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Dáil Éireann debate -
Thursday, 20 Mar 1969

Vol. 239 No. 5

Vote 48: Health (Resumed).

Debate resumed on the following Motion:
"That the Estimate be referred back for reconsideration".
— (Deputy Ryan).

When I reported progress, I had opened the question of the future of the religious in the administration of hospitals. I think this is an appropriate time for Dáil Éireann to turn its mind to the fundamentals of the question. There is not any doubt that there exists what I must describe as the technocratic attitude to hospital organisation. I do not think I am being unfair to Deputy Dr. O'Connell, whom I believe to be a very humane man and who is also a doctor, if I say that he is obsessed by the technical efficiency with which the available resources are used. That is typified, I think, by his anxiety in relation to the admission of a patient to a general hospital on a Friday night and the necessary tests not being carried out until the following Monday. He says that his experience in the United States of America and elsewhere abroad is that such patients are admitted on a Friday night and the necessary tests are carried out forthwith and the patient is discharged on the Saturday. I have some experience of hospitals in New York, London, Paris and various capital cities in the world. I am not satisfied that the American practice, which Deputy Dr. O'Connell describes, is superior to the practice in Ireland where it is recognised that, for the average patient, admission to hospital is somewhat of a traumatic experience.

Hear, hear.

The atmosphere is strange to him. He needs to become settled and adapted to what is, for him, a very great event in his life.

I remember speaking in this city to the wife of a member of the Cabinet of the President of the United States of America. She said she had experience of hospitalisation in London, Paris, New York, Washington and Dublin but that she found in Dublin something which she had found nowhere else — TLC. I asked her what she meant and she replied, "I have found in Dublin tender loving care." That made up for a great deal of chromium plate, the automatic beds and the asceptic surroundings with which we are so familiar in better-equipped institutions in larger and wealthier communities. Let us not forget that, if someone is brought into a hospital on a Friday night who requires examination and tests, he or she will suffer nothing by being allowed to settle down on Saturday and Sunday and then to undergo the tests on the Monday and be discharged. It may not be the least important part of the person's treatment that he or she feels this tender loving care as well as scientific investigation.

That brings me, Sir, to the fundamental issue which I should like to have considered by Dáil Éireann.

We are building — I refer to the contents of the Fitzgerald Report — or contemplating building large regional hospitals and three general hospitals in the city of Dublin. Some hospitals are run by committees of laymen and there are also categories of hospitals administered by local authorities. Some of these general hospitals will be hospitals owned and operated by religious. It is not proposed to take over the ownership of the actual hospital from the religious. I want to put it to the House that we should make it perfectly clear not only that we do not intend to take over the actual physical buildings and equipment from the religious but we do not propose to take over the control either. I am quite prepared to let the two systems operate side by side. If you want lay committees to run hospitals and if you want the kind of committees envisaged in the Fitzgerald Report to be directly responsible for hospitals then let hospitals under that kind of dispensation continue to function side by side with hospitals owned and operated by religious.

I want to make it quite clear that I recognise as the administration of large hospitals becomes more and more complex there is the temptation to say that nuns are not qualified, by the very nature of their vocation, to undertake the complex administrative problem, with its vast field of research and supervision, presented by a modern hospital. That is to take an entirely distorted view of the function of the religious in a big hospital. You might just as well say that the board of directors of Arthur Guinness, Son & Co. are not competent to go down and brew. Of course, they are not, they employ brewers, but they have run a great industry. There is no use imagining that the directors of Imperial Chemical Industries can go down and manufacture chemicals. The vast majority of them have nothing to do with the chemical industry, they are administrators, but they employ chemists to carry out the technical work of the great institutions over which they preside. There is no use imagining that the directors of either of the two great commercial institutions I have mentioned spend their time on the factory floor directing operations in every department of the factory; they do not, and if they did they would not be fit to be directors. They devolve under the heads of departments the specialist functions which those specialist are competent to discharge, but in the last analysis the final decision rests with the board.

I want to ensure that in hospitals operated and owned by the religious we will face the implications of saying categorically that the final decision will rest with the superior for the time being of the religious community, or her delegate, in a hospital operated by religious. I do not want to conceal from the House that I know this may involve some abridgement of the optimum of technocratic efficiency but if we throw away the extraordinary high tradition of Irish nursing and Irish nursing hospitalisation under the control of the religious for the sake of seeking technocratic perfection in the administration of hospitals, we will make the most shockingly bad bargain. I recognise, of course, that religious running a hospital require, on the one hand, technocratic advice, and on the other hand professional medical and surgical advice. I know from my experience of religious orders who have been operating in this country for the last 100 years that they have perennially equipped themselves with such counsellors on the right and on the left, but the essential thing in the last analysis is that the mother superior or the rectress was the ultimate authority in the hospital over which she presided.

Some will say that this is an outmoded idea. This is where young people like Deputy Andrews go wrong. Youngsters find it very hard to think of death; it shocks and distresses them and they are inclined to avert their heads from it, but those of us who are older know that every man and woman who experiences the crisis of entering a hospital, unless he or she is altogether bereft of wisdom, recognises that there is an eschatological aspect and that when you enter a hospital you hope, under the Providence of God and by the skill of those employed around you, to come out restored to health but if you are a wise man or woman you go in in the knowledge that under the Providence of God you may be called to your account. When I speak of an eschatological aspect I recall that the word means death, judgment, heaven and hell. I remember all my life a friend of mine who had the best of hospital treatment and who said to his wife: "Remember, I am not going to get well; I know that sooner or later one of these trips to hospital, which are becoming more frequent, will be the last one I will have to take, but I want to make one thing certain, when I die I want to have a nun by my bed." Under the strange dispensation of Providence he had everything medical skill could give him, everything efficient nursing could give him, almost everything technocratic perfection could give him, but at the supreme moment of death he had not got the one thing he wanted — he had not a nun by his bed because it so happened that at that particular period of hospital treatment he was in a lay hospital and not in a hospital run by religious as he had been heretofore.

Those of us who are nearer to that aspect of hospital life have a duty to impress on the Minister, who is a relatively young man, and on the more enthusiastic young Deputies, that there are two aspects of this. I do not want to thrust down the throats of the ardent technocrats among my colleagues here my view; I am quite happy to let this issue be tried out by human experience. Let the religious run their hospitals, establish beyond doubt or cavil their ultimate authority in their own institutions and let the lay hospitals which have given splendid service — no one can doubt it — operate side by side with the local authority hospitals, some of which are run by religious and some of which are run by laymen, and let the patients, in so far as may be practicable, choose themselves to which hospital they elect to go. I would choose to go to a hospital run by religious.

Perhaps, there are other Deputies who will make another choice but let us not perpetrate the folly of throwing away what we have in the belief that there is to be found in Great Britain or New York some system which is inherently superior. I guarantee that is not so. Let us not throw away the wooden hospitals with golden staffs to secure golden hospitals with wooden staffs. Let me have, every time, the hospital that takes in the sick person on Friday and gives him until Monday to settle down and get his tests in preference to the medical machine which glories in the total of its admissions and discharges and the expedition with which the bodies are passed through.

I want that to be my material contribution to this discussion. I do not want to conclude without adding another word. I believe the present Minister for Health has had handed to him an absolutely impossible job and I want to remind Dáil Éireann of something which we are only too prone to forget, that the illusory yearning for a universal free health system has brought not only Great Britain but the United States of America itself to their knees financially. And the Labour Government in Britain has itself reintroduced prescription charges in order to stem the economic flood that was engulfing them. The USA, with its almost incredible resources, economically speaking, is finding that the programme designed for the protection of the old, Medicare, as introduced by President Johnson's administration, is overwhelming their resources and they have not reached out at all, comparatively speaking, to the able-bodied.

I want to warn the House, God knows I am tired issuing these warnings and have earned derision at the hands of the Fourth Estate for reiterating them. The Minister for Finance has appeared on television in the past few days to tell us that we are on the verge of economic catastrophe. He did not go on to say that his Government have been in office for the previous 12 years nor did he pause to explain how we found ourselves on the edge of economic catastrophe after 12 years of an administration of which he himself was a member. But in that situation, Deputies on every side of the House are urging the Minister for Health to find vast sums to relieve the rates—a most desirable thing to do, I agree, when you hear of the people of Cork city paying £5 in the £ in the rates of which over £2 is in respect of health services which are in the early stages of expansion.

Everyone must sympathise with the clamorous demands that some relief be provided for the rates but relief of rates can only be provided by the Exchequer and the Minister for Finance says that the Exchequer is almost flat on its back. What Deputies are inclined to forget is that when you speak of the Irish Exchequer you speak of the Irish taxpayer. We are reaching a stage when the only public enemy we have in this country is the man or woman earning his or her own living. There is no use in saying to the Minister for Health: "You must double the expenditure on this, that or anything else and if you do not, you are a heartless, unsympathetic and ineffective Minister." The plain truth is that our desire to help the afflicted is circumscribed by the resources at our disposal and instead of yelling that everything must be increased ad lib., responsible Deputies should point out what money is available and what are the right priorities to pursue.

If I were to discuss the question of priorities I would stretch the patience of the Chair paper-thin and so, I do not propose to follow it further, but I think the House should face the fact that we are on the verge of an economic precipice. We are close to the point when the money will not be there for the essential service that must be maintained if this society is to survive as an independent society. I do not think that is a matter I can adequately ventilate on this Vote but I feel bound to mention it in order to emphasise the fact that when the Minister comes to reply he cannot avoid finding himself forced into the position of asserting that there are limits to the resources at his disposal and that within those limits he must fix priorities, whatever they may be. I hope, when he does come to fix them, he will grasp the nettle firmly on this whole issue of the religious and the hospitals they own and operate because until it is done authoritatively and definitively there will subsist in the country a growing suspicion of the Minister and his Department.

I have had some experience both of the Minister and of his Department. I do not believe those suspicions are justified but I want to see them swept away and the religious Orders looking on the Department and on the Minister for Health for the time being, whomever he may be, as a friend and a protector and co-operator rather than as an enemy to be feared, who has designs on their existing establishments and plans to eliminate them in the long term from the hospital service of Ireland. I do not speak of their great missionary projects which are closely interwoven with their domestic hospital activities. These are as much present to the mind of the Minister as they are to mine. I do not speak of the glorious tradition of Irish nursing for which these religious are very largely responsible, having conducted the earliest nursing schools that exist in this country. I need not dwell on the fact that Irish trained nurses are preeminent in their profession in every city in the world, but I want to recall to the Minister that all these things, of which we have every reason to be proud, are in large measure—not exclusively—due to the religious who have devoted their lives to the operation of hospitals for the sick poor. It is right to urge at this time that their survival be guaranteed in an irrevocable way. I hope the Minister will take the opportunity of giving that guarantee in very categorical terms when he comes to conclude on this Estimate.

There is much more I could say on the subjects covered by this Estimate, I attach so high an importance to this particular aspect of the problem that I prefer to abbreviate my comments and impress on the Minister the necessity of an authoritative and final declaration of his enthusiasm in this regard while he is Minister for Health, he being that for the time being, but speaking as he is now entitled to speak as Minister for Health not only for the day but in the name of other Ministers who will succeed him.

I, like other Deputies, wish to put on record my deep appreciation for the courtesy extended to me by the Minister for Health and by the officials of his Department. I, like Deputy Dillon, would like so say, as I think he said, that he is a friend and a helper. I have the utmost regard for Deputy Flanagan as Minister for Health and, like Deputy Dillon, I also feel that he has inherited an impossible task inasmuch as very many of the problems coming under the Department of Health still have to be tackled and solved.

Like other Deputies who have what one would loosely describe as their own pet subjects, I feel there is one aspect which I have not heard any Deputy mention so far. I do not wish to go over points made by previous speakers but I feel that the question of foster children in this country is something we public representatives can no longer ignore. In my own county, Donegal, we have approximately 60 children, who are orphans for one reason or another. I do not believe that Donegal County Council are the worst offenders in this regard. I am satisfied Donegal County Council probably rank very high in the list of local authorities which are doing something, but not just enough, to improve the standards and to elevate the status, for want of a better description I use that word, of those children. It is alarming, disgusting and in my opinion criminal when the demand for adoption, which I know does not come under this Estimate, but which is very closely linked with it, exceeds the supply of children. It is alarming to find that there are so many institutions, particularly when you bear in mind that the people who control those institutions are doing a reasonably fine job, who must accept certain criticisms. If they are prepared to do the work they must accept the criticism. They are only human. They are performing in all probability an impossible task. Nevertheless, if we as public representatives believe that there is not enough accommodation for mentally handicapped children and that the cry at the moment is for more bed accommodation for physically and mentally handicapped children, we would be failing in our duty if we did not point out that we have institutions blocked to the door with children who are crying out for fosterage.

I do not believe that enough is being done in this regard. I am going to try to embarrass public opinion to do something about this. It is disgusting to see, as we found out in reply to a Parliamentary question which I tabled a fortnight or so ago, that we have local authorities paying as little as 11/6d per week for the maintenance of a foster child. Here we have society from Departmental level right down to local authority level expecting foster parents to provide a home for a child, who should be the responsibility of society, for 11/6d per week. I consider this is disgusting. I know the Minister for Health would feel like I do and I would like him to issue a direction to local authorities to have another look at this matter.

Needless to say in County Donegal which tops the list, heads the first division, they pay £2 a week but this has only been increased from £1 due to a fight, for which I do not take credit, because out of shame I tabled a motion to have the increase made from £1 to £2. My proposal was to have it increased to £3 and I had to put it before the vote of the council four times before I could get any increase. One councillor had the audacity to say to me: "You have seven members in our own home and if we had to pay £3 a week surely county council workers would resign from employment if they were to get £21 a week to maintain seven children." I must say that remark made me think but when I left the council chamber the obvious struck me. If we could provide the same happiness for seven foster children in a home, which I hope I am providing for my family, for which there is the complaint about paying £3 a week why should we object to paying £3 a week for a mother and father who would give of their life to provide a family unit and family love for seven children who do not find it in an institution?

It is my purpose from here on to embarrass not alone members of my own local authority, and officials of my own local authority but the Department of Health, and I know colleagues of my own Party who would take similar steps in every local authority in Ireland to shame them out of this ridiculous situation which exists at the present time. Over the last few days I have been in contact with social workers in this city, possibly motivated by the fact that I tabled this question to the Minister on Thursday, 6th March and some of the information I have to hand surprised me. The points which have been brought to my notice are things we cannot ignore. If we consider the situation of a child in an institution through no fault of its own, that this is its lot because of illegitimacy, because of the death of both parents or maybe some other reasons, that child has got to be kept in an institution until it is 16 years of age and is then allowed to stay in that institution until it marries or goes away. Some of the disadvantages of institutional life were explained to me. One of them is that a boy in an institution will only meet boys. He will never meet girls. He will never meet an adult female. He will never sit down to eat at a table with adults. He does not know what a kitchen looks like. If he sits down at a table for four he feels strange because he is used to tables for 20 and upwards. He has a chip on his shoulder for the rest of his life.

We must concede at this stage that adoption is a solution, but that comes under another Department. However, it is so closely related to fosterage that it is very difficult to separate them in a debate such as this. Despite all the arguments in favour of fosterage local authorities will pay more for the maintenance of a child in an institution than they will pay for the maintenance of a child in a foster home. I have not got the figures for the country. I hope when the debate resumes on Tuesday that I will have the figures. The Minister might provide me with the total figures of the number of children in institutions under the age of 16. In Donegal we have boarded out at the moment 40 children. Last year we had 28. This year we have estimated we will have 43. The total estimate for the year is £5,030 at £2 per week, which is the largest amount paid by any local authority in Ireland, a fact I am not terribly proud of. The total is £4,472. There is an allowance of £470——

I do not want to interrupt the Deputy but is this relevant on the Health Estimate which is before the House?

Yes, there is money in this Estimate for local authorities.

For health authorities?

Health authorities and local authorities are one and the same thing.

Is the Deputy making the case that this is in the care of the Minister for Health?

Yes, it comes under the Estimate for Health.

We in Donegal are paying an allowance of £470 for clothing. We allow something over £10 per year per child. We allow £250 for education. This is to buy books for children who attend national schools. Approximately £100 has been spent on advertising for foster parents and there is a miscellaneous item of £8. The total sum is £5,030. Bearing in mind that we pay the largest amount of any county in Ireland we are prepared to pay £3,440 for 20 children who are in approved schools. It costs us almost twice as much to keep a child in an approved school or institution as we are prepared to pay to have it fostered by foster parents. This to me is criminal.

I appreciate that superintendent assistance officers, particularly the superintendent assistance officer for Donegal, are doing a wonderful job. They are doing their best, but I do not think it should be the responsibility of the home assistance section to deal with this problem. We have come to realise that this is a social problem and that the person dealing with it should be a person qualified in social science. There should be more emphasis on social work and there should be small committees in each local authority to deal with this matter.

I know that, while this is the responsibility of the Department of Health, the local authorities can play a big part in it. I wish to give a lead to other Members of this House who are members of local authorities and to state that I propose to work towards this end as a member of Donegal County Council. I have discovered some amazing things from interviews I have had with social workers in the last week or so. If an unmarried mother has a child which she wants to keep I feel she should be encouraged to keep it.

She should be given the same status as a foster parent. We know that children born in these circumstances are more embarrassing at times than welcome, but if it is the wish of the mother then it is the proper thing for the child. Basically our interest should be concentrated on the child and not on the particular circumstances which brought the child into the world. The strange thing about this is that, if we agree to allow the child to stay with its mother and if we agree to pay for the maintenance of the child so that the mother can go out to work and if at a later date that mother decides to marry a person of a different religion, she cannot legally adopt the child. The Minister for Health should bring this to the notice of the Department of Justice who are the responsible Department. In these days of ecumenism it is a difficulty that should not be there. The basic right of any child born into this world is to have a family life. I do not think the local authorities are doing enough to get these children out of institutions and give them a chance to join family groups.

If we cannot get the type of foster home which I would like, then there is a system operated in Britain known as the cottage homes. The local authority employs a professional person— a nurse or a teacher—to run a cottage home to cater for a group of children, ranging from a teenager to an infant. As the teenager grows older and marries, a younger child is added to the home. There is at all times the atmosphere that one would find in the home of ordinary people.

Progress reported: Committee to sit again.