I move that the Bill be now read a Second Time.
This Bill provides for the establishment of machinery to enable seven voluntary hospitals in Dublin city to form themselves into a group; the hospitals concerned being the Adelaide, the Meath, Mercer's the National Children's the Royal City of Dublin, Sir Patrick Dun's and Dr. Steevens hospitals.
Initially, the form of association envisaged is a federation, but the Bill contains provisions to enable the hospitals subsequently to amalgamate, if they so desire. I should emphasise that the measure is an agreed one and that its terms have been approved by the hospitals concerned. Moreover, its introduction at the present stage in the development of our health services is, I think, highly opportune.
Deputies will be aware that in the period from 1947 to date, a number of important and fundamental changes have taken place in the organisation of the services for which the Minister for Health is responsible. The funds which are available for health purposes, whether from voted moneys or from the Hospitals Trust Fund, are now very fully committed, and during the past few years, I have had to take steps to rationalise and improve the existing services, in order that the community might obtain the maximum benefit from our expenditure upon them. The Health Authorities Act, 1960, which provided a more compact and logical form of control over health services at local level, was one such measure. The Bill now before the House is another. It is designed to enable the hospitals to which it applies to continue more effectively the important contributions which they have been making heretofore to the provision of health services in the Dublin area, and indeed for the country generally.
Since the early part of the eighteenth century, all the hospitals in question have played a notable part in the development of medicine in Ireland. The first in point of time, the hospital bearing the name of Richard Stephens, and founded on his beneficence, was established in the year 1720, and Dean Swift and John Wesley, amongst many other notabilities, are known to have taken an interest in its affairs. Indeed, in the early days of the hospital's existence, Swift was a Governor, and in her will "Stella" with whom his name is historically linked, left £1,000 for the advancement of Christian worship in the institution.
Mercer's Hospital, founded by the illustrious Mary Mercer and situated upon the site of the ancient Lazar House of St. Stephen, followed in 1734. It may be of interest to the House to know that the first public performance in 1742 of Handel's "Messiah" in the Fishamble Street Theatre was for the benefit of this hospital.
The Meath Hospital was opened in 1753. Originally, it was to serve particularly the surrounding district of the Coombe, where lived the woollen weavers of Dublin. Incidentally, at that time the plight of these operatives was pitiable, for their livelihood had been ruined by the calamitous laws which the English Parliament had enacted for the protection of the English woollen trade.
Sir Patrick Dun's Hospital may, perhaps, justify a more extended notice. Its founder, Sir Patrick Dun, a native of Aberdeen, came to Ireland towards the end of the 17th century as Physician to the Lord Lieutenant, the Earl of Essex. He remained to win a reputation as a successful and highly esteemed physician, and became President of the College of Physicians in 1681. By his will he provided a trust in perpetuity to endow a Chair of Physic in the College of Physicians. The Chair was duly established; but the administration of the trust became the subject of an investigation by a House of Lords Committee in 1799. The Committee's report disclosed a fantastic but fascinating state of affairs. "Your Committee," it said, "hold themselves bound to notice a present of claret to the President of the College of Physick annually; an immoderate purchase of books, in some instances twice paid for; lawsuits carried on in which the said College were both plaintiffs and defendants and actually paid from said funds the expenses of both; the loans to indigent members of said College which were never repaid in many instances."
It is not surprising, therefore, that one of the last statutes passed by an Irish Parliament provided that most of the trust funds should be sequestrated and devoted to the building of a hospital to perpetuate the name of Sir Patrick Dun.
The National Children's Hospital is a modern successor of two earlier institutions, one of which, the Institute for Sick Children, was founded as far back as 1821.
In the year 1832, the Royal City of Dublin Hospital, Baggot Street, was founded, with the distinguished medical practitioners Henry Marsh, Abraham Colles and Samuel Wilmot as consultants.
This was followed in 1839 by the establishment of the Adelaide Hospital, with which Isaac Butt was connected. It is interesting to recall also that in its early days one of Miss Florence Nightingale's young ladies of the Crimea was a nurse tutor here.
I must resist the temptation to dilate further on the history of the hospitals. I hope that I have said enough to indicate their long and proud records of service to the community. So I revert to the purpose of the Bill.
The federation or amalgamation of hospitals, such as it proposes is by no means a recent idea. In the course of the last century legislation for coordinating Dublin hospitals was mooted from time to time, but nothing effective was ever done. It was not until 1947 that a definite legislative proposal for an amalgamation emerged under the title of the St. Luke's General Hospital Bill. That measure provided for the amalgamation of three of the hospitals now to be dealt with, to wit, Sir Patrick Dun's, Mercer's and the Royal City of Dublin. It was given a First Reading in Dáil Éireann in June of 1947, but the general election of 1948 supervened and for one reason and another the measure was not revived.
About two years ago it came to my notice that certain hospitals had this question of federation under consideration. I contacted them and invited them to send representatives to a meeting to discuss this possibility. Arising out of this meeting it was decided to set up a Committee under the Chairmanship of the Secretary of my Department to work out a scheme for legislation. The present Bill is based on the work of that Committee and I am happy to say that it has received the unqualified assent of all the hospitals to which it relates. I should say, certainly at this stage, how indebted all those concerned must be to the Chairman and the members of the Committee for the time and patience which they gave to working out this solution to a very difficult and intricate problem. If the measure fulfils our expectations a major re-organisation of a substantial sector of the Dublin hospital services will be accomplished as the figures which I am going to give indicate.
In 1959, which is the last complete year for which figures are available, out of a total of less than 3,100 beds in all the Dublin voluntary general and children's hospitals there were some 1,200 beds in the seven hospitals concerned. During that year, some 20,000 patients were treated in these hospitals and their total expenditure was approximately £750,000.
I do not know to what extent federation, the initial step which this Bill proposes, will operate to reduce costs. It should tend to do so, however, at least in a relative sense. For one thing, with the pooling of knowledge and experience and a measure of overall control by the proposed Central Council, it is to be expected that the unnecessary and wasteful duplication of facilities will be avoided; and where duplication of this kind now exists, we may trust that in due course it will be eliminated. The great advantage of the federation, however, should manifest itself in a better over-all service to the community from the rationalisation which is being aimed at by the individual hospitals concerned.
I should now like to refer in brief to the salient provisions of the Bill.
Section 1 contains the usual necessary definitions. Section 2 provides for the appointing of a day by order to be the establishment day. This will be the day on which, under Section 4, the separate hospitals will come together in a federation, while retaining their separate identities. On this day also the new Central Council, referred to in Section 5, will be established.
Section 3 provides for the appointment of a day to be the transfer day. The transfer day is the day on which, at some time in the future, not too far distant I hope, the hospitals concerned will, if they so decide, amalgamate completely. An order fixing this day cannot be made unless the Central Council so requests, and to make such a request the Council must have the consent of two-thirds of the individual hospital boards which are represented on it. If, at this stage, a hospital wishes to opt out of this ultimate step of amalgamation, there is provision in sub-section 3 of the section whereby it may do so.
Section 5 provides for the establishment of a Central Council for the new federated group. The Council is charged with the performance of all the functions set out in Section 14 of the Bill. The usual provisions conferring corporate character on the Council are included.
In Section 6 there is provision for replacing by hospital boards the various governing bodies of the participating hospitals.
Section 7 makes provision for membership of the Central Council. It will consist of five members elected by each of the participating hospitals and five elected by the Dublin Health Authority, so that, basically, there will be forty members. The section also makes provision for the representation on the Council of a university, college or institution with which the Council has entered into agreement regarding the clinical education of medical students. The term of office of the members of the Council appointed by the hospital boards will normally be three years and that for members elected by the Dublin Health Authority five years. The latter period of five years has been determined by the fact that it is the period intervening between local elections.
There is provision in the section for the Minister to vary by order the composition of the Council, but only at the request of the Council. I should mention that in Committee I shall propose a few drafting amendments to this section.
Section 8 makes provision for the membership of hospital boards to be established under the Bill. Those on the governing bodies of the hospitals will, on the establishment day, become members of the respective hospital boards and will retain such membership until death, resignation or cessor of membership through continuous failure to attend meetings without sufficient explanation. Vacancies on a hospital board will be filled by cooption. These provisions, however, in regard to membership will not apply to the Meath Hospital Board, appointments to which are governed by the terms of the Meath Hospital Act, 1951, as amended by the Health Authorities Act, 1960.
Sections 9, 10 and 11 contain provisions on the usual lines relating to the time and place of meetings, the tenure of office—in general three years—of the chairman and vice-chairman and the procedure at meetings of the Council.
In Section 12 there is provision for the appointment of committees of the Council. It is provided that where members of a committee contain persons other than members of the Council such members shall not exceed one-fourth of the total membership of the committee. Section 13 provides for the employment by the Council of any necessary staff for its purposes.
Section 14 defines in some detail the functions which shall be performable by the Central Council. In the initial period of four years after the establishment day, the Council will have the function of examining the estimates of expenditure by the individual hospitals and of suggesting amendments. After the expiration of that period, the Council's financial powers will be strengthened, Thereafter its approval will be necessary to the adoption of the annual estimate of each hospital board. The functions of the Council will also include the determination of the form of accounts of the individual hospitals and the control of capital expenditure. Another important function of the Council will be the appointment of visiting medical staff. After the establishment day, such staff will not be appointed by the boards of the individual hospitals, but by the Council and further, they will be appointed not to the service of any individual hospital but to the group as a whole. After appointment, the Council will assign them to the hospital or hospitals in which they are to work.
Other functions of the Council will be the determination of the location of particular clinical units, the assignment of professorial units, the apportionment of beds amongst the visiting medical staff, the co-ordination of activities in relation to medical education and the control of activities in relation to nursing education.
In respect of the assignment of medical staff and nursing education, there are safeguards respecting the denominational character of a hospital.
Section 15 sets out the functions of the hospital boards which, in brief, will be the functions performable by the governing body of the hospital concerned before the establishment day, other than those reserved by the Bill to the Central Council. One important limitation is imposed by sub-section (3) of Section 15. It provides that moneys collected by a hospital board by public appeal shall not be used by the board for capital purposes without the consent of the Council.
Section 16 makes provision for the amalgamation, with their consent and that of the Minister, of two or more hospital boards. In such an event representation of the amalgamated board on the Central Council would be aggregated so as to be equivalent to the sum of the number of representatives accorded to each of the boards which it replaced. Under Section 17 the Council will have power to dissolve a hospital board and take over its functions, provided that the board in question and the Minister consent. In both Sections 16 and 17 there are provisions providing for the necessary modifications (including modifications of the provisions of the Bill) to effect the amalgamation or dissolution concerned.
Section 18 will allow the Central Council to make arrangements, with the consent of the Minister, for joint action with a hospital which is not a participating hospital concerned in the Bill.
Section 19 is included so that, on the decision being taken to amalgamate, the hospitals can be taken over by the Central Council on the transfer day. The section provides for the dissolution of the hospital boards on that day and for the application of the usual provisions regarding the disposal of assets, liabilities, choses in action, etc. There are safeguards in regard to the position of persons employed on the transfer day and also provision for compensation by way of superannuation for any person whose employment is terminated through amalgamation.
Section 20 of the Bill provides for the payment of the expenses of the Council before amalgamation. These will be met, in so far as they are not met from other sources, by contributions from the participating hospitals and will be divided in the ratio of the number of beds available for patients in a hospital to the total number of such beds in the group. Such contributions will rank, pari passu with other legitimate charges in determining the payment to be made to the hospital concerned from the Hospitals Trust Fund on foot of a budget deficit.
In Section 21 of the Bill provision is made for the membership of the Central Council after the transfer day, that is after amalgamation. On the transfer day, the hospital boards will be dissolved but the representatives on the Council of such boards on the transfer day will be members until death, or resignation or termination of membership for failure to attend meetings. The provisions in Section 7 regarding the Dublin Health Authority representatives and members appointed by the medical schools will continue to apply.
