Committee on Finance. - Health Authorities Bill, 1959—Committee Stage.

Question proposed: "That Section I stand part of the Bill."

This is the usual interpretation section.

Question put and agreed to.

I move amendment No. 1:

In page 3, before subsection (6), to insert the following subsection:—

"(6) (a) Subsection (5) of this section shall cease to have effect on its being so provided by order made by the Minister.

(b) An order under this subsection shall not be made save upon request made by the council of the county of Wicklow by resolution."

The House is aware, of course, that under Section 2 of the Bill there is certain provision being made for the representation of the Wicklow County Council on the Dublin Health Authority. Well, it may happen that the Wicklow County Council may wish to be relieved of the obligation of being represented there and the purpose of the amendment is to give the Minister power by regulation to relieve them of that responsibility.

Has the Minister any reason to give the House as to why Wicklow County Council would wish to be removed from this body? As I know the position at the moment, the Grangegorman Hospital is administered by several of the existing Dublin health authorities and it is also related to Wicklow and from the County of Wicklow the ordinary patient is admitted to the Grangegorman Hospital. Has the Minister any reason to think that Wicklow would wish to opt themselves out of a body on which they would have some say in the administration, some say in the expenses? I presume they have to strike the rate, even though in future it will not be the rate of a mental authority alone because in this case they will not be affiliated to the body as they were before but they will have some considerable say in the administration. Surely it is reasonable to assume that Wicklow would want to stay there?

The only reason why I rise is that Wicklow adjoins Wexford, where I live, and quite a lot of Wexford people live in Wicklow. There must be something in the Minister's mind when he particularly refers to Wicklow as wishing to opt out. I would like the Minister to be more explicit on the subject.

The Deputy has secured a rather tenuous foothold in the debate by speaking for his neighbours but the position is this: This is a purely permissive amendment, which would give the Minister power to permit the Wicklow County Council to release itself from the obligation of appointing three persons to act on the Dublin Health Authority for the narrow purpose of all business relating to the Mental Treatment Act which is, in fact, the management, one might say, of the Dublin Mental Hospital. The Minister cannot make that regulation unless the county council by resolution ask him to do so.

Assume the Wicklow County Council by resolution did, in fact, request the Minister to make an order cancelling the application of subsection (5) in relation to Wicklow, the amendment then says the subsection shall cease to have effect. Is it envisaged that the Wicklow County Council may at a later stage alter its attitude and desire representation and, if it did so would the Minister say whether the subsection could then be put into operation again?

I would not like to answer that "off the cuff" but I think the Deputy may have a point there. I promise I shall look into it between now and the Report Stage.

Amendment agreed to.
Question proposed: "That Section 2, as amended, stand part of the Bill."

On the section, one matter I wish to raise arises out of directions which were recently given by the County Manager in respect of holders of general service medical cards. Recently the County Manager issued a direction to the district medical officer that the holders of general service medical cards who require hospital treatment must go to St. Colmcille's, Loughlinstown. This has given rise to some criticism in Dún Laoghaire Borough Area because Loughlinstown is for them not as convenient as St. Michael's. It is true there are certain exceptions. Certain brain cases or cancer cases do not come under this direction and so far as they are concerned the doctor is free to send them wherever he considers is the most suitable hospital. As well as doctors having an objection to this, relatives have objected on the ground that St. Colmcille's is not as convenient as St. Michael's.

This direction, which was an oral direction, not a written one, has arisen because of a fairly recent decision by the Wicklow County Council not to send patients to St. Colmcille's. As the Minister is aware, St. Colmcille's hospital, Loughlinstown, is a Rathdown hospital and up to quite recently Wicklow County Council also sent patients there as well as the Rathdown patients being sent. Recently Wicklow changed and the result is that the hospital is not as full as it was previously, and since then the County Manager has issued this direction.

While many of the patients from Dún Laoghaire Borough were in the ordinary course sent there, it was not obligatory on the dispensary doctors to do so. As a result of this direction not merely is the patient liable, if sent elsewhere, for the cost, but in addition there is the point that was put to me that while in a matter of distance St. Colmcille's is within the Rathdown area, it is on a different artery from the Dún Laoghaire area and transport facilities are not anything like as convenient for residents of Dún Laoghaire Borough.

I should like also to ask the Minister what will be the position when the various health authorities are amalgamated. As I understand the position and as I think it operated up to quite recently, a dispensary doctor or a patient who has one of these cards was free to choose, provided accommodation was available, any hospital in the whole Dublin area. They could be sent to any one of the voluntary hospitals or to St. Colmcille's or St. Michael's which is a voluntary hospital or to St. Kevin's. Under this new direction they are restricted to St. Colmcille's and that has given rise to a certain amount of apprehension. I should be glad, if the Minister is not in a position to answer now—he may not have heard of this before now—if he would have the matter examined between now and the Report Stage.

I had no knowledge of the incident to which Deputy Cosgrave has referred but I do not think it is relevant to the Bill. It is a matter of administration. It is true that in the city of Dublin generally people have a very wide choice of hospital in so far as they can go to any general hospital and be treated there as a Section 14 patient, but that is done purely as an act of grace by the health authority. If the health authority decided to reduce the number of hospitals which would be available to Section 14 cases, I do not think the Minister has any power to interfere under the law as it stands. I do not think this Section we are now introducing will make any change in that position.

I have not recently looked at Section 14 but I understood that the principle operated was that the patient and the doctor had a choice of hospitals and that that was granted under Section 25. The patient, I suppose, in consultation with the doctor, or the doctor, in consultation with the patient, could opt for a particular hospital, and that freedom of choice was preserved. This recent direction limits entirely that freedom and those people who have mentioned this to me already—it is only quite recently I was approached about it—regard it as a radical departure from the practice which has operated up to the present.

I referred just now to Section 14 cases; I ought to have said Section 15, but again it is a matter of administration over which the Minister had no control. I am not making the case for the manager but one can see that if an institution which belongs to the health authority is not being fully and economically utilised the manager is in duty bound to the ratepayers to ensure it is run as economically as possible.

I am aware of this problem to which Deputy Cosgrave has referred but it would pose a question in people's minds as to what might happen under a unified health authority covering all the areas, if the result were to be that people say, in Shankhill, found themselves directed to a hospital in Dún Laoghaire or people in Dún Laoghaire found themselves directed to a hospital in Loughlinstown. While it is an administrative matter I would imagine that on enquiry the balance administratively would be very much against that kind of direction and it would be found far more desirable to leave things as they had been up to this where any person entitled to the services under the section, once he found himself in any of the Dublin hospitals, would not be asked how he got there but would be treated as if entitled under the Act and the appropriate charge would fall to be paid by the health authority responsible for him.

Perhaps the situation would improve if we had the unified authority because the burden of giving that facility, which they have in the city of Dublin, to people in suburbs, in Dún Laoghaire and in the county generally would be greatly eased. It will be distributed over a much wider area of charge.

That is true but in so far as T.B. patients are concerned the local authorities have been tending to ply Blanchardstown hospital with patients on the consideration that the Minister mentioned—that it is a local authority hospital. At the same time in the county area, there are two non-local authority hospitals—Our Lady of Lourdes at Peamount and the other at Newcastle. For some years past neither of these two hospitals has been full because of the drop in the number of patients and while it may be reasonable enough for the county manager to direct the patients to Blanchardstown the actual hospital position is that we have excessive accommodation for T.B. patients and some inquiry into the general situation might be made.

We are hoping that Our Lady of Lourdes may be closed as a T.B. hospital and that we shall have another use for it.

There is another point I want to raise. It is a question relating to the rights and privileges of the holder of a medical card. Apparently the Dublin County Council have recently taken a decision whereby, if the holder of a medical card goes to a private doctor, he is not entitled to get the free use of the ambulance.

That question does not seem to be relevant to the matter under discussion.

It is a decision of the Dublin County Council which is now being amalgamated with other health bodies such as Dún Laoghaire, Rathdown, Balrothery and Dublin Corporation. If we are going to have a unified authority such as that, the Minister should give us a guarantee that such a state of affairs would not apply to Dublin as a whole. In Dublin County, as in all rural parts of Ireland, in the majority of localities you have only one doctor. In the City of Dublin, however, you may have in the one area a half a dozen or a dozen doctors. It might be that relations of a patient might like to take the opinion of a private doctor, even though the patient is a holder of a medical card. That may happen in County Dublin occasionally but in the City of Dublin it might happen twice a day that the ratepayers would call in a private doctor. Are they then to be denied the right of free use of the ambulance? The precedent has been set in County Dublin that such a person could not have the free use of the ambulance. Under this new Bill the object of which is to promote greater efficiency is it likely to happen in the City of Dublin?

Does the Deputy not think that he might make that point to a member of Dublin County Council? That would be much more effective. The point has already been made elsewhere. I am surprised at the Deputy coming along with that kind of old hash.

I protest strongly against the Minister's attitude and what he has said. This is a general case I am putting forward. It can happen in Dublin. I have been a medical officer myself and I know it does arise. When people are anxious about a case they are likely to go to a private doctor and this is quite likely to happen in Dublin. I am asking the Minister to tell the House whether the holder of a medical card, if he goes to a private doctor, is entitled to the service of the ambulance.

Question put and agreed to.

I move amendment No. 2:—

In subsection (2), page 3, to delete "sixteen" in line 58 and substitute "twenty-eight", and to delete "eight" in line 59 and substitute "twelve".

The purpose of this amendment is to increase the representation of Cork County on the health authority so as to bring it into line with the number of county electoral areas. Amendment No 24 should be read in conjunction with this. It is an amendment to Rule 2 in the First Schedule and under that each county electoral area is entitled to have three members appointed to the health authority.

Amendment agreed to.
Question proposed: "That Section 3, as amended, stand part of the Bill."

This section is opposed. At the outset let us make it quite clear that there is as much in common between the Minister and ourselves in so far as we have proved that we are all interested in the Health Act. We appreciate the fact that the Minister is anxious to improve it. So also are we anxious to do our part towards making this improvement. It is because we believe that this section will be detrimental to Cork and to the present health services in Cork that we are opposed to it.

Last November, when the Minister was speaking on the Second Stage of the Bill, he posed a question when he stated that he often wondered whether Cork was part of Ireland or Ireland was part of Cork. As a Cork Deputy, I shall try to answer the Minister by stating that when a person goes to a doctor and gets a bottle of medicine we often find on the label the instruction: "Keep it corked when not in use." Since the Minister posed his question we have passed through the happy season of Christmas. In every house, including that of the Minister, I am sure there was a bottle for friends who might be calling and I am sure that everybody knows that, no matter how good the contents of such a bottle may be, they are no good if not kept corked. We believe that without Cork Ireland would be no good either.

It has been mentioned by Deputy O'Higgins that the explanatory memorandum issued with the Bill starts off by saying that the primary object of the Bill is to provide more efficient and more economic administration.

We realise the Minister has one advantage in so far as he is being supplied with reports from his expert advisers in relation to the operation of the Health Act in Cork City and County, as well as elsewhere. If there are flaws in the operation of the present Act the Minister is in a position to know what is happening. In many instances he then, through the advice tendered to him, will be able to make up his mind on what he believes will remedy the flaws. We appreciate, therefore, that from the viewpoint of reports submitted to him he has that advantage.

Without offering criticism in any derogatory manner, I should like the Minister to understand that our approach to this section is based not on reports submitted to us as members of the Cork County Council or as members of the Cork Corporation but on actual experience as members of these public bodies. It is from our experience as members of these boards that we offer criticism to the proposals in section 3.

At present we have North, West and South Cork Committees combining South Cork and Cork City with the South Cork Board of Public Assistance. We also have the County Health Services Committee. The main fact is that all matters in relation to West Cork, all matters in relation to health services as obtaining in North Cork are dealt with first and foremost by members of the local authority elected in these areas. That in itself must give these members a certain advantage in relation to the needs under the Health Act of the people in these areas, particularly when these members are advised by the local authority officials of the medical opinion of the officers of the various committees.

It is only on that advice and on their own judgment that these members can from time to time offer suggestions as to the successful operation of the various committees in these areas. In South Cork, we are in the same position. In that area, we have five cottage hospitals and one main hospital. Combine that with the fact that we have an orthopaedic hospital.

In relation to all these areas, therefore if we are to take the different combined units and if we are to consider the position of the orthopaedic hospital, of the Cork Mental Hospital and its subsidiary Youghal, and also the sanatorium in Cork, we must pose one question to the Minister: What is wrong with the present system? Is there something weak in the operation of the general health services in relation to, in South Cork, St. Finbarr's, the Bandon, Macroom and other Cottage Hospitals? We have in that area an M.O. Naturally, in the new Bantry Hospital, the same arrangements must be made in West Cork as in North Cork. All these men are considered at the present time as R.M.O.s in each area. With regard to the R.M.O. in the mental hospital and the men holding equal rank in the sanatorium, are they all as it were to come under the one roof and be placed under some supreme authority?

I am not opposing the Bill in any critical manner. I want to draw attention to the difficulties that may arise. Will they all be placed in the position that while in the past they carried out their work in an admirable manner they must now accept an inferior status in so far as somebody in authority is to be placed over them? Whether we like it or not, at least the county manager and the city manager must stand in line with the ordinary members of the councils when it comes to a question of medical opinion. In all questions he must consider the advice tendered to him by the R.M.S. or the R.M.O. in the various areas. What will happen under section 3? That is one of the points. We consider the present situation to be far better than any suggested improvement through the Bill with this section 3.

We fail to understand how, based on their activities in the past, any system envisaged in the Bill will give us, as stated in the memorandum, a more efficient—leaving out the question of economic—service. By bringing all these units under one roof, as it were, where is the possibility of achieving a more efficient service?

I have yet to hear of any complaint of the relationship between the mental hospital authorities and the R.M.O. there, as against the R.M.O. and the other hospitals under general health. I appreciate, as a member, the close liaison between the orthopaedic hospital, and the surgeon and matron there, and the St. Finbarr's Hospital authorities. I realise that all that can be done is being done in the way of co-operation between these two hospitals. I am also aware that, whenever required, there was always a close-knit co-operation between the mental hospital medical authorities and the authorities of the sanatorium at Sarsfield's Court. If such has been the case in the past how is it hoped that, under section 3, these systems which have been in operation will be improved on the basis, as stated here by him, of a "more efficient" service, apart altogether from the question of its being more economical? We believe that cannot be and therefore we are opposing the section in part.

Furthermore, in relation to the present working of the sanatoria board, though some of us are not members of that board we believe, as members of the local authority, the system in operation there is such that excellent results are achieved, particularly from the viewpoint of the treatment being given to patients. We realise that the fullest and utmost co-operation exists between the sanatoria board and the staff of the sanatorium in Sarsfield's Court and of every part of the County of Cork as well as the city. That being so, why suggest there is a more satisfactory method of running that hospital under the so-called unification of the health services in Cork?

Much publicity can at times be given to patients leaving this country and going abroad for treatment. We know also of the outstanding achievements in surgery in Sarsfield's Court. Nothing is ever heard of it. We are proud a Corkman is doing brilliant work there. It is a pity more consideration is not being given to that aspect rather than to suggest that that board and that hospital be brought under the one roof due to the so-called unification of the health services in Cork.

Another point that must receive consideration is this. Take the city and the county of Cork. In the city there are 112,098 persons, according to the recent census. In the county of Cork we have 224,565 persons. That gives a total of 336,663 persons. The Minister may say that that would not bear a relationship to the over-all population in Dublin and the county where agreement has been reached on unification. But even the Minister on the Second Stage himself admitted that Cork must stand out on its own in so far as conditions and geographical considerations were concerned. The outlying areas in the county must be considered, as he admitted on the Second Stage of the Bill, on a different basis completely from that of Dublin and elsewhere. We consider that one committee meeting discussing the problems of Cork city, with a population of over 112,000, and the same committee discussing the problems of 224,500 people in the county, will be faced with a colossal problem, not to mention the question at all of administering this unified authority.

It is because of the problem involved that we believe that in spite of shortcomings—we all realise there are shortcomings connected with the Health Act; we appreciate that in every system there is some shortcomings—the present system even as it is, is better than that now being proposed or being forced on the people in the city and county of Cork by the Minister in Section 3 of this Bill. I am not going into the matter in great detail as other members will be anxious to speak on this as well, but considering that you will have some city members attending meetings where problems in relation to medical cards and matters of that kind for people in Castletownbere are to be discussed; where a man from East Cork will raise his voice in relation to the problems of some one around Youghal and other parts of the county, if the members are to do their duty properly—and I will say that members of every Party in Cork, who are members of the County Council, are anxious to do their best—that committee of 28 suggested by the Minister will have to meet at least once each week.

Where then, I ask the Minister does the question of more economic administration come in? If they are not to meet regularly, it means that the administration of the Act in relation to the various parts of north, south and east of the county cannot be attended to in the same diligent manner as in the past and at the present time. Again, is it fair to the 112,000 people in the city of Cork, that so much time must be allotted at the various meetings, so much time with the manager, whether the city or county manager, who is to operate this, time taken from the city in relation to health services so the same official can give sufficient time to the administration of it than in the county? All these are questions we are anxious to have answered because, while we may be at a disadvantage in relation to the overall reports of the Health Act, we base these questions on our experience. It is from our own experience we can see everything at this stage that will arise day after day if Section 3 stands part of this Bill.

I know the Minister has already in the amendment that has just been passed increased the membership. It must be understood that, even when speaking on the Second Stage of this Bill, I did not base my sole argument on the question of membership. I did say then, and I say now, it is important that every member of the local authority should be on the committees as at present but it is not solely the case with me, and it never has been, of begging for an increase in the membership of the board. We cannot be satisfied by the Minister telling us: "I have increased membership now to 28." It is the service and the operation of the Health Act upon which we must base our first considerations, not on a question of who is going to be on the board, whether a member here speaking in this House or a member of the local authority or their friends.

The two points can be coupled. The local men in West Cork are in the best position to consider the overall local problems in West Cork; so also does that apply in North, South and East Cork but, fundamentally, the most important thing of all is the administration of the Health Act in these areas. Therefore, I could not agree with the Minister that just because he brought in this amendment to increase the membership of the board, bringing in a few extra members, that can in itself provide the improvements we wish for or could bring on a level plane the conditions at present existing there.

We have had our problems in the past and the Minister knows it. The Minister knows that in relation to South Cork we are in a terrible condition over dispensaries but it is not our fault and the Minister knows that. Grants towards the erection of dispensaries have been denied us. Does the Minister say now that under Section 3 of this Bill, if it passes, grants are going to be given for the erection of dispensaries in Cork?

Section 3 covers future activities in relation to Cork. We want to know where we stand in relation to the services that we have been trying to offer to the people. We are anxious to know why it is that the recommendations are submitted to the manager and in turn submitted to the Minister; why it is, on the one hand we are told of a more economical and efficient service and at the same time there is no question of giving us more economical services based on the improvements that we have already asked for.

Again, we have had many other complaints; perhaps this is not the time to go into them in detail, holding up the House, but how often have members here, members of the Minister's Party as well, been with us when we asked the Minister, would he inform us of what may be contained in reports in relation to the operation of the Health Act in connection with the dispensary services? We knew of course, as in other years, an inspector would go down from the Minister's Department once every year and a half but beyond that we were refused any information. We do not know whether the Minister is satisfied through the reports that the dispensary system is working properly for the whole of the area or whether any bad or faulty parts of it exist. Is this new authority, this unified service, to be given all that information we had requested and which we have been refused? Is the unified authority to be placed in a position of making the necessary improvements in relation to the dispensary service in South Cork as well as North and West Cork. If it is, then perhaps the Minister may say something will be done but we cannot see any improvements whatever as envisaged by this Bill.

No later than yesterday, the Cork County Council, through its health service committee, met and discussed the estimates for the coming year. The result was an increase for health services of something over £29,000. Admittedly, a 50 per cent. grant will be given towards it. Nevertheless, provision is being made for approximately £15,000 more than last year. Is that not proof that the members are helping to operate the present system and doing their best to provide the best possible health services? If the Minister could show that the officials were not carrying out their duties or that the members were not cooperating with the County Manager or the various officials, he might be justified in asking for unification of the health services in Cork. But where the opposite is true, where it can be shown that all concerned are co-operating to the best of their ability to give the best possible services under the present system, the Minister can hardly say that the Cork City and County health services require unification. It is on these points we are basing our opposition.

Speaking in the Dáil on 5th November, 1959, the Minister said at column 807, Volume 177 of the Dáil Debates:—

"The existing staffs and the existing institutions will have to be maintained but there is the fact that we shall be able to make a more effective use of these institutions and of these staffs."

For a long time past the members and officials in Cork have been pleading to be allowed use portion of St. Stephen's Hospital for the curing of little children. Why is it the Minister is satisfied to see some blocks of that hospital closed without acceding to the members' request? There is a serious hospital accommodation problem in South Cork, yet there is a hospital closed in Macroom. The Minister said lately that it is small, but nevertheless it is a hospital. It is still closed although the local authorities have been asking the Minister to be allowed use it for other purposes under the Health Acts.

Section 3 of the Bill is in itself a condemnation of the present system of operating the Health Acts in Cork. There is no use suggesting we are not getting the best out of the Health Acts when we can point to these hospital problems in Cork.

The Minister also stated at Column 807:—

"In relation to Cork, it may be that the need for further examination may arise and that we may not be able to carry through the same close-knit integration as we hope to achieve in the case of the City of Dublin because, perhaps, of the territorial difficulties."

It all boils down to this. This is a small country and there is no use saying that what should be done in regard to the unification of health services in the City of Dublin should also be done in Cork. On the Second Stage the Minister submitted there was a great difference between conditions in the two areas. The Minister said a lot might be done on the Committee Stage, but nothing is being done by the Minister except on this question of the few extra members on the Committee. That is one step in the right direction but it is far removed from 46 or 28.

We are interested only in the improvement of health services and did not raise the question of advantages from the financial point of view. The Minister has admitted there can be no changes in present staffing arrangements. That means there cannot be any financial advantage. Of course, it may relieve a couple of Assistant County Managers of a little work, but we will still have to pay them and there will be no saving to the country on that score. One member of a staff may be switched from one section to another, but in view of the Minister's statement that staffs cannot be interfered with, we believe there cannot be a saving but instead that there will be an increase in costs.

Our opposition to this section is based on the belief that the Minister is on the wrong lines in the matter of improving the Cork Health Services. It cannot be done through unification; it can be done only through the opposite—by leaving things as they are. The Minister knows that there are regular conferences between the city and county managers and the other officials concerned. What is to prevent them bringing the medical officers into these conferences? If there are any weaknesses in the health services, could they not be remedied at such conferences? If Section 3 stands part of this Bill I must say we believe it will be detrimental to the health of the people of Cork city and county.

The Deputy and I are at one, I am sure, in that we both want to do the best we can for the people of Cork as far as the health services are concerned. The only question which arises is whether you can do better for them if you make available to every citizen to the extent to which it is practicable to do so whether he lives in Cork city, in the suburbs of Cork or in the more remote districts of Cork, all the joint resources of the health institutions and services in both the city and the county.

The Deputy has praised very highly the work of the Cork Sanatoria Board and he has told us about the professional eminence of some of the members of the staff there but that Board is, in itself, a unified authority for one particular service. It is a service which covers the city of Cork and the county of Cork as well. If it is good in that case, if it is useful to have that sort of unification in one institution or in a service devoted to the care of tuberculosis patients, why would it not be equally good to have the same sort of unification, a little more decentralised in its operations in respect of the whole city and county?

The Deputy has spoken about the Cork Mental Hospital Board. There, again, you have an institution which provides the treatment for mental illnesses which is necessary for those who are so unfortunate as to be afflicted in that way, whether they live in the city or in the county. What are we trying to do under this section? Nothing more than to make available to everybody that same sort of uniform service—perhaps "uniform" is not quite the word—the same sort of comprehensive service in respect of all forms of illness, as well as those which are being so effectively treated when we are dealing with these two particular types—those who suffer from tuberculosis and those who suffer from mental illness. We want to do that—to put everybody in the city or county of Cork who may suffer from other maladies in a position to have the resources of the city and country at his disposal.

What is the present position in Cork? You have Cork Corporation. It is the health authority for the Cork city area but its services, except as an act of grace, are reserved in general for the population who live inside the city of Cork, some 80,000 people. Those services relate to the infectious diseases services generally, food control measures, the services under the Health Act, 1953, which relate to general practitioner, maternity care, institutional services and extern institutions generally, specialist services and disabled person's allowances The operations of Cork Corporation in respect of the health services are strictly limited to those who live inside the city boundary.

We know of course that the present city boundary in Cork does not include all those who make their living in Cork and who by the mere chance that Cork Corporation was not able to find appropriate places to house them inside the city boundary, where they make their living, have been compelled to live outside the city boundary where you have a large urban population of between 30,000 and 40,000. For all intents and purposes they are townspeople. Being in that category they might not appeal to a certain Deputy in this House, but at least I think they ought to appeal to Deputy Desmond and his colleagues because a very large number of them are wage-earners. Cork County Council only has dealt hitherto with these people who might perhaps more properly be the immediate concern as things stand of Cork Corporation. The County Council is the health authority for the county area and provides its own set of services. I am not saying —I have never suggested—that these services are not being run efficiently. The only thing is that they could be run in such a way that the services provided both by Cork Corporation and the County Council would be more readily available or more conveniently available to everybody in the city and county of Cork whether a person happens to live inside the county borough or in a rural area in Cork.

Then you have the South Cork Board of Asistance which also runs its own institutions and provides its own services. There may be a degree of overlapping and for that reason there may be—I think there is certainly in the case of certain services a degree of overlapping and therefore a degree of unnecessary expense. I am not making a case for this Bill let me point out, on the ground that it is going to produce economies. I think it will produce economies, but that is not the purpose for which we have introduced this Bill, or are trying to secure the acceptance of the principle that there should be one common authority wherever there are contiguous populations with common interests. That is not why we are trying to get this unified authority for—perhaps I had better be specific—Dublin, Limerick, Waterford and Cork. It is not merely because we hope that there will be economies accruing by reason of the unification. It is because we will be able to make better use of our resources that I am asking the House to accept this Bill. I am asking it because I think it is going to make it much easier for a person who has to avail of the health services to get the treatment which he requires. That is the primary purpose—to improve the services—although we do think, and I want to repeat it, that as well as improving the services which is the primary objective, we will also eventually secure a certain degree of economy.

The Deputy referred to the speech which I made on the Second Reading of the Bill, dealing with Cork and I think he quoted me quite accurately. I did say that the existing staffs and existing institutions will have to be maintained but there is the fact that we shall be able to make more effective use of these institutions and of these staffs. That is what we hope to do. We are not proposing at this stage to close any institutions although the time may come—and with the blessing of Providence will come—when we should certainly be able to find another use for say, Sarsfield Court, but at the present moment it is not proposed to close any institution what we do hope is this: If we secure the unification which we are looking for, if we can make these institutions available for the use of every person in Cork city and county, the need to enlarge institutions, to spend more money on buildings will be obviated. That is the purpose and that is why I said that at the moment we must maintain the existing institutions and staffs but we hope by reason of what we are doing in this Bill to obviate the need—I am sorry to be repetitive, but I want this to get home—for further building and perhaps building which time will show to have been unnecessary.

Now, I did say also that, for the time, until it is clearly demonstrated that there is no need to do so, the Cork unified health authority will have to maintain its existing facilities which it has in Mallow and elsewhere— Clonakilty I think — for the convenience of those members of the public who have to avail of them. What I do think, however, is that here again we will be able to avoid an unnecessary expansion of staff because in most instances we have three staffs. We certainly have in Dublin. We have three separate staffs, perhaps, dealing with the one person and it would be much more economical if we were able to have that one person dealt with by one unit of staff rather than by three separate units.

Another thing, I think the Deputy was under a misapprehension as to what is going to happen under this Bill. The existing R.M.S. or R.M.O. as the case may be, in the mental hospital will maintain his status. So also will the R.M.S. in the case of the sanatoria. The county physicians serving the hospitals in Bantry and Mallow and the county surgeons will all maintain their status. We are not going to put one hospital over the other in any way, but what we do hope is that, perhaps, in due time, we will be able to dispense, say, with one county medical officer. There is, I think, a vacancy already or, if there is not one already in Cork, one is about to arise. The same is the case in Dublin. It will not be necessary to fill one of these vacancies if we have this unified authority because the top man there will be able to serve the city and county as a whole. He may need an additional assistant but at least that additional assistant will receive an assistant's remuneration and will not be receiving the remuneration of a county officer.

That is the situation in relation to it. That is the only case I can think of where there is likely to be any substantial change in that direction. Let me put this again. While, with the need to maintain and improve the health services, we do not anticipate that there is going to be any reduction in staff, and certainly not any that could be regarded as drastic, we do think that there will be a fuller utilisation of the services of the staffs and of the institutions and that, as I have said so often, but I would like to get it over even by this sort of uninteresting repetition, we do hope that we may be spared the need to incur certain capital expenditure involving loan charges, and additional burdens upon the ratepayers and that we can utilise whatever money we may be able to save in the way for the future extension of the health services.

I should like to correct one mistake the Minister made. I am afraid that he is so anxiously looking after Dublin that he has not kept himself up to date in regard to Cork. The houses built by the Corporation of Cork outside the previous city boundaries have been taken inside the city boundaries of Cork and are portion of the city now. I would just like to correct that portion of the Minister's speech.

In so far as play is being made about those living outside the city, I would make a present of it and let them all into the city. We are better off without them, together with the bill that they are costing the county. They said, "No fear. We are not taking them". I should like the Minister to look at the loan charges for housing, sanitary arrangements, sewerage arrangements and all such facilities——

It scarcely arises on this measure.

The case is being made —and the last portion of this Bill is built on it—of the number of people in the suburbs of Cork who should be in Cork City.

I never look at the Department of Health without a feeling of dread and frustration. I say that solemnly, as one who for the past 17 years has been endeavouring, as chairman of the Board of Assistance in Cork, to deal with the Department of Health. They were 17 years building a regional hospital.

The general administration of the Department of Health does not arise on this Bill.

This is another proposal from the Department of Health.

The Deputy may not discuss every other activity, or inactivity, of the Department on this Bill.

I, unfortunately, have a habit of judging a team by their previous actions and I have a recollection—it is a bad thing to have a long memory—of a previous departure in this particular direction. A long number of years ago there was very solemnly installed, with bell, book and candle, by that Department, a Board of Health for Cork County.

The Deputy is travelling outside the limits of this measure. He must confine himself to what is in the Bill. The administration of the Department of Health in general does not arise on this measure.

I am not dealing with the Department of Health in general, a Cheann Comhairle. What I am dealing with is a previous move of the same Department. This thing was tried before. We had a Board of Health before for Cork County. I admit that the city was not embraced in our arms that time. The Board of Health consisted of eight members who were to look after housing, sanitary services, everything in the county, for about eight years. It lasted about two years and was withdrawn in fear and trembling by the Department, who fell back and left it so. I never exactly found out the means by which it was abolished but it was abolished.

I said on the Second Reading of this Bill that as far as I was concerned I was supporting the Bill for one thing that is in it, and that is, that the unfortunate people of South Cork rural area were no longer going to be loaded with, not alone their own poor, but the poor of Cork City. However, I do not believe there will be the economies the Minister has suggested.

Progress reported; Committee to sit again.