I move:
That the James Connolly Memorial Hospital Board (Establishment) Order, 1971 (S.I. No. 97 of 1971) be and is hereby annulled.
This motion asks that statutory order S.I. No. 97 of 1971 established under the 1961 Corporate Bodies Act be rejected. It proposes to amalgamate one local authority hospital, the James Connolly Memorial Hospital, with three voluntary hospitals, Jervis Street, the Mater and St. Laurence's. We are asking that the order be not accepted for the purpose in the first instance of having a discussion about the decision the Minister has taken and secondly in order to elicit some information about what proposals he has for the future of this new hospital. In reply to questions. I have asked the Minister did not give sufficient information. We feel much more information should be available to us before we take this important step.
The general pattern of hospital development in this country has changed in a dramatic way in recent years in that the old voluntary system of financial support and the voluntary control of hospitals has become to a considerable extent equalled, if not superseded, by the great improvement in the quality of control of the local authority hospitals. Throughout the country we have a very fine local authority hospital service based on the country regional hospitals and the bigger hospitals in the cities like St. Kevin's. As local representatives we are very proud of the achievements of representatives in creating this magnificent hospital service. I do not think anybody will doubt that as to personnel, nursing, medical, technical and para-medical personnel it is certainly as good as anything they have in the voluntary hospitals and in some cases it is better.
At the same time we are very glad indeed to see the realistic evolution of the merger idea of the voluntary and local authority hospitals. There is no doubt that the voluntary hospitals have a wonderful tradition of very good level medical service, with very highly qualified medical personnel on the whole and with a very high level of both nursing and medical care. We would not like to take away from that in the slightest. We have the greatest admiration for it. Even 20 years ago I was anxious to see some sort of cross-fertilisation between the voluntary hospital and the local authority hospital. Each has something to bring to the other and the amalgam of both could be a very fine institution giving a very fine service to the public. We have nothing at all against the principle of the merger.
We are anxious about the fact that the board proposed for this hospital has nine representatives from the voluntary board, three from the Mater, three from St. Laurence's and three from Jervis Street and six from the eastern regional board—presumably these would be members of the Dublin Health Authority. This gives a majority of three to the voluntary hospitals. Admittedly, the chairman of the board must be a member of the Eastern Health Board but in any decisions it is quite obvious that local authority representatives can be out-voted at any time.
The voluntary hospitals have had to accept that the old system by which they founded their services could no longer continue. The voluntary aspect of the so-called voluntary hospitals has gone. They are now funded either from the Sweep funds or from taxation or rates. They are effectively publicly paid-for institutions. I must confess I had a certain hand in this 20 years ago when I realised the Hospitals Sweep Fund, not for this purpose specifically, but because I wanted to build many hospitals. We liquidated £20 million, mortgaged the next £10 million, which gave us £30 million and we built many hospitals with that money. At that time I had at the back of my mind the feeling that it would be much better if the hospitals were run and supported in a realistic way either by central funds or from the rates and this is where we now find ourselves.
In that situation I felt the next realistic step was the acquisition of power over these institutions by public representatives with voluntary representation. The Minister's proposal is completely in conflict with that broad policy, which is a perfectly rational one because it is based on the old idea of no taxation without representation. The people paying for the service should have complete right to conduct, maintain, manage and develop their own hospitals, with support from the voluntary representatives of course, but we should have majority control over any such board.
The functions of the new board under section 4 (1) are to conduct, maintain, manage and develop the James Connolly Memorial Hospital and the majority on this board will not as far as I can see be local authority representatives. This is a retrograde step. It is going back in time, outlook and policy from the whole process of the evolution of democratic control of our own affairs. It is going back to the various doubtful practices which did creep into the control of many voluntary hospitals, many of them excellent. I do not wish to take away from them at all or from the work that has been done by them, but I think the scheme of maintenance in the local authority hospitals, the policy decisions taken, most of the practices carried out in relation to financing, appointments, type of patient, ratio of public to private beds, and so on, are superior in the local authority hospitals. We are anxious to know to what extent the better features from the point of view of local authority supervision will be maintained in the new hospital.
This is local authority property. It cost, I think, something in the region of £700,000 to £1 million to build and equip; it must be worth some millions now in property, equipment, in earning potential and facility potential. All we are getting from the voluntary side is their prestige, which we welcome, and their technical knowledge in regard to the management of hospitals, which is also welcome but there appears to me to be no prima facie case for handing over this enormously complex, costly and relatively modern hospital to any body other than a local authority body.
The record of our local authority hospitals is outstanding. I do not think there is any great difficulty in the creation of a general hospital of a very high level and I would like to cite the remarkable achievement of the Dublin Health Authority in its creation of a magnificent municipal hospital out of the decrepit and badly equipped workhouse; I refer to St. Kevin's, the standing of which in the eyes of ordinary people has risen enormously since its establishment ten or 15 years ago. Our local representatives have shown themselves capable of doing that in the case of St. Kevin's and there is no reason why it could not be done in the case of the James Connolly Hospital as well We would be glad to know, therefore, what it was that motivated the Minister into taking this decision. We would be glad to know what the position is in relation to the system of appointment.
In the voluntary hospitals the system of appointment is completely irrational in practically all of them. In some of the hospitals run by religious the reverend mother makes appointments. In the so-called Church of Ireland hospitals one gets the Masonic Order making appointments. In some of them the Knights of St. Columbanus make the appointments. In yet others a doctor has to send his curricula vitae around to 130 lay persons and it is they who make the appointments. There is also the possibility of the medical board making appointments. They should not have this power because they may have to appoint a competitor and, human nature being what it is, they cannot be expected to opt for the best qualified competitor in their own field. I could give plenty of examples of that. Will the present system of making appointments to local authority hospitals through the Local Appointments Commission continue? On the whole, we all trust the Local Appointments Commission and believe it attempts, at any rate, to make the best appointment to a particular job. Will that system continue? Will there be some other system, a system which is not likely, in our view, to be as equitable as the one we have there at the moment?
One of the most disturbing experiences I had as Minister for Health was when I got a letter from a constituent complaining about a voluntary hospital. I was asked to inquire and I did inquire. I was shocked to find that I had absolutely no right of access whatever to the place. They wrote back and politely told me to mind my own business. This was a private voluntary hospital and, as far as I was concerned, I had as much power as the average layman. If hospitals are supported out of rates and taxes then public representatives should have a right of access, particularly where a member of the public feels aggrieved. He may not really have cause for grievance or complaint but the right of access to the controlling body in these hospitals must be retained. We have that at the moment in respect of this local authority hospital. Is that likely to be retained or will there be any interference with our right of access to this hospital? How will we safeguard our right of access?
There have been at times strange business methods practised in voluntary hospitals. May we take it that the existing methods used in relation to local authority hospitals will be maintained or is there any likelihood of the members of the board of the hospital exercising preferential treatment, for example, in the giving out of contracts and so forth?
The chairman will be elected from the members appointed by the Eastern Health Board or the Dublin Health Authority. What will happen in the case of the vice-chairman? There is no provision in this order covering that position. "The chairman shall be appointed by the members of the board." That means that a majority of the members will have the right to appoint a chairman. Does the Minister think that should be permitted or should he make provision to the effect that the chairman and vice-chairman be members of the Eastern Health Board? To what extent will these people be subject to the health authority, the people responsible for raising the funds by way of rates, and to what extent will they be responsible to the Minister? Will they be at all times subject to ministerial decision?
We are concerned that these people might decide to run the hospital in a most extravagant way and the ratepayers and taxpayers might be presented with bills they would consider unjustified.
Under section 21 the accounting system is dealt with:
The board shall cause to be kept proper accounts of all income and expenditure of the board, and of sources of such income and the subject matter of such expenditure, and of the property, credits and liabilities of the board.
What exactly is meant by that? To what extent will fees or salaries, or emoluments paid to the staff, medical or surgical, and the technical staff of one kind or another, be available for scrutiny by the Dublin Health Authority? I see that it can be made available to the Minister. To what extent has a Deputy looking for information a right to put down questions and inquiries into the incomes of persons who work in a hospital of this kind?
I know this is a very delicate subject but this is a very magnificent hospital and there is a danger that if there is a dominant element from the voluntary hospitals on the board there would be a big temptation to alter the ratio of the private to the public patient, both in the beds and on the consultation side, on the out-patient or clinical side. To what extent will the Minister exercise control in relation to this policy of the private patient and fees taken from private patients or fees taken from public patients? How will he control that?
He must know that at present, as a result of the activities of the voluntary insurance scheme, there has been a very steady redirection of the type of person occupying beds in many of our hospitals. Because they cannot get paid unless the patient is in hospital, considerable pressure is exerted on the practitioner to admit a person. If the Minister is worried about the number of people in his hospitals he should inquire into this question. A number of people may find their way into hospital who need not go there if you change the basic policy of any scheme or any hospital simply because payment is made for the person who is an inpatient or who is attending a clinic, and payment is not made if it is a domiciliary visit. I would be very interested to know what is the Minister's broad attitude in relation to the appointment system, the conditions of appointment of the various people who are appointed to the hospitals.
Section 21 (6) provides:
The board and the officers thereof shall, whenever so requested by the Minister, permit any person appointed by him to examine the books and accounts of the board in respect of any financial year...
Will this power be available to the corporation and to the new regional board formally as of right as well as to the Minister? At the moment it seems to me to be restricted to the Minister. I would be glad to know whether it is intended to make this power available to the regional board. I know it is available to them through their members, but is it available to them formally as a regional board?
In making appointments to this hospital what will the procedure be? Are the conditions and terms of appointment to be laid down? Are they to be submitted to the Minister for approval? Will they be submitted to the Eastern Regional Board for approval? Do they have to have the prior approval of the regional board, or the Minister, or can they go ahead and declare conditions of appointment and make appointments subject to those conditions? I am talking, of course, particularly in relation to consultant appointments and the methods by which they are made.
There is also a very regrettable policy change by many of our voluntary hospitals to which Deputy O'Connell referred the other day, that is, the extraordinary callousness shown by so many towards the difficulties of old people in getting admission to hospital, particularly in the terminal stages of their illness. I saw a lady the other day of 55 years with terminal cancer and she cannot get into a voluntary hospital anywhere. our only hope now is to see whether she can get into St. Kevin's. She has been treated in a voluntary hospital for a very long time. However, that is only a single case. The general finding of doctors is that people are not interested in the 60-plus type of patient. These are the people who require help. All of us will require help from that age on.
The local authority hospitals tend to be more humane about these things on the whole. They have got to be because we have control over them. One has no control whatsoever over a voluntary hospital. I should dislike very much to see the new James Connolly Memorial Hospital adopting this practice of refusing to admit old people, not because they were sick but simply because they were old. This is a problem all over the country. Because of the fact that so many of our people have emigrated we have many very young and very old people but that is another question.
If there were a preponderance of the voluntary hospital type mentality on this board this would be one of the possible developments. The consultant does not want the long-stay patient. He wants to get the person in, carry out whatever treatment he has to carry out, get the patient out, and then fill the bed again. In that way the bed is working at its optimum. With the widespread absence of facilities for old people, the hospitals should continue to accept their responsibilities.
Will they be permitted to change the ratio of the public to the private beds? I presume that the right to union activities and all these things which are more freely accepted in the local authority hospitals, will be safeguarded by the union representatives and I hope there will not be any question of any interference with the right of unions to enter and expand union activities in the hospitals.
We put down this motion so that we could ask the Minister to explain his reasons for taking this action. Possibly he has good reasons and we would certainly like to hear them. Section 6 (1) provides:
The term of office of the first members of the board shall commence on 22nd March, 1971.
Is this board already in existence?
