of the altered position arising from the establishment of the new health authorities.

It will be noted that, in the case of the Meath Hospital in Dublin and the Infirmaries in Cork and Waterford, it is intended that the health authority will in future make the appointments to the governing body which are now made by the county and city councils.

I think I can leave any explanation of other amendments provided for in this Section to the Committee Stage. The remaining Sections of the Bill are of a routine nature and I do not think that I need make any comment on them.

The First Schedule to the Bill lists the provisions which will govern the membership and meetings of the new Health Authorities. The first members of such an authority will be elected after it is established and subsequent appointments of members will follow each local election.

I have already referred to the provision in paragraph 2 of this Schedule which will ensure that each electoral area in a county is represented on the Authority. The procedure for election set out in this paragraph is based on the provisions which at present govern the election of members of joint public assistance boards and the remaining paragraphs of the Schedule are such as normally govern joint local bodies.

I have already referred particularly to paragraph 6, which permits an appointing authority to withdraw its members from the Health Authority and replace them should it so decide.

In the Second Schedule are two sections, which in respect of the Health Authorities, established by the Bill, will replace Sections 9 and 10 of the City and County Management (Amendment) Act, 1955. The latter sections are those which govern the preparation and adoption in the normal course of the estimates of a local authority. The difference between them, and the sections in the schedule, which will be applicable only to the new Health Authorities, is that, in the case of the latter sections, the estimated procedure is extended so as to permit the rating authorities to comment on the estimate of the joint authority before it is finally adopted by that body.

The paragraphs of the Third Schedule are such as are normally included in a Bill which provides for the transfer of functions from one set of authorities to another. The effect of the provisions of the Schedule is that the new Authority will, as respects property rights, liabilities, contracts, legal proceedings and the employment of officers, take the place of each body in their area which is dissolved under section 15 of the Bill. This Schedule will also apply to the dissolution under section 20 of the present joint mental hospital boards and their replacement by new health boards.

I trust the House will give the Bill a Second Reading.

The Minister is to be commended for the very full and comprehensive explanation he has given the House with reference to the terms of this Bill. It is implicit in the Minister's statement that the proposal in this Bill has been for long considered and has been put forward from time to time by the Minister's Department.

The principle in the Bill is in accord with a tendency which has grown up in this and other countries over the last 50 years or so, a tendency to make things uniform, to rationalise the various administrative expedients. Generally, those who propounded that view were styled some 40 years ago as the new bureaucracy. Any Minister proposing a Bill of this kind must expect criticism from those who like to see local effort and local bodies maintained and, indeed, one can sympathise with that point of view. Leaving that aside for the moment, we have to regard this Bill as being like the curate's egg; it is good in spots and bad in spots. The pity is that the Minister scrambled the egg and it may be difficult to extract the good spots from the bad. I propose to try to do so.

I sympathise with the proposal in the Bill to merge the mental health service into the general health services. That is a good proposal. For far too long, the mental health service has been regarded as a Cinderella. This proposal to make mental sickness and mental ill-health a problem common with other forms of sickness and ill-health is a very proper one and I appreciate that, in order to achieve that merging of the mental health service into the general health services, it is necessary drastically to alter the local administration of the service.

I welcome the statement made by the Minister that this proposal to merge the mental health service into the general health services is only part of a move to ameliorate the position in relation to mental ill-health. A great deal has to be done to make the general public appreciate that a man may be sick in his body or in his mind and that so far as the result is concerned it does not matter how he is sick; he is a sick man and requires hospital treatment. Any tendency to regard mental hospitals and mental health services as being amongst the most important of our health services should be encouraged. That proposal is a good proposal and, as I have said, I welcome it. I may add that I think that proposal in itself would justify a Bill and, indeed, perhaps such a Bill might have been introduced before this. For the fact that it has not been introduced before this, I must share some of the blame.

The other important proposal in the Bill is, of course, what has been known in the Minister's Department for some time as the unified health authority proposal. There, at this stage, I have some doubts. I appreciate that, in replying to any criticisms that I may have to offer, the Minister would be entitled to say that I, as Minister, pushed forward this idea and proposed it. I certainly did so. I felt at that time that, if it were possible to secure agreement in relation to the idea of unifying health services in the four parts of the country affected, it was a desirable thing to do. Not only did I think it was desirable, but I made it my business on, I think, two occasions, certainly on one occasion, to discuss the proposal with representatives of the local bodies affected—the representatives of Cork Corporation and county, the representatives of Limerick City and county, of the Waterford health authorities, and of the Dublin health authorities. I felt that the benefit to be derived from such a proposal should eventually lead to its being accepted by all the bodies concerned.

I know that in certain of the areas affected—Limerick County is one, so far as I can recollect; Waterford County is another—the representatives of the ratepayers felt that for them the eventual effect of such a unification would be a pretty steep increase in their rates. I cannot recollect what exactly was the position in Dublin and Cork but probably some increase might be entailed.

It is because I am not satisfied that the Minister has secured the kind of agreement which makes for real co-operation that I have some doubts now about this proposal. The Minister says that he is happy to think that the representatives of the bodies affected in both Dublin and Limerick find themselves in a measure of agreement with him concerning the Bill. I note that the Minister gives no details of the financial effect of this proposal on the ratepayers of Limerick county and Dublin county. I note that the manner in which he puts the measure of agreement reached is rather nebulous because it is on the basis that the fear of the agreeing parties about cost, or whatever it is, will not come true—I forget exactly how the Minister put it. If I felt, knowing the full story—and I think it is a story that should be known—that the representatives of the local bodies in Dublin and Limerick agree with the proposal, then much of my criticism in that regard could be left aside.

The Minister says that he has not secured agreement with the Waterford people and the Cork people. If that is so, I wonder is the Minister wise in proceeding with this proposal? He can, I have no doubt, after Deputy Corry has spoken at length, get it through this House. But I wonder is it the kind of health legislation we should embark upon at this stage? It is one thing for a Minister to say "That is my view and, even if you do not agree with me, I have the power and the means to put my view into operation."

I suggest that it would have been wiser, and in the long run better, for the Minister to continue the kind of discussions which I was having with the representatives of the Cork and Waterford bodies. I do not know whether the Minister has in the last two and a half years ever met any deputations from these bodies. If he has not, certainly one is entitled to ask, why not. It would be much better, and would make for better legislation, if agreement could be secured before legislation is actually proposed in this House. If the particular feelings of anxiety which local representatives may have can be allayed by sense, harmony and discussion, certainly it would make for better debate here.

It is because I feel that the Minister has not done that, that I enter a caveat with regard to this proposal. I think the idea of a unified health authority is sound, but I fear that the Minister may not have set about its introduction in a satisfactory way. I know the Minister will perhaps say, with certain justification, that this proposal has been knocking around the Custom House and has been sent by way of letter to different affected local authorities over the last seven years. Of course it has, but that does not mean much until there is a real effort made to get them to sit down with the Minister and discuss, quietly and in a co-operative way, what exactly is involved.

I want to make clear to Deputies what is involved in this proposal. It is another step in the trend which started in this country 50 years ago when there used to be, for instance, rural district councils and local boards of health. Bit by bit they have all been swept away. That has made for uniformity; it has made things administratively easier. It has meant that in a wider and wider area there has been —and there is good sense for it, particularly in health—a growing uniformity in the quality and kind of service. But it has meant—we cannot make an omelette without breaking eggs—that those who have to find certainly a proportion of the cost, the representatives of the ratepayers, have been pushed more and more out of the picture. Therefore, while you have had a growing uniformity, and a rising standard, too, in health services, it has been increasingly because there are more people in a position as individuals to carry out a policy. That may be a good thing or a bad thing, but it certainly has been the trend and the tendency.

This is completing the picture in so far as the four affected areas are concerned. You will have now in Dublin a huge new single health authority, a very large body indeed, large in its jurisdiction and in the number of persons for whom it will provide service. Close on 1,000,000 people will be subject to the new Dublin health authority. The chief executive officer of that authority will have a very responsible position indeed, as will eventually the chief medical officer. Undoubtedly that authority will be able to administer uniformly throughout Dublin city and county every kind of health service.

The Minister makes a gesture—it was implicit in the original proposal— to local representation in so far as certain aspects of the services are concerned, but the cost involved will be the disappearance of any effective local voice on policy. As I say, it is well that that should be understood. I would give a lot if I felt that the result would be a better quality of services for the people. I think, particularly in health, there are many disadvantages that can be shouldered provided the end result is satisfactory.

One other thing should be mentioned. The Minister also said that this policy will result—I do not think he was positive; I think he said "should result"—in economies. Since you cut out duplication and you have one body, instead of seven or eight bodies dealing with different aspects of what should be one service, it may lead to a saving of £10,000 or £100,000. That is the saving in a bill which now totals something approaching £17,000,000. I suggest to the Minister that we need not further consider that. I do not think it an argument worth making in support of this Bill. Indeed, I do not think it an argument which is justified.

If this proposal is to have the effect, which should really be the basis of the argument in its favour, then the result must be to raise health standards in many areas in which they are not at the moment sufficiently high. In each of these affected areas —I do not intend to specify which part of the affected areas I mean—it is true to say that there is a variation in standards; in Cork, in Dublin, in Waterford and in Limerick, there is at the moment a good standard in one area and the result of this unification will be to raise the lower standards in other areas to the same level. That is what is hoped for, at any rate, and I think it is a good ambition, but let us not cod ourselves. That ambition cannot be realised without paying for it and without the expenditure of more money.

The Minister should be prepared to take the House into his confidence to the extent of stating frankly that the effect of this measure, so far as the four areas mentioned are concerned, will be to increase expenditure on health because standards are not sufficiently high in one portion of each of the areas mentioned. In my time as Minister for Health, I met a great number of local representatives in all parts of the country. Despite political disagreement, I found them generally helpful and co-operative in health matters. I have little doubt that, if the Minister faced up properly to what is involved in this proposal, he would in the long run get the agreement of the majority of the representatives in the four affected areas.

I have mentioned certain doubts I have about the unified health authority proposal. I have made it clear that I can see the sense of it and the benefit to be got from it. I urged such a unification myself on many occasions. But the manner in which it is brought before this House, cloaked in a green paper, may not in the long run be to the benefit of the health services generally.

I shall pass from that now. There is another matter with which I wish to deal. From the point of view of the Bill, it is, perhaps, a small matter. I want to deal now with the Dublin Fever Hospital. I want the Minister to appreciate that I feel very deeply in this matter and in what I am about to say in relation to it. In this Bill— it was something referred to in passing by the Minister—there is a proposal to abolish the Dublin Fever Hospital Board and to merge into the new Dublin health authority the Dublin Fever Hospital Board and the services it provides. That is a very grave mistake, and I think the Minister is the last person who should have introduced this proposal.

In the Dublin Fever Hospital Board, we have an excellent example of effective voluntary effort in the field of health services. The Dublin Fever Hospital Board owes its origin to a number of charitably-minded people, people who did not share either the Faith or the outlook of the majority of our people. They were members of the Society of Friends who founded a charity in or around the beginning of the last century. The object was to provide a hospital to deal with the problem of disease and epidemics among the poor of Dublin. As a result of their action and initiative, the hospital at Cork Street was founded and built about the beginning of the last century. That hospital provided a most essential service throughout the century and a half of its existence in Cork Street.

In the middle of the 40s, when the present Minister was also in charge of Health, the then Parliamentary Secretary to the Minister ordered an inquiry into the affairs of Cork Street Hospital. I do not want to go into the controversies at the time, but the result of that inquiry was the abolition of the Cork Street Hospital Board. It will be remembered that the chief concern at the time was the fact that the report of the inquiry was never published. Following a change of Government in 1948, a decision to build a new fever hospital—a decision which had been taken previously— was implemented. A new fever hospital was built at Cherry Orchard. The board was reconstituted. It consisted of representatives of the Dublin Corporation, the Dublin County Council, the Minister for Health and a minority of seven trustee members. These seven trustee members represented, as they still do, the charity which originally founded and ran the hospital for very many years. On the building of the new hospital at Cherry Orchard, the trustee members handed over Cork Street Fever Hospital to the Board of Assistance. They also agreed to make available their capital funds and the income therefrom for the running of Cherry Orchard.

In this Bill it is proposed to abolish the Board entirely, to take from the trustees this new hospital at Cherry Orchard and dispossess them. That is bad enough, but it is also proposed to take from them their trustee funds, which amount to something like £50,000. I wonder who thought up that proposal. It is not a proposal that should be put forward by any Minister for Health. One may frequently feel that the actions taken by different voluntary organisations might be better taken, but that is no reason for seeking their exclusion or abolition. Where there is, as there is in this case, a great hospital built under an undertaking given, with the Minister's approval, in this House by the then Parliamentary Secretary to the Minister, as reported in column 1140 of the Official Report of 19th June, 1936, when he said that we are bound in honour to stand by any undertakings we came to in relation to the representatives of the existing trustees, I suggest that that binding in honour still remains and I earnestly suggest to the Minister that he should reconsider the proposal in this Bill.

It is not necessary. It merely dots an "i" and crosses a "t". It merely makes the thing more precise, more uniform, and more in accordance with the administrators' dream, but it forgets, it disregards, all the undertakings given in the past. It disregards the fact that this is an old-established charity run by trustees who are committed in honour, as they must be, to fulfil the terms and the principles involved in the charity. They own a hospital which was built voluntarily with these funds and the result of this proposal is to take from them something which they have.

I earnestly suggest to the Minister that he should reconsider that matter. I know well that perhaps next week, or the week after, or on some occasion in the near future, the Minister will, at a meeting of an association of one kind or another, stand up and say how delighted he is to be in such company. I am sure he will say that, as Minister for Health, he commends voluntary effort and he will praise the people who get together in a spirit of Christian duty to their fellows, to do something voluntarily to help less favoured people. That idea of voluntary effort must surely have the support of persons responsible for public health in this or any other country.

I warn the Minister that in this Bill there is an assault on voluntary effort and a proposal to prevent worthwhile people from doing worthwhile work. The Minister says that the reason is that fevers are not as serious a problem as they were in the past. Of course they are not. The Minister says that it may be necessary to be in a position to put Cherry Orchard to other uses. That may be so. What is the difficulty in doing it? The powers are there already in the Fever Hospitals Act and, even if it has to be done by a decision and by persuasion of the Cork Street Hospital Board, why should it not be done in that way?

I often wonder why it is so necessary for Ministers to have the power to do a thing by merely pressing a bell. It would be far better if they achieved what they believe in by persuading the persons affected that their case is sound. I know well—I am sure things have not changed—from the discussions I have had in the past with the Dublin Fever Hospital Board that they are only too willing to make their hospital available for any worthwhile health service. There is no difficulty involved in that. Therefore, I cannot see why this proposal should be in the Bill.

I want to make one correction in relation to the Minister's speech. He said that the idea of merging the Dublin Fever Hospital Board into a unified health authority was recognised from the time the proposals were first developed in his Department in 1952 and that the proposal in relation to the Dublin Fever Hospital Board has remained part of the scheme ever since. I want to assert that I never heard of such a proposal. If I had, I certainly would not have been a party to it. When I was Minister for Health, the proposal to unify the health authorities concerned the four areas involved with a possible provision in relation to the mental services, but I never heard it suggested that Cherry Orchard and the Dublin Fever Hospital Board should be merged into a unified health authority. Indeed, I remember considering and finding a solution as to the manner in which the Dublin Fever Hospital Board and this hospital could be secured in the event of epidemics or anything of that kind.

I suggest to the Minister that he should reconsider this section of the Bill. It may be only a small section. It will not alter, dramatically or significantly, the Bill itself. It is a small thing but it is something which in its implications could be far larger than the Bill itself. It would be very wrong if, by any action we take here, we say unnecessarily to any organised effort amongst the ordinary Christian public that they shall not have a share in the provision of worthwhile health services. It would be very wrong if we established a code whereby only the administrators and the recognised bodies were entitled to indulge in the Christian duty of helping one another. I urge the Minister to have regard to the implications of this section and to take it out of the Bill at a later stage.

As I said, like the curate's egg, this Bill is good in spots. I have endeavoured to point out what I conceive to be its good features and what I regard as its bad features. I have little doubt that the Minister who gave us to-day this very comprehensive review of the problems he has to face, will consider not in any partisan way, the views expressed in this debate. I have no doubt that if the Minister is persuaded by argument here that some of the proposals should not be in the Bill he will make every effort on the Committee Stage to meet the points of view which have been expressed.

This Bill has been hanging around the Minister's Department for a number of years. It has been before us on a number of occasions. I heard Deputy O'Higgins on this Bill a few years ago, when he was trying to palm it off on the Cork front. It is before us again now Whilst I hate amalgamation and have every reason, as a ratepayer's representative, to hate it, still, if I can find any way of relieving the ratepayers of South Cork of the Old Man of the Sea which has been hanging around their necks since 1924 and which was confirmed under the 1939 Home Assistance Act, I would even hope to achieve it under this Bill.

In his introductory speech the Minister dealt with the three Committees in Cork which he now proposes to abolish—the South Cork Board of Public Assistance, the Mental Hospital Committee and the Sanatorium Committee. It is rather extraordinary that in the legislation that came from his Department in previous years in regard to these different Committees we had, under the Sanatorium Act, the charges levied per capita and paid for on that basis. However, under the South Cork Board of Public Assistance Act, we have this provision:

"Where a public assistance district consists of a county borough and a county or part of a county, the money required to meet the expenses of the public assistance authority for such public assistance district shall be supplied to such authority by the corporation of such county borough and the council of such county rateably in proportion to the totals of the valuations appearing in the valuation lists for the time being in force under the Valuation Acts of the rateable property in the respective portions of such public assistance districts ..."

That is rather an extraordinary change in regard to the three bodies now proposed to be abolished. In the case of two of them, Cork City and Cork County will pay per capita but, in the case of the South Cork Board of Public Assistance, the unfortunates in Macroom, Kinsale, Bandon, Youghal, Midleton and Cobh must, in addition to paying for their own home assistance people, pay for a city which is the capital of the South and one of the most prosperous cities in the world.

When we were last dealing with the matter in 1939, I raised this question. I went this afternoon to the Library to refresh my memory. I found that, on the Second Reading of the Public Assistance Act on 6th June, 1939, I called attention to this anomaly. The reference is Column 557 of the Official Report of 6th June, 1939:

There is one particular matter contained in this Bill that amazes me. Under Section 7, power is taken to divide the area to which the Act applies into public assistance districts. Since the amalgamation scheme was brought in, six rural districts have been amalgamated with Cork city. That is an amazing position, when Dublin city is an area in itself for the purpose of home assistance. Waterford city, I understand, is also a separate area for the purpose of home assistance. The position in Cork is that although the rural areas subscribe two-thirds of the total amount subscribed, the city spends two-thirds of the total amount and the county obtains only one-third. That is, one-third of the total money is spent on the people in the six rural districts; and Cork city, which subscribed only one-third, has two-thirds of the total money spent in Cork city area.

I made that speech in 1939, 20 long years ago. I was assisted in my arguments at that time by the late Mr. W. J. Broderick who was chairman of our county council for a number of years; by the late Mr. Eamonn O'Neill who was Leas-Cheann Comhairle of this House for a period of years, and by the late Mr. Brooke Brasier who also represented the constituency with me. We even went so far as to endeavour to force a decision in this House. The reference is Column 1544 of the Official Report of Dáil Éireann of 22nd June, 1939: "Deputies W.J. Broderick, Brasier, Daly and Corry, stood in their places.” We called for a division on that outrage but failed. When discussing the matter afterwards, on Committee, we again challenged a division and were, of course, defeated.

That condition of affairs has continued and, despite repeated appeals made here by myself and other Deputies representing the different areas, the Department of Health, and the Department of Local Government who had charge of it before that, turned a deaf ear and did not care. I shall give you the figures I have here as an indication of the manner in which the money is going. The total expenditure for the year 1959-60 was £712,948. Receipts amounted to £169,800 and the net expenditure £543,148. Of that the city pays £181,049 and the rural areas pay £362,099.

Let us now turn to the distribution of that money. The total amount for home assistance was £38,725. Of that Cork city contributed £12,908 and received £20,437. The rural areas of South Cork contributed £26,817 and received £18,288. That means the rural areas around Cork city not alone paid for all their own home assistance but contributed £7,529 to the home assistance of Cork city thus helping the prosperous merchants there.

As regards the footwear scheme, which has been so much juggled around by the Department of Health that what were once free boots are now ratepayers' boots, the total amount was £15,100; the grant was £5,500 leaving £9,600 to be found by the ratepayers of Cork city and South Cork. The city contributed £3,200 and received footwear to the value of £9,040. The county paid £6,400 and received footwear to the value of £6,060. Therefore, the whole of the £5,500 grant went to Cork city. We paid for our own boots and, in addition to that, we had to contribute £360 to provide boots for Cork city. This was as a result of legislation passed by this House in relation to which the elected representatives for the area were ignored.

During the past 20 years—I shall not go back to what happened between 1924 and 1939—we have paid not alone for our own services but £180,000 a year for the services of Cork City. These are the figures, on a valuation basis, imposed on us by the Department of Health.

The Minister is responsible.

By the Minister and his Department and enforced by them. In plain language, the rural areas surrounding Cork City, in addition to paying for their own home assistance and their own services have contributed during the past 20 years £3,250,000 towards the support of the poor of Cork City. Those are the figures which the Minister and his Department can verify if they write down to the County Manager.

I have the honour of being chairman of the South Cork Board of Assistance for the last 16 years. I know what the burden is and the uselessness of appealing to the Minister or his Department. Ninety per cent. of the Bill that is before us is occupied with the problems of Dublin City and the rest is thrown in as a make-weight. Under this Bill the Minister is relieving us of that burden, that is, if I am to place any weight on the statement made by the Minister within the past half hour, and I listened very carefully to him.

There is now going to be a per capita charge on each area, and for that reason I am supporting the Bill. I would support Old Nick if he took a burden of £100,000 off the unfortunate ratepayers of South Cork. I have stated the position here frankly and I have here previous promises by Ministers in respect of that matter and know what they are worth. Anyone who reads Dr. Ward's statement in connection with the matter to which I have alluded will know just where I stand. I have a duty to the ratepayers I represent. My constituents come first as far as I am concerned and that outrageous burden would not be found in any other country outside that of the Bashi Bazouks. That legislation was passed through Parliament despite the objections and the appeals here by all the elected representatives of the areas concerned. The machine went into operation and the protests of the elected representatives were ignored.

The statement made by me on the 6th June, 1939, is borne out by the figures I have given here for the year 1959/60. We contribute two-thirds of the rates in South Cork, and Cork City contributes one-third. Cork City gets two-thirds and we receive 4d. for our 8d.

The Deputy has already referred to that matter.

Those are the facts.

The Deputy has already referred to that matter.

Unfortunately, a Leas-Cheann Comhairle, if you take this little volume with you on your holidays sometime and read it, you will see how much time I had to waste 20 long years ago in this House and how much time the late Deputy Broderick had to waste on it, and how much time the late Deputy Eamonn O'Neill, the former Leas-Cheann Comhairle, had to waste on it. You will see the burden that the unfortunate man in Macroom, outside in the rocks and the heather, has to bear, paying for the poor of his area and paying for the poor who should be paid for by the opulent merchants of Cork city.

The Deputy has already said that.

I can go into that town where there is no industry and see that the only thing they have to look forward to is the time when they can get enough money to go to England or America. I can go to the town of Kinsale and see the same position. I can also look at the towns of Youghal, Midleton or Cobh. I should like to point out that the rateable valuation on the shopkeepers in Cobh is at least three times as high as the rate per square foot for the largest shop in Patrick Street in Cork.

Perhaps the Deputy might get a more relevant opportunity than this to raise that grievance.

You cannot get a more relevant opportunity than when dealing with two areas which are now being pulled in on a valuation basis. That is the time to deal with them. This is an iniquitous state of affairs and if we can get rid of it now, then now is the time to do so. I should like to hear from the Minister some reason why he had those different bases of valuations; why he had the per capita charges in respect of the mental hospital and sanatorium board and the valuation on the board of assistance. I should like to hear that from the Minister.

Those are hard and stubborn facts. I am prepared to support the Bill to get rid of them but I shall watch carefully the Committee Stages of the Bill. I am going now to endeavour to get hold of the Minister's introductory statement. I want to see that burden taken off the backs of the unfortunate poor devils scratching the ground in Macroom in order to pay what it should be the duty——

The Deputy should not repeat himself. Repetition is disorderly.

There is such a thing as justice. I do not think there is much in this House. At least I have been 32 years in this House and I saw very little of it.

The Minister, in his introductory speech, drew attention to his ambitions. Apparently they are better health services and, at the same time, economy. I do not know if we can help in relation to whether this Bill will give us economy in South Cork as outlined by Deputy Corry. I am afraid I cannot agree with him. From reading the Bill as an ordinary member of the House, like Deputy Corry, it seems to me that except for the question of public assistance, the problem will still remain in regard to the relationship between Cork Corporation and the South Cork Board of Public Assistance. I may be wrong but I believe that Deputy Corry's approach is rather like that of the man who suffered from a toothache and who in order to relieve himself of the pain had his toenail drawn.

We will see whose toenail will be drawn.

Deputy Corry realises that it is important for him—and perhaps for others—to show cause and justification as to why he is going to vote for a Bill that over the years he has strenuously opposed when it was dressed in similar fashion by other Ministers. It must be said truthfully that in Cork, when proposals somewhat similar to these were put before the Cork County Council, the county council were unanimous in rejecting the proposals relating to Cork county and Deputy Corry was fully in agreement.

I am interested, first of all, in whether or not we are to get improved health services and secondly, but only secondly in the question of economy. I believe that, first and foremost, the problem we are confronted with in relation to this Bill and the overall problem that ties us up with Cork county is the question of improved health services. The Minister has drawn attention to overlapping and in doing so, I noticed he concentrated on overlapping in Dublin. He spoke, rightly so, I suppose, of a lady in Churchtown in Dublin, and also somewhere else, Rathmines or Rathgar. He mentioned the grave difficulties of individuals. We have difficulties, too, in regard to individual cases in Cork but I am convinced that a greater concentration on an improvement of the services as they are would help the individuals more than a complete scrapping of the services which, over the years, have been improving, perhaps slowly. I believe that should be done rather than facing about now and entering into a new channel as directed by the Minister for Health.

It seemed to me that the Minister laid emphasis on the health services in the counties. Naturally, my approach to the problem is how it affects Cork county and city. Because we are in receipt of State grants, a Minister can say that because the State is paying, it can call the tune. I believe that is the wrong approach. I believe if we could get a greater sense of co-operation between the Minister and his Department, on the one hand, and the local authority, on the other, in trying to remedy any defects which we see, then we would get somewhere in improving the existing services and avoid some of the overlapping.

I should like at this stage to remind the Minister, when we speak of overlapping in the health services, that not all the overlapping takes place in local authorities. Time and again, we find a certain amount of overlapping in Departments of State, including the Department of Health. Nevertheless, I expect that the various Ministers, with the assistance of their personal advisers, do their utmost to improve the system in their Departments so as to avoid overlapping. Why not give us the same opportunity and the same help? If the Minister approached this problem from that angle, we would be discussing this Bill in a much happier frame of mind.

The Minister has spoken of the possibility of savings. Let us look at the problem that confronts us in Cork county and Cork city. In both these places, there are hospital charges and the people know that the charges are operated through the county council offices. Therefore, if there is the question of staffing, we must face a problem that apparently so far the Minister wishes to avoid, because the Bill provides that in Cork city and Cork county, we shall have a city and county medical officer. That is a new position and we shall be appointing a new generalissimo in charge of our so-called improved health services.

At present, we have, as is mentioned in the Bill, the Cork Mental Hospital which has an R.M.S. in charge of it. We have a sanatorium with another R.M.S. and we have an R.M.S. in charge of St. Finbarr's, another local authority hospital. What provision is there in this Bill in relation to the co-operation and the inter-dependence of these hospitals and those in charge of them with the new appointment of county and city medical officer? Where will the saving be there?

With the entry of a new official, much higher up in officialdom, naturally there will be added staff from every angle. Even with the entry of such a person into the health arena in Cork, no Minister can suggest that the R.M.S.s of other institutions can be subordinated to such extent that they will be small boys in relation to the work in their hospitals. We, the members of the local authorities, have confidence in these officials, and each R.M.S. in each institution has proved himself an outstanding individual. Are we then to hope from what the Minister tells us that this new proposal will be of such benefit that we will have a savings in relation to staff? For one moment I could not possibly believe that to be true. On the other hand, I am firmly convinced that integration will automatically mean additional staff and extra expense in relation to staffing.

The Minister mentioned other services that will be in the charge of this new body. We have, of course, the dispensary medical service, the institutional services, the specialist and child welfare services and the school medical service. Is the dispensary medical service going to be improved in county Cork under the Minister's proposal? He is convinced that it will, but I am firmly convinced that this is a retrograde step in relation to this service. From the files in his Department, the Minister knows that the dispensary service in Cork county is such that, while the local authority members have been striving over the years to improve it by improving dispensary buildings and acquiring new ones, the Minister for Health—not alone the present Minister but his predecessors—has not co-operated in the provision of these new buildings. Let it be said here and now that the present Minister went further than others in relation to this question when he decided that the local authorities would not continue to receive the benefits of contribution, by way of grant, for the erection of dispensaries. That has been the case for the past few years. We are being denied such grants; yet the Minister says that under this new body we will have better health services.

Institutional services create another problem and apparently the Minister firmly believes this new body will relieve the people of Cork county and Cork city of that problem, with which is associated the overcrowding of hospitals. How long have we been striving to secure additional hospital accommodation in Cork city for the benefit of the people of the city and county? How long have we been striving to get a decision from the Minister on the proposal for a new hospital in Wilton, Cork? Our big problem—and there are other members in the Chamber who can bear me out in this—is the headache of not being able to provide satisfactory hospital accommodation, under present conditions, for the very many people who are trying to enter our hospitals as patients. Will this proposal of the Minister provide additional hospital accommodation for the people in the city and county of Cork?

There is also the school medical service and I should like to know to what extent this new health authority will improve that service in Cork city and county? I will admit quite readily and openly that the school medical service in County Cork is not all that it should be. All members on the Cork County Council's Health Services Committee have been unanimous in their desire to improve that service and, if necessary, provide additional staff so that each school can be visited at regular intervals, rather than, as at present, over a period of from one to three years. That improvement can be provided by a little more co-operation and help from the Minister for Health to the county council and Cork Corporation.

We have other services coming under this new body such as maternity cash grants, disablement allowances, the provision of milk, T.B. allowances, control of infectious diseases, hospital services, food hygiene, and other services administered by Cork County Council and Cork Corporation. Deputy Corry, apparently, did not wish to draw attention to the fact that all these services that are being offered, and which we are all anxious to give to those entitled to them, from the border of Waterford to the border of Kerry and from Cork harbour to the Limerick border, all thrown in with the city of Cork, can, according to the Minister, be worked in a much better way by this unified committee of 16 members from the county and eight from the city. Apparently, he knows the present system under which we have the western and northern committees in the county and the South Cork Board and apparently he considers they are too unwieldy and may be too expensive.

I want to draw attention to the fact that members of these committees find it necessary, in order to carry out their responsibilities, to have frequent meetings in the various areas, and North Cork, West Cork and the South Cork Boards have their own days for dealing with the problems that arise in regard to health and other services. Is it suggested that this new authority with 16 members will be able to deal with the problems of that vast area in the county and city of Cork in, perhaps, the same period of time as at present? If the Minister believes that or wants it to be so, I should like to tell him he has no knowledge of local government problems at least in relation to Cork county, and his approach is as far removed from sanity as are Deputy Corry's views in relation to savings on certain services.

I do not wish to dwell too long on these points at this stage. I understand that members representing other areas, Dublin, Waterford or Limerick, may be in favour of this Bill—it may suit them. Should that be so, they would naturally be anxious for the introduction of this improved service. My remarks are confined to the area of which I have experience as other members have experience in regard to activities in other areas and in regard to the service and co-operation given by the officials in these areas.

The Minister touched very briefly on one point—medical cards. The proposed authority will apparently still be in the same situation as regards medical cards as at present. I hope the Minister will at least understand that under this Bill there will be as much overlapping on the question of whether or not people are entitled to any of the various services as under the old system. If the Minister were really interested in trying to improve the services, he would attack this problem, first of all, in relation to the issue of, and method of dealing with medical cards. That is one of the angles that we members of local authorities have found to be a great headache and if there has been overlapping between some of the offices of the various health authorities, that, to a great extent, is due to the approach to the issue of medical cards.

This Bill makes no attempt to improve the present system of dealing with medical cards. That is another point that shows that if this Bill becomes law, it will not be of benefit to the people concerned or to the ratepayers or taxpayers.

I do not know whether or not the Minister gave this matter consideration in introducing the Bill. Mention is made in the Bill of the rights of other members of local authorities who will not be members of the famous committee to question or make representations at the annual estimates meeting of the local authority in regard to the cost, etc., of the services provided by the health authority. May I ask the Minister a question? Sixteen members of Cork County Council are to be appointed members of the new authority, leaving 30 members excluded, as Cork County Council has a full membership of 46. Should the 16 members decide, on the advice of the manager of the new authority, on a certain figure for the annual estimate and if, when that estimate is submitted to the local authority, Cork County Council, for ratification or otherwise, the other 30 members vote against it for any reason, what happens?

Members might consider sufficient money is not being provided, while others might decide that too much was being provided, but if a majority of Cork County Council decided by their votes at the annual estimates meeting that they would not approve the submitted estimate of this authority, what would happen? Would the Minister revert to the procedure adopted some years ago in other places, Kerry, Dublin and elsewhere? Would we then be threatened in Cork with another newly appointed official, a commissioner to run the committee because we did not obey the Minister? It could come to that. I should like to know from the Minister what will happen.

Has the Minister informed the members of his own Party in Cork who on different occasions in the past decided to agree with the other members of Cork County Council to oppose unanimously any such unified health service as is being submitted in this Bill? Has he informed the members of his Party or of any other Party? I think it only fair and proper even at this late stage that he should be prepared to tell his own supporters what he intends to do in the future. We all know that he likes having such high name plates, as it were, attached to people as "commissioner" and "county manager".

While it is useless to suggest anything to the Minister for Health, I believe there is a simple remedy for all this. The Minister for Health, just as he did when Minister for Local Government, loves to see the county managers trooping in procession up to the Custom House to hear his learned advice and to take from him and his Department the words of wisdom that they will in turn impart to the members of the local authority.

In Cork, where we have a county manager and three assistant county managers, I understand they have weekly conferences. It is essential that they should discuss the various services and the possibility of improving any of them under their command. Would it not be possible for the Minister, instead of insisting on this new system which apparently suits himself and also Dublin, and insisting that Cork should follow in the train in regard to this so-called improvement, to have a conference? Perhaps it would be best if he arranged a conference for the county and city and attended it himself with the county manager and the assistant county managers and the R.M.S. from each of the various hospitals and officials of his Department who would certainly be able to help by making suggestions to eliminate some of the overlapping that may exist. Would it be possible for the Minister to approach it from that angle rather than adopt his own line of thought?

I believe the great difficulty confronting the Minister lies in the fact that the Minister's knowledge of local authority work is nil, except in so far as he looks down on the activities of the local authorities in the various parts of the country from his office in the Custom House. Had he been a member of some local authority for some years, perhaps his approach to this might have been somewhat better than apparently it is, according to this Bill. In the last analysis, this Bill is just another example of insisting that the power of the few shall govern the many.

We are entitled to consider what may happen in the future by examining what happened in the past. We know what happened in the past in relation to the Minister's activities in the Department of Health and in another Department. The Minister insists upon imposing on the people of the city and county of Cork a system which he believes will bring about a vast improvement. This is the Minister who refused for the past few years to allow grants to those local authorities who are anxious to improve the service by building new dispensaries. Will he give to this new authority the power, and what is more important, the necessary grants, to erect these dispensaries in County Cork?

I believe that this Bill will not relieve from a financial point of view any burden whatsoever on the people. Indeed, it will not improve the health services. At a meeting of the Cork County Council held within the past week or two, by the decision of a large majority, it was decided to inform the Minister for Health that Cork County Council did not wish to have this new service imposed on the people. The members of that council, from their own experience and because of their knowledge of the operations of the health services in various parts of that huge county, considered that there was no necessity for scrapping— that is what it amounts to—the present system and bringing about a position in which they will be faced with the problem of wondering whether the new service imposed by the Minister will be somewhat better.

The trouble is that the Minister wishes to steamroll this Bill through the House. He has the majority to do so. He has stifled the views of some of his own members from the South. Should he be successful in this, he or some of his successors in years to come will come back to this House and point out that the worst Bill introduced in this House in 1959 was the Bill in relation to the so-called improvement of the health services in the city and county of Cork.

I am making it clear that on this Stage we are not opposing the Bill, because, if we did so, it would mean that we would be asking other members of the Labour Party in Dublin, Waterford, Limerick and other places to oppose it with us. We are opposing it because we believe it is imposing on the city and county of Cork a service which in the years to come, will prove much worse than the present. We can inform the Minister that on Committee Stage we are determined, in spite of the speeches of Deputy Corry, to go the whole way and prove that Cork County Council are quite satisfied that the present service can be improved but the imposition on the county of this new service will lead to chaos for many and improved positions for some of the Minister's friends.

I should like to say at the outset how much I appreciated the speech of Deputy O'Higgins. With many of his remarks I find myself in very full agreement, indeed. I am particularly grateful to him for his reference to the proposed dissolution of the Dublin Fever Hospital Board. Deputy O'Higgins spoke with great eloquence and very genuine feeling and in a way which, I think, was very helpful to the cause which he had so much at heart.

I particularly appreciate how he stressed in so appropriate a way the fact that this fever hospital was originally an old Quaker foundation and that its foundation was due to the generosity of a small group of charitable people in this city very many years ago. I do not wish to stress for a moment any question of religion whatever but I feel as I think Deputy O'Higgins felt when he expressed himself so well.

There is, in addition, a legal point involved here. It is that a small body who are now known as trustee members of the Board are the only legal representatives as trustees of the original founders of this institution. They acted in a very proper way throughout. They safeguarded the money and assets which were entrusted to them and at the same time, they proved very co-operative in the formation of the present Fever Hospital Board.

They put their capital at the disposal of the authorities for building a new hospital and any funds which they have are invested. The income was devoted to the work which was the object of the original founders. I cannot feel that the exclusion from this Bill of the Dublin Fever Hospital Board would react in any way unfavourably on the general functioning of the health authority to be set up for the whole of the Dublin area. I should like to add my voice to that of Deputy O'Higgins in support of the proposal that the Minister should very seriously consider making this exclusion.

I agree with Deputy O'Higgins, too, that there is a tremendous value in the voluntary charitable work which is represented by the members of this hospital board and by the committees and organisation which are working in conjunction with it for the welfare of the patients. It is a very healthy sign in any community. I hope the Minister will not make these people feel that their services are simply no longer required.

In general, I feel that, so far as Dublin is concerned, this Bill or some such Bill is essential. I have some anxieties still in my own mind as to whether the new Dublin health authority will really be able to exercise control over the various institutions and the numerous services which will be its responsibility. I have been a member of only one of the bodies which is to be dissolved—the Rathdown Board of Assistance—but I do know that Board was greatly aided in its work by being able to hold its meetings in the hospital in Loughlinstown, where we could take an actual, personal interest in the institution which was our responsibility. I find it rather hard to imagine that this new Dublin health authority, composed of 27 members, will be able to give that personal attention to institutions as far apart as Loughlinstown and Portrane.

I do agree with the Minister that the integration of all health services is most desirable so that mental health problems will be dealt with on precisely the same level as other health problems but I am rather anxious, with Deputy O'Higgns, that possibly the search for unification, uniformity and centralisation, may make it very difficult for democratic control to be maintained. I foresee that the Dublin health authority will be almost entirely office-bound, sitting in some premises in Dublin, without personal, direct knowledge of the various institutions which will come under its control. The only solution I can see to that is, possibly, the formation of sub-committees which would have the functions of a visiting committee, to visit each institution very regularly and to report to the whole Dublin health authority. That is a matter of detail which can be dealt with later but I should like to add my voice to the appeal that every effort should be made to keep democratic control as a real item in the administration of the health services.

I am very conscious that many discrepancies and difficulties have occurred in the administration of health services in the Dublin city area and the Dublin county area and I feel that members of the public should certainly get better service by reason of being able to avail of the services anywhere in the city and county areas but I am always anxious about any assurance given that mere centralisation by itself will produce efficiency. A very big body may move extremely slowly or may cease to move at all or may move rather spasmodically. For that reason, I am not in favour of big bodies as such and I do not believe unreservedly that increased efficiency will result from central control. At the same time, we are faced with the obvious difficulty that the present administration does not lead to efficiency or uniformity or a uniformly high standard and I agree with those who said that the standard does vary, that there is a very high standard in some places and a low standard in others.

In general, I feel that this is a very essential Bill. I should like to utter a word of warning that, unless great care is taken in its administration when it becomes law, there may be a danger that it will become an entirely bureaucratic institution with very little, if any, democratic control by the representatives of the public. As long as that is appreciated, the danger may be avoided.

I would be sorry if the question of the Dublin Fever Hospital Board became a matter of any hard feelings. I would imagine, and I hope I am right, that its inclusion was simply decided upon to tidy up matters and I would hope that this was done simply without a full recognition of all the factors involved. When the Minister has reconsidered the matter in the light of what Deputy O'Higgins has said, and in the light of a very detailed memorandum which I shall pass on to the Minister, and on which Deputy O'Higgins also spoke, I hope he will be able to exclude the Dublin Fever Hospital Board from the terms of this Bill. If he does, he will not damage the uniform working of the health services in the area but will reinforce a very vital principle that, wherever possible, voluntary charitable work should be encouraged. It will also reinforce the vital legal principle that where moneys have been subscribed and vested in trustees for the execution of certain works those trustees, while they may co-operate with other bodies in using that money for required purposes, must have some exclusive representation on whatever controlling body may be appointed. I hope the Minister will regard this as a very vital matter, which, as Deputy O'Higgins said, is a small matter in its own way but very vital, and that he will see his way to introduce an amendment to make this exclusion.

I would be in favour of this Bill if I could get an assurance from the Minister that when this Bill is put into force, it will reduce the cost of the services but I do not think that it will. I am almost sure it will increase the cost of the services. If the Minister gave that assurance, I would be inclined to vote for the Bill even though I had an unfortunate experience with a predecessor of the Minister. When representatives of all the local authorities in Munster were called to Cork by the then Minister for Health, Dr. Ryan, in 1952, I asked him what he considered the health services would cost if the Health Bill was passed and he said two shillings in the £. I thought I was a political adult at the time but I was not. I took that for granted. Members of the House who are also members of local authorities know the result.

The debate in the House tonight was interesting. It was the first time in my life I heard Cork being attacked by a Corkman. I heard Deputy Corry punish the City of Cork and, strange to say, the great City of Cork had not a voice in this House to reply. I shall confine myself to Waterford.

On page 4 of the Minister's speech he said:—

The question of unifying the administration of the health services in Dublin, Cork, Limerick and Waterford had, however, been under consideration before the 1953 Health Bill was introduced, and it has since been the subject of correspondence and discussion with the local bodies concerned. Thus these bodies have had the opportunity of considering unification exhaustively and of furnishing their views on the proposals in the Bill.

Did they furnish their views and what were their views? I do not think the local authority of which I am a member is in favour of this Bill.

Another reason given for the introduction of the Bill concerned the question of border cases, such as that of a city resident who is a patient in Dún Laoghaire, or the lady in Churchtown which is near the border. This will happen everywhere. I am sure it will happen to my constituents in County Waterford who want to go to the hospital in Clonmel over the river in County Tipperary. I am sure it will happen in Limerick where it might be more convenient for patients from Clare to go to a hospital in Limerick rather than their own hospital. But that is no good reason for bringing in this Bill. I know it can be said that we have people in County Kilkenny and there is a hospital in Waterford. Without making any comment on it, I know that people from Kilkenny have come to hospitals in Waterford. I do not know how it was done, but it was done; and more power to the people who did it.

If we have this unified control, with one person or a small group of persons running all the institutions in my constituency, I do not think it would be desirable. It would be much better to have the health authority in Waterford. We are doing all right with our existing institutions. There is a danger that the new arrangement will do away with hospital boards. It may be said they have not much power now, but they have one great function. They meet in the hospitals and inspect them. It is right that the representatives of the people paying the piper should go through the hospitals. I do not think it would be good if these hospitals were left without that type of inspection. It is possible that the person in charge of a large hospital, having no one to answer to, might become all-powerful, and the hospital might go to blazes. It might be three or four years before complaints would reach the local authority, and eventually here, so that this citadel of centralised control might be penetrated.

The Minister should take into consideration that the local authorities I know are not in favour of this Bill. The Committee Stage should be delayed for two or three weeks to enable special meetings to be held in the areas concerned from which constructive amendments might come for the Committee Stage. I heard a previous Minister for Health say that when he visited local authorities during his term of office, they opposed this Bill. The Minister should take note of that. I say to the Minister and every Minister who will ever be over there: Ministers should not think they are either the masters or leaders of the people; they should be the servants of the people. If they get a consensus of opinion from responsible Deputies on all sides and from responsible public representatives in various local authorities, they should pay heed to it.

I hope that constructive amendments for the Committee Stage will be put forward from both sides of the House—I have an idea they will be put forward from both sides—and I hope the Minister will consider them. If he does, this Bill can be made a good Bill. As it is at present, it could be one of the worst pieces of health legislation ever put through this House.

I think that, in general, Deputies are prepared to welcome any Bill that tends to improve health services. As this Bill appears to have that tendency in some respects, it should be welcome. One part of the Bill—that dealing with a desirable change in attitude to mental health services—is very welcome indeed. It is a crying shame that for years mental treatment was the neglected orphan of the health services. Even though in recent years we have seen modern hospitals close down in various parts of the country for lack of patients, we have continued to have a picture of overcrowding, with all its attendant evils, in most mental institutions. If this Bill has the effect, as it appears to have, of bringing mental treatment in line with the enlightenment shown in our other health services, it certainly should be welcome.

Having said that, I should like to comment on a major aspect of the Bill —the provision for the abolition of existing health service authorities. I am referring primarily to Dublin City and county. A number of these boards, despite all the handicaps, have endeavoured to carry out their duties over many years. A significant feature in regard to the personnel of these boards, such as that in St. Brendan's Mental Hospital, the Dublin Board of Assistance, the Rathdown Board of Assistance, and so forth is that the members, whether members of local authorities, nominees of local authorities, or trustees, such as those in the Dublin Fever Hospital Board, take a very keen personal interest not only in the financial administration but also in the patients and other personnel for whom and to whom they have a certain responsibility.

It is proposed in this Bill to remove these boards and to place these institutions under a health authority consisting of representatives of both the city and county of Dublin. Does the Minister and his advisers believe that such a health authority will be able to devote the same time, attention and personal consideration to the care of those for whom they have a certain responsibility, and particularly those under treatment in hospitals or institutions? The Minister must be aware that local authority representatives on this health authority will have many other responsibilities. Remembering the magnitude of the task confronting an authority which controls all the health services in the city and county of Dublin, is there not a grave danger that this proposed authority—I do not want to cast any reflections on the future personnel of this authority— will be in a position only next best to that of a rubber stamp? I do not think it would be possible for such an authority to devote the same time and attention to the problems confronting it as are those who at present man the various boards which will be affected by the provisions of this Bill.

There is another aspect to which the Minister should give some attention and on which he should give the House more information. Apart from the abolition of these boards, is any change envisaged in administration? To me, the only change appears to be a change of title. The Assistant City Manager will become the Chief Executive Officer. At the present time the various institutions affected, with the exception of the Dublin Fever Hospital, are administered by the assistant city manager. Under the Bill, administration will be practically identical with that which obtains at present.

The Minister should give us some information as to whether or not the Bill will provide any substantial or significant benefit for the various groups which will come within its scope. It is true that there is necessity for organising health services on a proper basis. Will this Bill make it any easier for people to get treatment in hospitals? Will it make it any less difficult for a person to get such benefits as are provided for those holding blue cards? Will there be, as a result of this Bill, any reduction in the numbers of those engaged in the investigation of means in order to discover whether or not a family may have 5/-, 10/-, or a few shillings above a certain level and so be deprived of hospital benefits? There is nothing in the Bill which indicates any substantial change as far as the recipients of health service benefits are concerned. I trust the Minister will provide the House with information on that aspect when he comes to reply.

The health services are provided mainly by two sections of the community, the taxpayer and the ratepayer. Can the Minister indicate to what extent the Bill will provide for an actual reduction in costs falling on the State and to what extent, if any, the health services costs of those who contribute to the expenses of local authorities will be reduced or eased by the passing of this Bill? I do not think that making provision for the abolition of a number of hospital boards will effect any great saving in the expenditure of the various boards, particularly if the provisions which make possible the appointment of a limited number of sub-committees are operated. I should be particularly interested to hear the Minister indicate what degree of saving there will be under that heading.

On the question of health services, and particularly in connection with the question of incidental services where the two main interests involved are, first of all, the patients, and secondly those who look after the patients, will the Minister tell the House to what extent the present administrative machinery, if changed by this Bill, will cure the ills which have developed over the years in dealing with the complaints of nursing and other personnel? The situation in recent years, because of the operation of the Managerial Acts in these authorities, particularly in Dublin, has become impossible. The smallest grievance, the smallest complaint, the smallest matter that should be dealt with on the spot, in an instant, by someone with authority, requires the attention and signature of the Assistant City Manager.

Everything must go to the Assistant City Manager. Legitimate complaints of the nursing personnel, and legitimate complaints of other personnel, or claims which should be dealt with on a local basis by a registrar, a clerk or somebody with authority, are put on the long finger and have to await the attention of an officer who has to administer all the services in an area like the city or the county of Dublin and part of Dún Laoghaire and Rathdown. At the present moment that officer is the Assistant City Manager and it appears from this Bill that the only effect will be that the title will be changed and we shall have a Chief Executive Officer.

I ask the Minister to consider sympathetically the possibility of introducing at a later stage changes in the Bill for the negotiation and settlement of minor matters which could be dealt with, in each instance, by somebody charged with responsibility. I shall give just one instance. I have to travel tomorrow morning to Portrane to meet the Assistant City Manager of Dublin to discuss the question of whether or not some of the nursing personnel who live on the estate there can get a couple of panes of glass in the windows of the house. That cannot be done, in existing circumstances, unless the Assistant City Manager approves it. That is only one instance of what is happening all the time. No one has any authority to make any final decision except the Assistant City Manager.

I appeal to the Minister that if we are to improve our health services— and I think we all want to improve them—we should think in terms of providing realistic and reasonably workable machinery for dealing with the legitimate claims and problems of those whose lives are devoted to looking after the ill and the afflicted members of our community. I do not think the Minister wants the situation —I doubt if any Minister would really desire it—in which he himself would have to deal with almost every detail of what happened in his Department. I believe if the Minister makes it his business to inquire into the situation before this Bill goes through the House, he will agree that there is a very strong case for introducing some amendments to it to deal with the situation.

There is another aspect of the Bill on which I should like to comment. It appears that in place of the machinery which existed for deciding on what amount of money was to be provided for the various services in the bodies which this Bill proposes to abolish, there is a new type of machinery. It is set out in some detail in, I think, the Second Schedule. What does that machinery purport to do? What does it do? It appears to me that it makes rather elaborate provision for holding a series of meetings with the authorities and that the estimated expenses of the authority for the subsequent year shall be reported and notified to the rating authority. The rating authority can then discuss the proposed expenditure and make recommendations which may or may not be accepted.

At present, the Grangegorman Hospital Board would normally be preparing its estimates under the direct control and guidance of the Assistant City Manager. The Board of Assistance would be doing the same. After examination of those estimates by the Grangegorman Board and by the Board of Assistance, a resolution would be adopted providing that the expenditure in a subsequent year would amount to £x. The local authority would then get a statutory demand. Whether the local authority be Dublin Corporation, County Dublin and County Wicklow, they would get the statutory demand stating that they would be required to pay proportion of the expenditure and they could not vary it. They would have to comply with the statutory demand. There has been much complaint about this by local representatives down the years.

The present position appears to be that the new health authority have the estimates of expenditure prepared and examined and send a copy to the local rating authority. The local rating authority can express their views. Those of us with critical views of the proposals can make recommendations which would go back to the health authority as such and the health authority, as a health authority, can say: "We have heard your views and we are adopting our original estimate." That appears to me to be the position and I should be glad to have the matter clarified if it is not.

In that regard, the situation appears somewhat peculiar. It gives the rating authority an opportunity of expressing their views. That sounds nice in public, but, as far as I am aware, every board which it is now proposed to abolish has consisted up to the present time of a very substantial proportion of local representatives. Certainly, in reference to the Grangegorman Board, no estimate of expenses has ever gone through without the knowledge and consent and support of the elected representatives of the city of Dublin, the county of Dublin and the county of Wicklow. Furthermore, those members had the estimate of expenses in advance. The only difference appears to be that this Bill provides that a copy of the estimate of expenses will be supplied to the rating authorities and to the general public—but it will come back again on recommendation and the Board which consists of approximately 27 members, can then decide again. Even if they have recommendations to reduce or increase any of from one to half a dozen items from the Dublin Corporation, County Dublin, and so on, and may have recommendations adopted by an overwhelming majority of these bodies, when it comes back to the health authority, the majority of the 27 members can then decide not to accept the recommendations. It appears to me to be a very round about way of advising the public of what the expenditure under these headings will be.

I am inclined to think that an attempt is still being made to convince the public that certain sections of health expenditure and certain benefits under the health services can be varied by the action of local representatives. For years, some of our citizens in this capital city and in the county have believed that certain health and social welfare benefits can be obtained by making representations, or having representations made, to a local representative, particularly on bodies such as the Board of Assistance. No matter how often the representatives of these boards endeavour to clarify the position by making it plain that the sole authority for making certain decisions as regards the level of means, and so on, rests with the Assistant City Manager, or officials designated by him, that belief persists and the Second Schedule of this Bill appears to some extent to be endeavouring to perpetuate that illusion.

There is a peculiar feature about the way this Bill has appeared in this House. I think it is correct to say that in my own local authority here in Dublin, approval of it, in principle, was indicated, I think, nearly five years ago. Yet it is also a fact that members of local authorities—I think even members of the Minister's Party in Dublin Corporation—up to about a month ago were not even aware that it was proposed to abolish bodies such as the Grangegorman Board, the Dublin Board of Assistance, and so on. They are so aware now and I am sure they will be in the future. Whether or not the abolition of such bodies will be to the eventual benefit of the patients' institutions, I do not know.

However, this Bill should not go through without an expression of appreciation of the services of persons on those bodies. I am not referring to the services of elected representatives now but to the services of those who were appointed—not being members of local authorities or trustees, such as the people in the Dublin Fever Hospital. It has been the experience in every case that the persons concerned carried out their duties on the various bodies with care and attention, and that their main objective was to help and assist the people under their care.

I am in favour of the general principle of unifying our health services with a view to ensuring that our citizens will get the benefit of such services without needless obstacles being placed in their way. The Bill is particularly valuable in its application of the modern approach to the treatment of mental illness. However, I would ask the Minister to consider the basic fact that a dissatisfied, disillusioned and frustrated staff in a health institution or hospital cannot benefit as they should the patients in these institutions, so far as their comfort and general welfare is concerned.

A chief executive officer or some such person may be in all things a first class administrator. He may be a very humane and understanding individual, but it is only common sense that machinery should be introduced whereby complaints and grievances can be dealt with speedily. Local or minor matters which might drag on from day to day and create an atmosphere of frustration in an institution should be dealt with by a chief clerk or some properly qualified officer. To expect any individual to run health services of the magnitude proposed under this Bill without making this necessary provision will doom the health services to eventual confusion of the worst kind. I hope the Minister will indicate his willingness to consider the points I have made.

I think it is generally accepted that the principles and objectives of this Bill which is designed to integrate the medical services, to provide for the treatment of physical and mental ailments, to eliminate overlapping and to effect economies, deserve our heartiest commendation.

One of the ways this Bill proposes to deal with these problems is to abolish a number of existing statutory bodies. We can right away pay a tribute to these bodies for their work in the past and it is due in great measure to what they have done that the time has now come to take this step towards the unification of the medical services. The hospital building programme, perhaps with the exception of the mental hospitals side and some provision for infirm, old people, is nearing completion and the statistics prove that we are almost in the lead among the countries of the world in the number of hospital beds provided for people requiring treatment in these institutions. The problem facing us is mainly one of administration and co-ordination so as to provide the most effective health services our resources can finance.

In the county I have the honour to represent with other members here, I doubt if we can immediately achieve the objectives mentioned in the Bill. It is rather unwieldy to bring under one central body more than one-tenth of the population, in an area stretching from Mizen Head to Youghal, a distance greater than from Cork to Dublin which involves passing through seven counties, in the midst of which we have a city and suburban population of approximately 115,000.

It is undesirable to make distinctions between city and county as some members are endeavouring to do tonight because many of the people in the city have come from the country and in many cases their parents and relatives are still living in the country. That is an undesirable distinction. On the other hand, some of the statutory bodies it is now proposed to co-ordinate or change are formed on a proportional basis as between the city authority and the county council so that there is no new principle being introduced. However, there is a danger that the public representatives will not have direct contact with those they represent so as to hear their grievances, to try to provide for them in the matter of health services and to advise them.

Everybody knows that the local councillor and T.D. is—and should be —the guide, philosopher and friend of everybody in trouble in his area and if the public representative has not direct contact with the health services, so that he can ventilate at public meetings matters from his particular area, then in many cases the services which should be given are delayed or perhaps not as efficient as they should be.

That is one of the problems I see facing us in this Bill. Whilst I do not want to go into detail at this stage I should say that in Cork County we have at the moment three health areas. They are also engineering areas and it was considered good business by reason of the size of the county to make these divisions. If all the public representatives in, say, the West Cork area could meet there to deal with all the health services in their area—the same applies to South Cork, to North Cork, and also to the city—and the central body were the co-ordinating authority for dealing with such problems as applied to the county as a whole, we might get somewhere towards a unified administration which would be effective and would not lose contact with the people. At some stage or another every elected public representative would be on a health committee dealing with the health problems of his area.

Of course the method suggested is left open in the Bill, and I am sure the Minister would be prepared to hear suggestions as to how these sub-committees should be formed and what their functions should be, but I think the central body is a most complicated method of selection. Would it not be a fair proposition to say that the eight electoral areas in Cork County would each appoint three members, and the city area would provide, say, 12, or a proportionate number? The question, of course, would be whether these members would be appointed on a valuation basis or on a population basis. I think they should be appointed on a population basis. The county population is very widely scattered. Dublin is a compact unit and what applies there does not apply in the largest county of Ireland or in some of the other counties that are almost as large and as difficult of access. In this case, the provisions of this Bill apply only to four counties altogether. I have not any great anxieties about it. I think it can be worked out, but until such time as we have a central body, which is not contemplated for years, in Cork, where we have the health services divided in three or four buildings in the city and in a couple of the hospitals as well, we want to secure the co-ordination of administration that this Bill envisages. Still, it is coming and it is well to take that step.

Some criticism has been made about having one medical officer in charge of the whole area. We are in the happy position that the county office is vacant and the city medical officer was for three or four years medical officer of the county. Therefore from experience he is already well aware of what the conditions are and the problems that he has to meet. Were it not for the difficulty of hospital control, I would suggest that the city and county would have separate administrations, but that is the difficulty. These are jointly serving the city and county and, as I say, there is no new principle in appointing a proportionate number from each of the local authorities to work these services.

The Bill, in general, will be welcomed in that ultimately it will make for economy and will co-ordinate the health services. Some time ago I had an experience, which I mentioned to the county council, where a request was made from the Town Commissioners for an extension of clinical services. They wanted a few more clinics. I wrote to the county health authorities and I was told by them that I should go to the public assistance board which controls the dispensary services. All of these services should be amalgamated at this stage. This Bill is a step in the right direction, but the contact of the elected representatives with their people should be preserved in the framework of the Bill when it comes up for amendment on the Committee Stage. That is something which is fundamental. You have one or two men in an area, which perhaps is a big area, and they try to represent all the people of that area. If you have three you can have each of the interests represented on that committee. In Cork we have never fallen out in any way by having any divisions on health services or on housing services.

We feel that the people appointed by the public are entitled to their due proportion on these bodies and they have always got it. If that spirit prevails in the future, and if there is the happy contact between the elected representatives in the manner that prevailed in the past, to my mind we can work out from this Bill something that will be of real service to the people in unifying the services, preventing overlapping and getting more efficient administration.

On the whole this Bill, even from Deputies behind the Minister, has received a very lukewarm reception. Certainly, it is not receiving a very enthusiastic reception from other sections of the House. Even Deputy MacCarthy who has just spoken while he praised the Bill really spoke against it and I admire him for doing so. This Bill to my mind is totalitarian. We have heard about integration, co-ordination and amalgamation. Those are very nice words but the considerations that should lie before us when considering our attitude towards this Bill are whether, as a result of those actions, the health services will be better, cheaper, more efficiently carried out, whether the patients will get into the hospitals quicker and out of them quicker, and whether the medical and nursing staffs will be more content and perhaps better paid.

In my opinion, and in the opinion of those in Opposition on this side of the House, the Minister has not made any case for the Bill. Is administration to be any cheaper? In other words have these Boards to be abolished suffered from squander-mania? Have they been neglectful in their duties? Have they wasted time when a civil servant could have done their duties more efficiently? No. The Minister has not said that and we know that that is not a fact. For many years bodies throughout the length and breadth of the country, unpaid bodies and now, indeed, un-thanked bodies, have been carrying out tiring and exhausting work in connection with hospitals and have been doing it very well, very willingly, and gladly.

It is always possible to find people who will give public service unrewarded and, indeed, unrecognised. I would say that the part of this Bill which envisages a newer outlook and better ways of dealing with mental health is one I would welcome, but I still cannot see that the abolition of these democratic, voluntary bodies will in any way help the problem of public health in Ireland. In fact, I can see a very great danger that the exact opposite may result. Deputy Larkin referred to the fact that he would have to go out tomorrow, I think, to Portrane, to see a high official of this city in connection with a couple of panes of glass. That sort of situation is obviously one which is more likely to increase under a highly centralised authority.

I am quite well aware that there will be a Dublin health authority appointed, consisting of a number of members, but those members cannot do the work which the Portrane, Grangegorman, Dublin Fever Hospital and Rathdown Board did in the past. The geographical distances between Loughlinstown and Portrane are very great. How will any body of people be able to give the service which the individual hospital boards were able to give in the past?

I have had a certain amount of experience on hospital boards and I have always been amazed and, indeed, humbled by the work put in by the ordinary members of those boards. I think every Corporation member would agree with me that we who are members of local authorities have not always the time which some of these members on hospital boards have. Many of these members are people who attend day, after day, after day. They walk about a hospital. They get to know every nurse and every patient. They get to know difficulties about its administration and they can play a great part in smoothing over such difficulties. They get to know conditions in the hospital kitchen and they observe when cups are cracked. These are comparatively small things but they add up to a very important contribution, a very vital contribution to the well-being of the patients and to the comfort, well-being and so on of the medical and nursing staff. That is something that we stand a very great danger of losing under this Bill.

I should like to see more concern for the democratic activities of our people. That is why I used the word "totalitarian" at the beginning of my speech. Perhaps it was somewhat too strong but, at any rate, this Bill shows the State getting evermore powerful and asking the citizens to do less—to give less free service on the part of humanity. To my mind that is not statemanship. That is not good for our people. We are engaged now, and have been for the last 40 years, in building up this State. We are still in a formation period and it is very important that we should call on our people willingly to give their services where we can make use of them and not slap their faces as apparently we are, or I should say, the Minister is doing in the case of the Dublin Fever Hospital Board.

Other Deputies have referred to that and I think I cannot refrain from mentioning it too. That was a hospital founded by philanthropically-minded people in the past, and apparently there is a legal position arising out of certain funds of which the trustees have charge. That is a legal matter which I do not wish to examine here because I really do not think that the financial side of it is the vitally important one. What is vitally important, and what should concern every Deputy in the House, is that a body of people who give voluntary service should be pushed out under this Bill. Indeed, they were pushed out by a Parliamentary Secretary some years ago. I remember the incident and so can other Deputies. That was, perhaps, an example of State interference and State pride and we do not want to see that type of situation arising again, but that is the sort of situation which can well arise in the future.

The Grangegorman Board, the Portrane and the Rathdown Board are composed of people making voluntary efforts towards helping the sick and afflicted people who come under their care. Why is it not possible to do this integration, co-ordination and amalgamation, and still keep these bodies? I do not see that the two are mutually exclusive. At any rate, I am always rather suspicious of these vague words like co-ordination. Co-ordination sounds magnificent. It sounds as if everything were going to be cheaper, easier and smoother, but it very often works out exactly the opposite.

Debate adjourned.