Dáil Éireann debate -
Thursday, 11 Feb 1960

Vol. 179 No. 2

Health Authorities Bill, 1959—Committee Stage (Resumed).

Question again proposed: That Section 3, as amended, stand part of the Bill.

Mr. Desmond

In relation to the Minister's remarks last night, I just want to draw attention to one aspect. On the Second Stage, the Minister was able to mention various cases under the Health Act affecting people in Dublin. He mentioned an individual in Churchtown and he mentioned the case of the man who became ill in Dún Laoghaire. So far, the Minister has made no mention of any specific cases in relation to complaints about shortcomings of the Act as it is in operation in Cork at the present time. I should like to draw particular attention to the Minister's remarks last night about the people living in the city suburbs. I hope and expect that he is not suggesting that the people, even though working in Cork city but living in the suburbs and who come within the jurisdiction of the county council, are not getting the benefits which should be theirs under the Health Act.

The Minister spoke of the specialist services in the city. Let the Minister understand that the very same services apply in the county. They are afforded by the county council to all the people in the suburbs.

Deputy Corry was not correct last night when he mentioned the question of these people. The 33,000 people mentioned by the Minister are the people living in the Blackrock, St. Mary's, Bishopstown and other areas, but, because of the fact that they are living in the county, they are getting the county services. If there are shortcomings in the operation of the Health Act in Cork City, the shortcomings are not noticeable to any degree whatever in those areas.

Deputy Healy, a supporter of the Minister, will bear me out when I say that one of the difficulties there is the shortage of dispensaries. The acute position in relation to the number of dispensaries in the suburban areas of the city is not the fault of the local authority. Indeed, I doubt very much, as I said last night, that even the socalled unification of the health services in that area will be of any extra benefit in speeding up the provision of dispensaries in that district. Therefore, I believe the Minister will have to go further if he wants to be able to justify the inclusion of Cork city and county within the proposals for unification of the health services. I would with to leave it to other members to express their views after that.

The Minister mentioned the form as at present in operation in relation to the sanatoria board and also the Mental Hospital Board. Should the Minister wish the Sanatoria Board to operate as a unified health authority within its own limits, well and good— we have never objected to that—but the point is that the Sanatoria Board, in conjunction with the manager and the officials and also in relation to the mental hospital authorities, are working satisfactory on their own.

I have not yet heard any member of the Mental Hospital Committee say that he got any complaint in relation to the facilities afforded to patients or the facilities given to relations to visit them. Therefore, if that service is giving satisfaction, why interfere with it? The people of Cork city and county are quite satisfied with what they have in relation to sanatorium treatment and mental hospital treatment. That being so, surely that area cannot be put on a par with Dublin in relation to the failure of the system. We have no Churchtown or Dún Laoghaire difficulties in Cork. We have had our own difficulties and we are still awaiting a decision from the Minister to enable us to solve them. I believe that this system of so-called unification will ultimately be detrimental to the people of Cork city and County.

Mr. Corry

When dealing with this matter last night, I pointed out that where Deputy Desmond and I differ is that Deputy Desmond says that the people of Cork county are fully satisfied with the present set-up. The people of the South Cork area, whom Deputy Desmond and I represent, are paying through the nose, at the rate of about £2,000,000 in all, for legislation passed by this House 20 years ago. We have been paying that amount for the up-keep of the poor of Cork city. That is the sole reason I am backing this Bill and I do so in the hope that we shall get the situation altered. That is the sole reason and I am not concerned with anything else.

The people of South Cork, if I may give examples which have been given in this House before, paid in home assistance last year the sum of £38,900, and the people of Cork city paid £12,200. For that amount, the people of Cork city received in home assistance £20,600 and the county got back only £18,300. Those are figures that cannot be contradicted and they are dure to legislation passed by this House in open defiance of the representatives of South Cork in the House at the time.

There is a free boot scheme supposed to be in operation and the bill for it this year was £15,500. Of that, the grant amounted to £5,600, leaving a levy on the ratepayers of £9,900. Of that amount, the city paid £3,300 and got back £9,400. The county paid £6,350 and got back £6,000. Those are the figures and they cannot be contradicted. They are the effect of legislation passed by this House to force the rural ratepayer to pay not alone for his own poor but for the poor of Cork city as well. There can be no justification for that.

I am hoping that this Bill will change all that if it is properly amended and looked after. There are enough plutocrats in Cork city to look after their own children who have fallen by the wayside. These people have been battening on the rural community for a long time and there is no reason why the ratepayers of South Cork should subscribe over £100,000 for the poor of Cork city. Others have questioned the reliability of these figures and the Manager gave them correctly. I am concerned also with the memory of the men who had courage enough to stand up here in all parts of this House when the Home Assistance Act of 1939 was being passed and challenge the manoeuvre by which the county paid two-thirds of the cost and got back one-third and the city paid one-third and got back two-thirds. I remember the late Deputy Broderick and the late Deputy O'Neill standing up to oppose that kind of legislation when it was being passed here.

We all know that there is no justice south of Dublin, as far as the ordinary people of this country are concerned. Anything that is going is for Dublin and north of it.

Mr. O'Malley

And for Cork.

Mr. Corry

Cork will some day in the near future throw off the shackles of the lot of you. We had to send a Cork man down to keep the Deputy's area out of bankruptcy. That is the position in Cork.

When I come to consider this Bill, I admit that we may get rid of some duplication of services. There is no doubt about that but I would have far more faith in the successful operation of this Bill if the Minister would stand up and say that for the next three years the Dept. of Health would not interfere. If he would say that, I would say we in Cork would work it out some way and make it a success, but what hope have we as things are? The cost of the sanatoria service in Cork county is decreasing. That disease was brought under control to that extent. However, there was the difficulty that the South Cork Board of Assistance had not enough beds. They applied for a wing in a sanatorium but their application was turned down.

An Ceann Comhairle

The Deputy is travelling into the realm of administration.

Mr. Corry

The Deputy is dealing with the improvements this Bill will make.

Mr. M.P. Murphy

In what way?

An Ceann Comhairle

Section 3, as amended, is before the House.

Mr. Corry

The Deputy is pointing out, as best he can, that when the one Board will have charge of the two hospitals they can make what changes they like.

An Ceann Comhairle

That may be the Deputy's intention but it is certainly not the result.

Mr. Corry

I am just coming to it.

An Ceann Comhairle

The Deputy was coming to it last night and he is coming to it this morning; I hope he will arrive very soon.

Mr. Corry

Under this Bill there will be no necessity for getting sanction from the Department of Health for the removal of patients from one hospital, the property of a local authority, to another hospital, the property of the same authority. That is one of the improvements I see in the Bill.

A similar incident occurred in relation to a place called Lota in Cork which was taken over by the Sanatorium Board at a period when we had grave difficulty as to what we were going to do with patients in the sanatorium. When we overcame that difficulty and did not require Lota to deal with the situation, we had 480 patients on the waiting list in the orthopaedic hospital and although the Sanatorium Board were quite willing to hand over the hospital, it took six months to obtain sanction for that from the Department of Health. That is another thing that cannot happen any more when this Bill is enacted.

I do not know how these bodies will be able to dispose of the business they will have to deal with at meetings. Usually it takes about four hours for the Sanatorium Board to deal with the sanatorium. Our Board of Assistance meetings sometimes last only a short time; more times they might go on for four or five hours. I wonder how a team can be got, composed of these bodies, that will roll all the items to be covered into one day's work at a meetings? What will be the function of these committees and how will they operate? These are the questions I should like the Minister to answer.

The Minister says we can have three committees. He has given no indication whether those three committees will be joint committees, as at present, where you can have in the Sanatorium Board or in the Mental Hospital Committee representatives of the Corporation and the Cork County Council. I cannot find a provision to that effect in the Bill. If a committee comes to a decision and that decision is brought before the Health Authority the following week and the corporation members are not members of that committee, can they use their steamroller of 28 votes to roll the committee down the hill?

I should like also some explanation from the Minister as to the effect of one of his amendments here. In the Bill as it stands the matter of public assistance under the South Cork Board of Public Assistance is taken out of the arbitrator's hands; he has no say in the manner in which payment will be made. I know I am digressing but this will govern our attitude towards the rest of the Bill.

An Ceann Comhairle

Section 3, as amended, is before the House.

Mr. Corry

What it is intended to do under Section 11 is a very importtant matter and will govern our attitude as regards Section 3.

An Ceann Comhairle

That is a very distant anticipation.

Mr. Corry

I am afraid it is not.

An Ceann Comhairle

The Deputy must confine himself to what is in Section 3 as amended. He will have ample opportunity to deal with Section 11 when we come to it.

Mr. Corry

I was relying on my own judgment and I do not think I am often wrong. I should like to have the question of the committees to be formed under the Bill clarified by the Minister. Are there to be joint committees? If so, what power is taken in order that we can have joint committees, and how many committees can we have? Supposing we have a committee dealing with santoria treatment, and a committee dealing with mental hospitals, and mental hospital treatment, can we delegate to the ordinary committees that at present exist powers in relation to home assistance? Those are the things that are quite natural for us, and those are the things on which I should like information from the Minister.

Minister for Health (Mr. MacEntee)

I hope I am not going to be called upon to be a sort of pacificator as between the city of Cork and county of Cork. I should find myself very much like the grain between the upper and the nether millstone if I were. I want to refer to Deputy Desmond's speech and to remind him that, as he pointed out, Cork is very well served by the Cork sanatoria board, and well served by the Cork joint mental hospital board. They serve all the people of Cork irrespective of whether they live within the city boundaries, or outside the city boundaries. That, I am told, has been found to be a very satisfactory arrangement.

What we are proposing to do in this Bill is to extend that arrangement which has been so satisfactory in respect of these Cork health services to all the other health services in the city and county of Cork. We are treating Cork, despite the unwillingness of its citizens, as one entity for the purpose of the health services, putting the county health services and the dispensary services on the basis that has been found to be so satisfactory in operation in regard to the mental hospital board and the sanatoria board.

There is no justification for fearing that when we extend that principle to all the other health services that the people of Cork will have any reason to be apprehensive that they will not be better off under the new arrangement than under the old arrangement from the point of view of convenience and availability of the services. I hope, in due course, to improve the services also because a degree of overlapping will be avoided; so that, as I said last night, we will be able to make a better utilisation of the institutions, and the personnel of these institutions which, at present, have five separate bodies in the city and county of Cork administering them. That is a reasonable case for adopting the principle in Section 3, the principle of having a unified health authority for city and county.

We have gone, I think, a considerable distance to meet the special circumstances of Cork. We have enlarged the size of the proposed health authority, and have increased the numbers of those who, as members of appointing bodies, will be eligible to be members of the unified health authority. We have made provision whereby the county of Cork will have 28 members, as against the previous proposal, and we are correspondingly increasing the number of members for the city of Cork from eight to 12. It will be realised that the electoral areas within the county will have the equivalent of four members each on the new board, and there is a further provision that at least three members from each one of the electoral areas must be on the board.

We understand that there is a rather rigid set-up, so far as one can see, in the composition of the Cork County Council. There are three major Parties there. I do not know where the Independents come in between, but there is provision anyhow to ensure that every interest will be as fairly represented as can be devised on the joint board. There is room, of course, by agreement, to find a place on the authority for those who are not attached to any of the political Parties. In addition to that, we have made further provision for local committees who will have certain statutory powers delegated to them, or conferred on them, by regulation to be made by the Minister.

We are assuming they will take the place of the existing local arrangements and will replace the Cork Board of Assistance and the other two committees which, at present, supervise the general administration of the health services in Cork city and county. These committees will be empowered to supervise the general operation of the local health services in the districts concerned and will be in a position to make any necessary representations to the county manager and to the other appropriate officers in relation to them.

On the question of any special arrangements which might require to be made, in regard to the management of the Cork sanatoria board and the Mental Hospital, as Deputy Corry mentioned there is nothing in this Bill which will prevent the unified authority, when it is established, from setting up special sub-committees to perform the functions in relation to these institutions which are already being performed by the joint boards. It is not necessary that there should be any special legislative provision to that end, but if any member of the House is in doubt, I shall have the matter further examined. My advice is that it is within the competence of the new unified authority to set up sub-committees and give them responsibility for discharging the functions which have been performed in whole or in part by the sanatoria board.

I do not want that statement to be taken quite in the most general sense because there may be some things which it will be found, when the authority comes into existence, that the authority will have to do, as a whole, which at the present moment might be done by the sanatoria board or the mental hospital board. By and large, however, I cannot see anything that would prohibit or prevent the authority from setting up sub-committees for special purposes, and giving certain powers to these sub-committees.

Another question was: how are we to get people to devote their whole time to the affairs of the unified authority? I do not see how there can be much greater difficulty under the new set-up than under the old set-up, particularly having regard to the position in relation to the establishment of the local committees, and having regard to the fact that sub-committees with delegated functions can be established to look after special institutions. The same demands are being made at the moment—demands which Deputy Corry thought would be too onerous and excessive—upon the personnel of the health authorities in the city and county of Cork. These demands will not be enlarged in any way by reason of the establishment of the unified authority. On the contrary, it is hoped that perhaps they may be a little less, and that the demands upon the time of public representatives will not be as great as Deputy Corry has indicated they are.

Take the case, for instance, of the Cork Sanatoria Board. It has 20 members, four nominated by Cork Corporation and 16 by Cork County Council. They have to spend a special day on that. I assume if a sub-committee is set up to deal with the affairs of the sanatoria that demands will be made on the sub-committee, the same sort of demands that at present are made on the Sanatoria Board itself. Similarly, with the Cork Mental Hospital Board. It has 26 members, four local authority members, five Cork Corporation members and 17 Cork County Council members.

Mr. Corry

That is the——

Mr. MacEntee

That is the existing arrangement.

Mr. Corry

This is the new arrangement.

Mr. MacEntee

I have already pointed out to the Deputy that, so far as I have been advised up to this, it is quite within the competence of the proposed new authority to set up special sub-committees to look after these specialised institutions and to function in respect of them by and large as they have been doing up to the present. There may be some question about certain functions which at the moment they perform and which will have to be performed in principle by the new unified authority. By and large, I think if the members of the unified authority want it that way there is nothing to prevent them having it that way under this Bill. If there is any doubt about it I will have it looked into and see what would be necessary and I will put down an amendment on Report Stage.

Mr. Manley

I am forced to admit that there is a good deal of substance in the points made by Deputy Desmond and in part by Deputy Corry. I am in complete agreement with the principles of the Bill as far as they are applicable to Dublin, Waterford and Limerick. These are compact areas. In Dublin with its centralised population these principles are easily workable but consider the distance from Youghal Harbour to the far point of the Beara Peninsula or let us realise the fact that when one reaches the Cork border, travelling from Dublin to Cork, one is as far from the extreme end of the Beara Peninsula as he is from Dublin.

There is another point we must remember. There is no geographical centre in County Cork which would be equi-distant from any remote point in the county. It is true that the city is the administrative centre. It is 30 miles from Youghal, 40 miles from the Limerick border on the Northern side and 90 miles from the end of the Beara Peninsula. I am quite dubious about the workability of this unified service in the County Cork.

It is true that the Minister has come part of the way to meet the points put up when he assures us that the central authority set up under this Bill can appoint sub-committees to administer the affairs of parts of the county. Why have the Bill at all if that is the case? I am not a member of any local authority. I cannot speak with the same familiarity of the county services in Cork as those who have already quoted. I take the detached, objective view. I am concerned about the efficiency the Minister has envisaged in this Bill and the provision of better services under this Bill.

I suggest to the Minister in all earnestness that the application of the Bill to County Cork should be deferred indefinitely until such time as he is assured that the Bill has behind it the desired results in the other areas, Dublin, Waterford and Limerick. In that way he would be able to speak with greater conviction. We would be all in the position to be better convinced at a later stage when we see how experience worked out in the operation of this Bill in other areas.

There is another point. In Cork City at the moment the county council services are diffused over the whole of the city because they have no central offices. I think the day is very far distant when they will have central offices. It would be unthinkable at the moment, with the state of the county finances and the high ceiling of rates, to envisage the building of central offices. The Board of Assistance is administered from George's Quay. Assistance is distributed at Grattan Street and in another part of the city. The Health Authority and the Sanatoria Board have offices in Grand Parade. The Mental Hospital has its meetings in the hospital itself away up at the western side of the city. Then we will have the City Hall in addition so that even with the unification of the Health Services in Cork there is no possibility of having the staff housed in any one particular area at the moment.

That in itself is a drawback and a reason why the application of the Bill to Cork should be deferred indefinitely until such time as we realise these hopes, and it will be made opportune for the public authorities in Cork to have central offices from which the unified services can be worked.

Mr. M.P. Murphy

In one rather short section of this Bill the Minister proposes to make revolutionary changes in the administration of the Health Services in the county and city of Cork. Where did this demand for such changes come from? Did it come from the people of the county and city of Cork? Did it come from the members of Cork Corporation or did it come from the members of the Cork county council? Indeed, it did not. There was no suggestion for any changes made either by the Oireachtas Members in Cork county, county councillors, local representatives or the general community.

This move to establish a unified health service authority in Cork originated in the Custom House because we heard about this some years ago. The idea is not a new one. Some four or five years ago, when Deputy O'Higgins was Minister for Health, in a democratic manner he put the viewpoint that Cork Corporation and Cork county council should consider the feasibility of establishing a unified health authority. It was rejected unanimously by the Cork County Council and there was no more vehement opponent to it on that body than the previous speaker here this morning, Deputy Corry. Having regard to the unanimity of its rejection by the Cork County Council and, I understand, by Cork Corporation, Deputy O'Higgins in a democratic way accepted the viewpoint of the public representatives of those two authorities and waived his proposal to implement a unified health authority in Cork City and County.

That was all very well until the present Minister came into office. Naturally the same promptings were at his disposal in the Department and what was his attitude to them? Did he consult Cork County Council or Cork Corporation, or did he consult any authority on health legislation in Cork County? He certainly did not. At least that is the information I have. Instead he introduced this Bill, with Section 3 in it, changing the health administration in Cork County. We had a rather lengthy discussion in Cork County Council on the proposed change and I feel the Minister will agree that the members of that body, with their local knowledge, are just as much conversant with health administration in Cork, and with the advantages and disadvantages of the proposed change, as are the people in the Custom House who have no personal knowledge of the difficulties to be faced in satisfactorily administering a health service in an area such as Cork, which comprises more than one seventh of this State.

The proposed change was rejected by Cork County Council and Deputy Healy will correct me if I am wrong when I say it was rejected by Cork Corporation. However, the opinions of these bodies were not acceptable to the Minister and now he proposes to make a change in the original section to increase the membership of the unified health authority, from 16 to 28 in the case of the council, and from eight to 12 in the case of the corporation. He further informed us this morning that even though he intends wiping out Cork Mental Hospital Board and the Cork Sanatoria Board as statutory bodies, he intends allowing the establishment of these same bodies under the title of "sub-committees". It seems ridiculous to me that with the passing of this Bill the Cork Mental Hospital Board will be wiped out but as a sub-committee it will be restored. The same thing will happen with the Sanatoria Board and I cannot see how economy will be effected by that.

If these Boards are to be established in the form of sub-committees it is natural to assume that the staffs attached to them will be retained and, along with their retention, is it not also reasonable to assume that new staffs will be recruited for the unified health authority? The Minister says that at present we have four or five different authorities in the country and city of Cork dealing with health administration but, judging from the statement he made a short time ago, it does not seem likely that he will reduce the number of these bodies.

The Sanatoria Board will continue to function as a sub-committee. I think there is very little in that because everybody knows that, so far as the administration of health services are concerned in any part of the country, the main functions rest with the county managers and it could be said that bodies like the Mental Hospital Board and the Sanatoria Board are only keeping a watchful eye on the manner in which the managers administer the moneys provided at the annual meetings of these bodies. Everybody knows that their functions are very limited because the Government and the Minister have the right to abolish a body or board that does not act in conformity with Governmental and Departmental regulations. Several such bodies who adopted an independent attitude were abolished in the past and it is not unlikely they will be abolished in the future.

I was amused to hear my colleague from Cork changing his viewpoint on this measure. Deputy Corry now says that the only nice thing about it is that the people in Cork City who are in receipt of home assistance, and who qualify under the free footwear scheme will have to pay for these services within the city confines. That is a very peculiar statement and I understand he has anticipated the Minister's approach to Section 11 of the Bill, that there will be a system of local charges. I am entirely and completely opposed to a system of local charges.

Deputy Corry seems to think that if the citizens within the South Cork Board of Assistance area get assistance, either in the shape of home assistance or free footwear, the Cork Corporation area should pay. I do not agree with that viewpoint and I do not agree that it should happen if we have a unified health service in Cork. I think if the rural part of the South Cork area is in the favourable position that much fewer of its citizens need public assistance in the way of allowances or free footwear, Deputy Corry and others on that body should be very pleased that is the position— that much fewer of their population need help and assistance from local authorities than do, say, residents of Cork City. That is a peculiar approach to the support of this measure because, if that is carried to its logical conclusion, it could be said that benefits given in a particular area should be charged to that area and that we should have a system of local charges.

It could be said that different electoral areas in the county should bear their local charges. I believe that is entirely out of place. I feel that if this unified health authority comes into being the proposals of Deputy Corry should be ignored. Charges should be on a uniform scale, extending over the city and the county as a whole. I make that statement even though I am completely opposed to the section and have my name down sponsoring its rejection. However, should the section be passed, I have a feeling the Minister will ignore the move being made to set up a series of local charges.

I represent possibly the poorest part of Cork County. I am a firm believer that wherever a local authority functions there should be the same rate of charges all over the area, irrespective of where the special or additional services are being provided. Deputy Manley has referred to this question that has agitated the minds of all of us in Cork County. It is more than 100 miles in length. Furthermore, within the county, there is a large population residing in Cork City.

What may be said to be applicable to people and to areas in West Cork or maybe in other parts of the county would not be applicable to Cork City. If a board, say, of 40 members is set up and say, Deputy Healy has some special case to make for residents within the Cork Corporation area, will opposition to the provision of benefits for the people of Cork City, as expounded here to-day, prevail and will the members, say, from West or North Cork adopt the attitude "What is happening in the city is not a close concern of ours; we will try to keep down the rates even in respect of a service that may be absolutely essential." I am not too positive that that will happen but if we have too many Deputy Corrys on the board it is quite within reason that it may happen.

I believe that once a person is on a board, whether a council or a health authority, he must approach questions coming before it on an equitable basis irrespective of where they come from, whether they come from the area from which he himself is getting his votes or from opposite parts of the area. If there is no uniformity of approach by the members, I am afraid such a body would not do much useful work.

I do not want to delay the House. I should not, however, like to resume my seat without asking the Minister, instead of expressing disapproval, to review once more the proposals submitted to him by the county health services committee regarding mentally defective children in County Cork. To give the Minister a résumé of the position, this has been a very serious problem in Cork County for the past number of years. We have several mentally defective children, divided into four classifications by the county medical officer, who cannot get suitable accommodation.

An Ceann Comhairle

How does this fall for discussion on Section 3?

Mr. M.P. Murphy

It certainly does. It comes within health administration. Speaking on this section, I am entitled to discuss the systems applicable in the administration of health services as they now exist and as they are likely to exist if this Bill is passed.

An Ceann Comhairle

Administration does not fall for discussion on this section.

Mr. M.P. Murphy

It is a Health Authorities Bill.

An Ceann Comhairle

It is, but a section is before the House. The administration of the Health Department does not fall for discussion on this section. The Deputy may find some other means of raising the matter.

Mr. M.P. Murphy

With respect, we are discussing the administration of health services in Cork as they will exist if this section is passed.

An Ceann Comhairle

No. We are discussing Section 3. That has nothing whatever to do with administration. It is a proposal to amend the legislation to unify control of health services——

Mr. M.P. Murphy

With respect, your ruling seems——

An Ceann Comhairle

The Deputy may disagree with my ruling but he must accept it.

Mr. M.P. Murphy

That is the trouble.

An Ceann Comhairle

Yes, it is.

Mr. M.P. Murphy

In view of the ruling of the Chair there is not much more for me to say except that probably as good a case could be made by the Minister for a unified health authority for the whole country. The length of Cork is very close on one-third of the length of the whole country and the population, as mentioned yesterday, is almost 350,000 persons, some 100,000 of whom live in Cork City. How can a unified health authority deal with Cork where there are such different conditions in different parts of the country—in remote isolated districts; in groups of islands, in a big urban population; in big farming areas such as that in which our friends resides in East Cork where I am sure the people are doing fairly well? Where there is a conglomeration of all kinds of rural life, no case can be made for a unified health authority.

I appeal to the Minister, if this section should be passed, to take no cognisance of any suggestion that there should be local charges. If there will be local charges surely we cannot say it will be a unified health authority. I agree that the Cork Corporation should be a separate area in every sense of the word. They should have a separate health authority. The members of that authority would be thoroughly conversant with the position that obtains in a rural area like Cork with which members living in far away districts would not be so conversant. The best way to achieve your purpose if you want to give over, as you say paying more assistance in respect of the Cork area than you are getting is by supporting section 3 of this Bill.

Mr. Healy

Deputy Murphy asked where the demand for this measure was coming from. Anybody connected with public life over the last few years must realise that there is great dissatisfaction with the way the Health Act is applied in many areas. There is great need for improvement in the administration of the services. That is very obvious in the part of the country from which I come. I can understand Deputy Murphy's feelings of disquiet because of the Mentality of the Deputy who spoke about putting charges on certain areas and keeping them to certain areas, but I do not think there is any necessity for that. There has never been any disinclination to help in any way possible the people who have come, sometimes in their hundreds and sometimes in their thousands, from outlying districts seeking employment or seeking residences in the city of Cork. They have never been treated differently from the people of longer standing in the city. I should be very surprised if the same mentality did not exist in any other part of the country. We have enough boundaries already without setting a boundary between city and country folk.

The only possible way of justifying confining the local authority completely to the city of Cork would be if the city boundary were moved out to reasonable proportions. At the moment the position is that the city is overflowing, but Cork Corporation is building residences for the citizens within half a mile of the city centre. That is unrealistic and will have to be dealt with in the future but, until such time as that is done, there is no use talking about an authority for Cork city alone. It must be obvious that the new health authority could simplify the position. We are told the authorities in Cork work very well. So they do, to my own knowledge, within the powers given to them. But, as Deputy Murphy said, we all know that sometimes patients cannot be transferred to hospital because there is doubt as to whether they come under some section of the Act. As a result the patient does not receive the immediate and special attention he requires. Our first consideration should be the patient; secondly, maybe, the efficiency; and, thirdly, economics, but, if the patient is suffering in any way, we should do something to improve the position.

On a previous occasion I mentioned the position in regard to the supply of dentures in Cork city and county, where in one place you paid £6,000 for, perhaps, little more than 50 per cent. the number of dentures one could get for the same sum in the adjoining part of the same county. I am not saying that the best is always the cheapest.

Mr. M.P. Murphy

That would be a dangerous policy for the Deputy.

Mr. Healy

I do say that the charge should be universal and that it should be possible to apply the best scheme to all the area rather than apply it to some of the area. I am privileged to be a member of a voluntary hospital board, of a mental hospital board and of the South Cork Board of Public Assistance. It is hard for somebody on the Minister's side to say it, but I feel sincerely, without any political bias, that the Minister's Bill is an improvement on the present position and well worth a trial. Only time will prove its weakness, if any, but it certainly is an improvement on the present position.

Mr. Corry

As I said before, this Bill follows a pattern. We have a county board of health for Cork county with eight representatives, and in the county we have three minor boards. We have to do away with the county board and leave the three minor boards to do the job. I am not at all surprised at Deputy Murphy's attitude. It is the attitude I would adopt if I were representing the people he represents. If I were another man, with my hands deep down in the other fellow's pocket, I would keep it there as long as I could. The representatives of West Cork have always got fair play and justice, and more than justice, from Cork County Council. They pay one-tenth of the rates of the area and get back about one-third. I do not think they have any reason to complain. I am not surprised that Deputy Murphy is joining hands with his brother in arms, Deputy Healy, in that attitude. When the cake is there every fellow must get a slice. Apparently that is the attitude as far as the rural population of South Cork are concerned.

I have given grave thought to this matter. I felt from the first day that it was iniquitous to have a different basis of payment in respect of two authorities. In respect of the mental hospital board and the sanatorium board there is a per capita charge, but in the case of the South Cork Board of Public Assistance there is a valuation charge. The valuation charge was made under very peculiar circumstances. Following the burning of Cork city in 1920 a special arrangement was made under which the rebuilt areas were not revalued. I appreciate the Minister's gesture in increasing the number of representatives, but whatever representatives come there, their job will be to administer an Act.

I can only treat Deputy Murphy's statement in regard to my attitude with contempt. For seventeen years I have been chairman of the South Cork Board of Public Assistance, which has been administering that Act. The people I represented paid two-thirds and got one-third back. I challenge Deputy Murphy or any other Deputy to compare the conditions in St. Finbarr's hospital twenty years ago with the conditions there today. Well over £500,000 has been spent on it. Due to the trickery of the Department of Health, two-thirds was paid by South Cork and one-third by Cork. If Deputy Murphy gets his wish, he will have the pleasure of seeing those he represents pay some of it.

Mr. M.P. Murphy

The Deputy said they did not pay anything.

Mr. Corry

Deputy Murphy hoped that would not occur. If Deputy Murphy's hope is carried out, Cork county as a whole, north and south, will pay its share for Cork city. Deputy Murphy's people and the North Cork people and the rest of them would be paying. I think that would be an iniquitous proceeding.

Deputy Healy refers to the city boundaries being moved out. There was never any objection to moving the city boundaries out. As chairman of the South Cork Board of Health for a long number of years I can say that we assisted in providing services outside the borough boundaries in the shape of housing, sanitary facilities and so on. When the offer was made to the city to have the boundaries moved out, we had no objection but the moment they found that they would have to pay they pulled out of it.

I appreciate what the Minister has said in regard to different committees. It takes my mind back to a very old pattern. I remember being a member of the old finance committee of the Cork County Council 30 years ago and a proposal came to us from the Department of Local Government that we should have one county surveyor and two assistants to run the county. I remember leaning across and asking one of the assistants who was there: "How do you think you will get on?" and he replied: "Oh, I will have plenty of time for fishing." Then I turned to the gentleman who was to be county surveyor and I asked him the same question and he replied: "Oh, I can be fishing all the time because the other two will be doing my job." This is the old pattern coming back again under this. I am voting for it for one reason alone and that reason is contained in Section 11.

Mr. M.P. Murphy

But if Section 11 is not accepted?

Mr. Corry

Deputy Murphy is representing his people here and I take it he has expressed their viewpoint and I have not objected to it. I am rather surprised at Deputy Manley's attitude with regard to it but, frankly, I confess I am deeply concerned with the fact that for many years the ratepayers in my portion of Cork county have been bled white under legislation passed by this House. I object to any continuation of it.

Mr. Briscoe

I should like to say that I am rather interested to hear the Cork Deputy's reference to Section 3. Section 2, of course, is what concerns us in Dublin. I should like to place on the records of the House that, in the view of those concerned in Dublin, it is somewhat similarly placed in regard to conditions and circumstances as Cork. We have no grievance against the Minister.

I was rather astonished to hear Deputy Murphy talk about this Bill being hatched in the Custom House, apparently behind the backs of the Cork authorities, because we in Dublin have been discussing this matter for a very long period. We had opportunities of discussing it amongst ourselves with the other authorities concerned and we found we could agree on most things and did in fact agree on representation and so forth.

The matter about which we are concerned in this House, as well as the local authorities, is that there should be some improvement in the health services, particularly with regard to ensuring efficiency in administration and, obviously, ultimately with a reduced cost of administration. There must be in Cork county and city the same overlapping that we have experienced. I do not understand why there should be objection to the principles of the Bill and the details as laid down.

I want to say that we had a variety of apprehensions when this was first mooted quite a considerable time ago. There was the question of the staffs of the various authorities. We now find that when this council is set up it will take over from us in the city of Dublin, and also in Dun Laoghaire and the county of Dublin, the staffs previously used by us to the extent that they will be required. There will not be any problem. As I have said before, we shall have full representation on the council, with numbers agreed by the authorities concerned.

The Minister and the Minister's Department were very generous in their discussions and correspondence with our corporation and the Dun Laoghaire Borough Corporation and the County Council of Dublin. I cannot understand why the Cork authorities' representatives could not have got together as we did and examined what the impact would be, particularly on the rates. The Cork representatives ought to have another look at it and then discuss the various areas concerned. As Deputy Healy has stated the patient should be the first consideration. In the long run patients will have greater service and prompter service. In every way the Bill will help in the administration of the health services which have now become part of the life of the people and part of the responsibility of the nation as a whole. The people will find it will be a better service at a much reduced cost.

Mr. Dillon

I wish to deal with one point on Section 3 which I think applies to Section 2 and to each of the sections setting up a unified authority. It is a matter which has been referred to by Deputy Cosgrave and one to which I should like to refer briefly to secure the Minister's sympathetic consideration. I believe, as Deputy Healy said, that our first concern in a matter of this kind should be for the patient. It is common knowledge when people fall ill and it is deemed necessary to send them to hospital—in the case of many of us who have had that experience more than once it is not very alarming—that to many of them their first introduction to a hospital for treatment carries with it a great deal of concern and anxiety. Heretofore, I understand it has been possible to allow a patient requiring hospital treatment to go to any hospital of his or her choice, provided it is a hospital recognised by the local authority and one with which the local authority can deal. I understand that in certain areas a practice threatens to grow up in which dispensary doctors are restricted from sending their patients to the hospital to which the patient would prefer to go, even though that hospital is in contact with the local authority and has accommodation, and are being pressed to send patients to a particular hospital, possibly because there is a temporary surplus of accommodation there or something of that kind.

I recognise that economic considerations would actuate the executive officer in a health area to try to send patients to the hospital that had a lot of accommodation available, whereas other hospitals were at the limit of their capacity, but I want to urge on the Minister that, as Deputy Healy pointed out, our first consideration should be the patient. It makes an immense difference if a nervous person facing his first hospital experience has a special feeling for the Sisters of Mercy or the Sisters of Charity or possibly knows one nun or somebody in one of the hospitals which are available. It makes an immense difference to that person if he is free to go to that hospital and have the feeling that there is somebody there who will come to him and perhaps speak a word to him and help him to become familiar with the physicians and the staff, if it is his first contact with hospital accommodation.

I would therefore suggest that, whether it is done administratively or otherwise, it should be made clear to the executive authorities of these unified health authorities that they should be extremely slow to send a patient to a hospital other than that of his or her own choice, when the patient has expressed a choice. I do not want to elaborate unduly on this matter. I do not think it is a matter which has reached anything approximating to an abuse, but I feel that if it were allowed to develop, we might fail to show a reasonable regard for the reasonable predilection of a patient for whom I think we ought to have special solicitude in that they are meeting an extremely disturbing experience for the first time in their lives in having to go to hospital.

Mr. MacEntee

I have no knowledge of the particular case to which Deputy Cosgrave referred last night and I shall have to ascertain the facts. We must not, however, forget that the executive officer has financial responsibility in matters of this sort. If a person elects to exercise his free choice of hospital, the executive officer must consider the financial advantages of having the patient go to a designated hospital. Dublin Corporation, which is a wealthy body compared with the impoverished city of Cork, has, as an act of grace, accepted patients for general, voluntary hospitals and this difficulty does not arise. As against that, the assistant county or city manager has the responsibility of trying to ensure that the local authority institutions are run as economically as possible and if everybody were to be permitted to go to the hospital of their choice, the cost of the health services, I am afraid, would soar enormously and we would have a number of derelict institutions on our hands. That is a real problem and while it will be dealt with with all the human consideration possible, it is something we shall have to look at with a degree of realism, bearing in mind that the attitude of the ratepayers may be very different from that of ourselves as private individuals.

Mr. Dillon

Do I understand from the Minister that where there are a number of designated hospitals in existence, no difficulty would be raised where the patient chooses one of them?

Mr. MacEntee

They are purely "acts of grace" hospitals. The position has been so well established here in the city of Dublin that a person can go into practically any hospital he likes and be regarded as a Section 15 case.

Mr. T.F. O'Higgins

"Act of grace" is scarcely the correct term.

Mr. MacEntee

I think it is.

Mr. MacCarthy

I agree entirely with the objectives of the Bill, but, as far as the city and county of Cork are concerned, I doubt very much if we are going the right way about achieving these aims. My view is that public representatives, elected for particular purposes, should have direct contact with the administration of the various services in the county and that if a member is elected to the county council and has no contact, no direct responsibility in regard to the health services, it is not fair to him or to the people whom he is elected to represent.

In the administrative areas of Cork city and county, we have at present a health committee in West Cork, and in North Cork, and a joint committee for Cork city and the surrounding area— Cork South. Under this Bill, as I see it, not more than three sub-committees can be appointed and the result will be that if you have members on the sub-committee of the sanatoria and the mental hospital, only one other sub-committee can be appointed.

Mr. MacEntee

That is quite wrong. The Deputy is under a misapprehension. The committees to be set up under Section 10 are local area committees dealing with the areas—which we assume will deal with the areas— which are at present under the control of South Cork Board of Assistance, the North Cork Committee and the West Cork Committee. The sub-committees which the authority can establish have no relation to areas but may be related to institutions.

Mr. MacCarthy

It says: "Not more than three committees shall stand established under this subsection at the same time at the instance of the same council of a county."

Mr. MacEntee

Local committees. Read what the section says. Not subcommittees—local committees.

Mr. MacCarthy

There is nothing, so far as I can see, in the Bill authorising the appointment of further sub-committees. There might be nothing in the Bill prohibiting it, but so far as I can read it, there is nothing which definitely authorises it.

Mr. MacEntee

And it is not necessary.

Mr. MacCarthy

It may not be necessary.

Mr. MacEntee

I have already explained that to the House.

Mr. MacCarthy

As I see it, we are setting out to unify the services and if we are unifying the services by just appointing the same number of committees and sub-committees, taking some of the functions from them and giving them to a local committee on which less than half the council are represented, then, to my mind, we are not setting about the thing in the right way, from my point of view, at any rate. I think those three committees should continue in the various areas with their statutory rights and authority and responsibility to those whom they were elected to represent.

The one great difficulty, of course, about having a separate area for the city and county arises from the number of institutions that take patients from both city and county. In addition, there are the voluntary hospitals where, up to the present, the controlling authority, the county council, appoints the members. Now it is proposed that the appointments will be made by the health authority, which does not consist of either all the members of the corporation or all the members of the county council. There will be a kind of executive appointing the members of those voluntary hospitals instead of the public representatives having the right to make the appointments.

With the present scheme of things, I do not see that for many years, until there are central offices, any success whatever can be achieved in our aim of having unified services. The county manager's office is in the Courthouse; the county health offices are in the Grand Parade; the dispensary services are in George's Quay. The offices are spread all over the place. Until there is centralisation, I cannot visualise very much success in achieving the aims the Minister has in mind in promoting this Bill.

I agree with the Bill in principle, undoubtedly, but, owing to the circumstances in Cork, I doubt that we are going the right way about doing what we have in mind. At times, one would think the county health authority would have responsibility for a service but is informed that the matter comes under the dispensary services and one has to go to George's Quay. There are staffs in all these places. Until there is a central office to unite the staffs and to allow them to function centrally, no great benefit will accrue to Cork city and county as a result of this Bill.

Mr. M.P. Murphy

If this section is approved, in regard to Deputy MacCarthy's point about the establishment of sub-committees, would the Minister agree that the personnel of these committees would be selected by the parent bodies, say, the county council and the corporation? I agree with Deputy MacCarthy that on the proposed unified health authority, there will be only a percentage of the elected representatives from the city and county. On the parent body, there will be all the representatives. They can agree as to the number of representatives each body will be entitled to have on the sub-committees. I feel that they should be appointed by the parent body.

I had a wrong impression about one committee, as I am pleased to learn from the Minister's statement. I refer to the Mental Hospital Committee. The one useful purpose that a sub-committee of the mental hospital would serve is that it would give a sense of security to the people, as the present committee is giving, particularly to the relatives of patients. When meetings are held periodically at the hospital and their local representatives are on the board, these people are satisfied that the hospital management is keenly looked after by their representatives. It would be a retrograde step to withdraw such a committee. In the Cork institutions, there are, unfortunately, 2,500 mental patients. There are monthly meetings of some 20 representatives from all over Cork city and county at the hospital to ensure that the patients receive satisfactory treatment. They do other useful work such as inquiring, at the request of relatives, about various patients. That is a feature of public representation in Cork in regard to mental illness and I am particularly glad that permission will be given under this Bill to have a mental hospital sub-committee, even though such committee may be much smaller than, say, the existing body.

The main point I wish to make is that which I made on rising, that is, to ask the Minister, in the event of the section being approved, will he agree with Deputy MacCarthy's suggestion that the appointment of the personnel of the sub-committees would not rest with the unified health authority but with the parent bodies, Cork County Council and Cork Corporation, in proportion to the numbers determined by them. Would the Minister be able to throw any light on that matter now, if the change is possible or feasible, or would he consider it for the next stage?

Major de Valera

The reason I intervene at this stage is not a desire to interfere with the local affairs of Cork but to recall Deputies' attention to the perspective of the Bill as a whole. The discussion has tended to become one of local mechanics in Cork and it seems that opposition to the section in the Bill will be based on that aspect. That would be a mistaken approach if that approach were to be adopted, for these reasons: We have to ask ourselves what is the Minister trying to do in this Bill and should what he is trying to do be done. What he is trying to do, incidentally, is something which affects Dublin, Cork, Limerick and Waterford. What is he trying to do? He is trying, in short, to bring a certain amount of order into the health services where there is manifestly disorder.

I do not think any Deputy from any one of these municipal areas, whether it is Dublin, Cork, Waterford or Limerick, will deny that there are serious administrative problems in regard to health services in those areas and there are many problems which we Deputies are meeting. Speaking for Dublin, I know that one of the acute public matters at the moment is just this question of the health services in some aspect or another. I need not go into it. There is the question of charges. The Minister has had it at Question time. There are a large number of questions relating to the health services which are causing concern to a number of people and which are causing a great deal of inconvenience and dissatisfaction amongst the members of the public who are affected at the present moment. That is an undeniable fact and the Minister is taking cognisance of that fact. I take it that we want to remedy that position. If anyone wants me to go into detail, I can give some details.

Mr. Desmond

About Cork?

Major de Valera

About the position in Dublin and I shall leave Waterford, Limerick and Cork for other people to give details in regard to them. That is not what is at issue. What is at issue is the unsatisfactory situation at the moment. What are we going to do, what is there to be done, to remedy that situation?

Clearly, the overall question of health services and the provision of public health services generally is one now that has taken on a national character. It has gone beyond the stage of being a local concern and whatever ideas there may have been that health is a purely local authority function have gone and everybody accepts that they have gone. Some people will complain that the load is too much to shift from the ratepayer to the general taxpayer, while other people take the point of view that people are entitled to these services and that the community should finance them. It has now become a national matter and not a local government matter.

If it is a national matter, there must be an element of co-ordination. There must be some overall rational co-ordination and that we have not got at present. If one reads the explanatory memorandum issued with the Bill, one finds that the objects of the Bill are clearly set out and in the second paragraph, there is a significant phrase that the Bill applies to every county except those mentioned. So far as I understand the position, there have been fewer complaints about confusion and injustice—I hesitate to use the word "injustice" as it will appear in cold print; I might say the voluntary injustice that is to be found in particular areas—from the rural areas. Those who have examined the situation take the attitude that in the rural areas there is a relatively satisfactory mechanism. And then there is the question of how to bring the situation in the different municipal areas into line with that in the country and with the general national approach, the Minister's approach, and whatever Minister is in office, there must be a unified approach.

What I am arguing is that what may be said in regard to Section 3 may, in general terms, be also applied to Sections 2, 4 and 5. If we look at Section 7...

Mr. Desmond

On a point of order, are we discussing Section 3 or are we to include other sections? Deputy Corry was ruled out of order for introducing other sections.

Major de Valera

I am dealing with Section 3 but I do not think I am out of order in saying that the same remarks could be made in regard to other sections. The problems that are high lighted and the questions that are brought to mind by a reading of Section 7 apply in their entirety to those in Section 3. Dealing specifically with Cork I am not out of order if I say that the same remarks apply to Dublin, Limerick and Waterford and the first act to bring the situation under control must be the setting-up of some rational mechanism that will operate a national scheme and a first essential of that is unity. Any scheme set up must be in accordance with the overall scheme for health services on a national basis and it must have an essential unity which does not exist in the areas mentioned.

If that is so, what possible objection can there be to the Minister's approach in this legislation and, in particular, to Section 3? What rational objection in principle can be argued against the setting up of the unification which that section envisages? One Deputy on the far side—I think it was Deputy Manley—argued not so much for its rejection as for its postponement indefinitely. I can understand the argument that there may be mechanical matters to be set right. That is a matter for the Cork Deputies themselves and I shall not interfere in it. Where there are such matters, let them be attended to. We all assume that when a general purpose section like this is passed, practical steps will be taken to make it effective.

Do not let the detailed mechanical problems of that kind confuse us to the extent of saying that we should throw the whole thing out. As Deputy Corry has said, the Bill is not perfect. There are flaws. Are we to destroy the general principle as a whole because of that? Though we admit there are flaws in the Bill, let us not be so blinded by these flaws as to seek to destroy the whole measure.

I have thought it well to intervene to stress the need for an overall plan and to ask the question: "What is the alternative?" Are we to take any one of these areas out? Do we want separate detailed legislation for each of these areas? You could say that you want a separate code for Dublin, Cork, Limerick or Waterford, but if you say you want a separate code for Cork, you should be logical and say that you want a local government approach to it. You have to take it completely out of the national scheme, if you take that line. I can understand Cork Deputies saying: "Let us have Cork to ourselves and we shall finance it" but I do not think any Cork Deputy will take that approach at present because it is a national problem which demands a national solution.

There has to be a contribution from the whole community and direction by the body that represents the whole community, namely, the Government and the Minister for Health. Section 3 does no more than legislate for an organised way of dealing with the problem. It does not merge Cork completely with Dublin or anywhere else. One of the things I like about this Bill is that there is in it a real attempt at organisation, an attempt properly to organise the administration of the health services in the local areas. When that is being done, it is rather a pity that the difficulties and mechanics should be used in a situation where the very fact that the Minister is trying to cater for decentralisation should lead us to help him.

Mr. Desmond

I am sorry for the prolonged debate on this section. I am anxious to finish it as there is so much in the Bill dealing with other areas. Deputy Briscoe, speaking very briefly, came to the point. He did not refer to the Bill as a whole. Deputy de Valera wandered away from the point, holding us up completely laying down laws for us. If he had been here last night and earlier this morning he might realise how far removed he was from the difficulties we are trying to straighten out and he might understand how unfair he was to the Minister in holding up the Bill in elaborating as he has done.

Major de Valera

I spoke only once. How many times has the Deputy spoken?

Mr. Desmond

Deputy de Valera lays down the law in stating we want local government law. Does he not realise that the system in operation in Cork is one that was put into operation by the laws passed by this House and all we were asking is that we be allowed to operate that system given to Cork under those laws? It is a complete waste of time for Deputy de Valera to speak as if we were looking for something completely contrary to the Health Act and completely contrary to democratic rule.

There is one point on which I must continue to disagree with the Minister. He has spoken about what he calls unification of the sanatoria services and unification of the mental illness services. He poses the question: if it is good in regard to the Sanatoria Board and the Mental Hospital Board, why should it not be applied to general health services. We say "no" in regard to Cork. There must be, of necessity, a scrutinising of the position in relation to the services given and the type of patient treated either in the mental hospital or in the sanatoria as against the problem of patients coming under the health services, whether it be the local dispensary services or of the hospitalisation kind. We know the system is being successfully operated for mental hospital services and the sanatoria services because the type of patients are so different; unfortunately the time patients spend in these hospitals very often means years; it is completely different for the person in the general hospital.

Deputy Dillon when speaking, a while ago, concentrated on choice of hospital. The choice of hospital in Cork does not come into it at all. The problem in Cork is to get more hospital beds for the people. I have yet to come across a case in south Cork where the relatives of a sick person insisted they must get a bed in a certain hospital; all they ask for is to get a bed in any hospital. Is the Minister suggesting to us that Section 3 will give us what we want in Cork? We say it will not.

Take the case of people in the Bandon area, Macroom area, the areas of west and north Cork. We consider the unification of services for the whole of County Cork and of Cork City will nullify any advantages to be gained from the services. Our opposition to this section is based on the present position of the dispensary services and our understanding of the conditions that exist.

I am not blaming the Minister alone because the Minister before him turned down our application to get county homes in various parts of Cork to implement our hospital plan. Does the Minister suggest that the unification of health services in Cork will give us what has been refused to us, an increase in the number of hospital beds, and the various dispensary buildings we want? Matters of that kind must decide the issue to a great extent. I am not interested to the same degree as others may be in the numbers in the various committees. I do agree that every member elected should have a say, but that must be of only secondary importance.

I agree with the Minister when he takes a different line from that of Deputy Corry on the financial issue. I am naturally as anxious as the Minister to improve health services and if there are unfortunate people who must depend on home assistance, free boots, and so on, it is the Christian duty of those who can afford to pay to do so. When this issue comes up in regard to Cork there are many on one side and few on the other.

There is provision for one medical officer for the city and county. No names are mentioned but I should like to know what he will do. What can he do except supervise the work of the officials? Who will suggest that one medical man could really act in an efficient manner as county medical officer and city medical officer combined? We shall still have our county medical officer under a different name; we shall still have all the officials concerned there. We are going to relieve a county manager or an assistant county manager of his present functions to deal with the health authority but it is obvious to every one of us that from the administrative side there will not be the improvements the Minister expects and there will not be any greater financial benefits than have already been given under the Health Act to the people concerned.

There is much we favour in the Bill. We said here last night we were in favour of the principles of the Bill and that the suggested improvements for Dublin and Waterford were not alone worth considering but worth supporting. We have given that support but, as regards Cork city and county, because we know from experience that the provisions of this section will not give us the benefits it is suggested will accrue and because there are so many disadvantages, we cannot support the section.

Question put.

The Committee divided: Tá, 62; Níl, 23.

Tá

• Bartley, Gerald.
• Blaney, Neil T.
• Boland, Kevin.
• Booth, Lionel.
• Brady, Seán.
• Brennan, Joseph.
• Brennan, Paudge.
• Breslin, Cormac.
• Briscoe, Robert.
• Browne, Seán.
• Burke, Patrick.
• Calleary, Phelim A.
• Carty, Michael.
• Childers, Erskine.
• Clohessy, Patrick.
• Collins, James J.
• Corry, Martin J.
• Cotter, Edward.
• Crowley, Honor M.
• Cummins, Patrick J.
• Cunningham, Liam.
• Davern, Mick.
• de Valera, Vivion.
• Doherty, Seán.
• Donegan, Batt.
• Dooley, Patrick.
• Egan, Kieran P.
• Egan, Nicholas.
• Fanning, John.
• Faulkner, Padraig.
• Flanagan, Seán.
• Flynn, Stephen.
• Gibbons, James.
• Gilbride, Eugene.
• Gogan, Richard P.
• Haughey, Charles.
• Healy, Augustine A.
• Hillery, Patrick J.
• Hilliard, Michael.
• Humphreys, Francis.
• Johnston, Henry M.
• Kenneally, William.
• Kennedy, Michael J.
• Kitt, Michael F.
• Lemass, Noel T.
• Loughman, Frank.
• Lynch, Celia.
• MacCarthy, Seán.
• MacEntee, Seán.
• Maher, Peadar.
• Medlar, Martin.
• Millar, Anthony G.
• Moher, John W.
• Moloney, Daniel J.
• Moran, Michael.
• Ó Briain, Donnchadh.
• O'Ceallaigh, Seán.
• O'Malley, Donogh.
• O'Toole, James.
• Ryan, James.
• Ryan, Mary B.
• Sheldon, William A.W.

Níl

• Carew, John.
• Carroll, James.
• Coogan, Fintan.
• Corish, Brendan.
• Crotty, Patrick J.
• Desmond, Daniel.
• Fagan, Charles.
• Giles, Patrick.
• Kyne, Thomas A.
• Lynch, Thaddeus.
• McAuliffe, Patrick.
• McMenamin, Daniel.
• Manley, Timothy.
• Mulcahy, Richard.
• Murphy, Michael P.
• Murphy, William.
• Norton, William.
• O'Donnell, Patrick.
• O'Reilly, Patrick.
• Palmer, Patrick W.
• Reynolds, Mary.
• Spring, Dan.
• Tierney, Patrick.

Tellers:—Tá: Deputies Ó Briain and Loughman; Níl: Deputies McAuliffe and M.P. Murphy.

Question declared carried.

SECTION 4

Mr. MacEntee

I move amendment No. 3:

In subsection (2), page 4, in line 15 to delete "ten" and substitute "fifteen", and in line 16 to delete "five" and substitute "eight".

The purpose of this amendment is to give effect to an arrangement whereby the Limerick County Council will have their representation increased to three times the number of county electoral areas in the county, which will give to the county council 15 representatives on the unified health authority. As compensation for that, we are increasing the city membership from five to eight.

Amendment No. 24 to Rule 2 in the First Schedule, under which two members of the authority will be appointed for each county electoral area, is associated with this amendment.

Mr. T.F. O'Higgins

Is the other amendment being moved now?

Mr. MacEntee

I did not move amendment No. 24, unfortunately.

Amendment agreed to.

Section 4, as amended, agreed to.

SECTION 5

Mr. MacEntee

I move amendment No. 4:

In subsection (2), page 4, in line 32 to delete "nine" and substitute "twelve", and in line 33 to delete "five" and substitute "seven".

Again, we are allowing the county council to appoint three members for each county electoral area which will increase their representation from the nine members, as originally proposed in the Bill, to 12 members. As a compensation for that, we are increasing the representation of Waterford city from five to seven. Again, Amendment No. 24 is associated with this amendment.

Amendment agreed to.

Section 5, as amended, agreed to.

Sections 6 to 9, inclusive, agreed to.

SECTION 10

Mr. MacEntee

I move Amendment No. 5:—

In subsection (1), page 7, to insert "County Health District of Dublin or the" before "county" in line 27 and before "county" in line 30.

This is a drafting amendment.

Amendment agreed to.

Section 10, as amended, agreed to.

SECTION 11.

Amendment No. 6 not moved.

Mr. MacEntee

I move amendment No. 7:—

In subsection (4), page 8, lines 57 and 58, to delete "(other than those under the Public Assistance Act, 1939)."

The purpose of this amendment is really to meet the position of the Cork Corporation. As the Bill is originally drafted, the person making a determination of the expenses could not have regard to expenses other than services under the Public Assistance Act, 1939. With the section, as amended, he may have regard to that. When he is making his determination, he does not apportion the expenses under the Public Assistance Act but in trying to arrive at a fair allocation of the general expenses of the board as a whole, he may have regard to the manner in which the public assistance expenses would be borne by each.

Mr. T.F. O'Higgins

Was this matter discussed with the Cork people?

Mr. MacEntee

It was, yes.

Amendment agreed to.

Mr. MacEntee

I move amendment No. 8:

In subsection (6), page 9, line 15, to delete "agreement" and substitute "determination."

This is a drafting amendment.

Amendment agreed to.

Mr. MacEntee

I move amendment No. 9:

To add to the section the following subsections:-

"(10) Nothing in this section shall be taken as preventing a demand by the council of the county of Dublin being made on, and being met by, the Dún Laoghaire Corporation, at any time after the local financial year in which the Dublin Health Authority are established, to provide for adjustments in respect of expenditure, for that year or any earlier financial year, on the services which are transferred to that authority.

(11) Without prejudice to, and subject to any adjustments arising from, the provisions of this Act in relation to the proportions in which the expenditure of health authorities established by this Act are to be met—

(a) a local authority who appoint members of a health authority established by this Act shall pay to that authority in the local financial year in which that authority are established—

(i) any moneys included in their estimates of expenses for services administered by them which are transferred to the health authority which, at the date of the establishment of that authority, have not been expended, and

(ii) any moneys demanded from them by a body dissolved by section 15 of this Act which, at the date of such establishment, have not been paid to that body, and

(b) the council of the county of Wicklow shall pay to the Dublin Health Authority, in the local financial year in which that authority are established, any moneys demanded from that council by the Grangegorman Mental Hospital Board which, at the date of such establishment, have not been paid to the board.

(12) An agreement under this section between two or more local authorities shall be made by resolutions of those authorities."

This amendment proposes to add three subsections to Section 11. In the Dublin areas at present, and until the end of the financial year in which the Dublin health authority will be set up, the Dublin Corporation and the Dublin County Council meet all the health expenditure. The Dublin County Council levies its share on the whole administrative county, raising the county health districts' share by their own rates and demanding the Dún Laoghaire borough's share from the corporation there, who raise it by means of the municipal rates. After the end of the local financial year in which the Dublin health authority is set up the Dún Laoghaire Borough Corporation will contribute direct to that authority their share of its expenses and the county council's share will then be levied only on the county health district. The purpose of the new subsection 10 is to make it clear that any adjustments needed then in relation to earlier periods when the county council was entitled to demand a share of their health expenditure from the Dún Laoghaire Corporation can be made by way of supplementary demands on that body.

Progress reported: Committee to sit again.