The Parliamentary Secretary to the Minister for Local Government and Public Health (Dr. Ward) is present to take charge of this Bill and I authorise him to attend and be heard under Standing Order 46.
Public Business. - Public Hospitals Bill, 1933—Second Stage.
Cathaoirleach
Question proposed: "That the Bill be now read a Second Time."
Three years ago, the first of the Public (Charitable) Hospitals Acts became law. The purpose of these Acts is to enable funds to be raised, by means of sweepstakes, for hospitals that provide treatment to a specified extent for poor patients. If a hospital, or a group of hospitals, desire to raise money in this way, they are required by the Principal Act to appoint a committee for the purpose. This committee has to draw up its scheme, submit the scheme to the Minister for Justice for his approval, and, when it obtains the sanction of the Minister for Justice, it becomes lawful to put the scheme into operation. Although the Act contemplates the possibility of a single hospital promoting a sweepstake for its own benefit, in actual practice individual hospitals, as everybody knows, have not promoted sweepstakes for their own special benefit. From the beginning, there has been a management committee, or, strictly speaking, a series of management committees, one being appointed for each sweepstake; these committees have been responsible for initiating schemes and carrying them through. The Act of 1930 contained a number of safeguards to ensure that each sweepstake would be properly conducted. The management committee were bound to deposit with trustees a sum equal to the total amount of the prizes and these trustees were authorised to pay, out of the money at their disposal, any prizes not duly paid or provided by the committee. Under the 1930 Act, not less than 20 per cent. of the money received from the sale of tickets was to go for the benefit of the hospitals. In fact over 25 per cent. has been made available to the voluntary hospitals. The expenses of sweepstakes, other than remuneration given in relation to the sale of tickets, was limited to 30 per cent. of the money received. In practice, the expenses of the sweepstakes have not reached that figure, and have not even approximated to that figure. In respect of the last sweepstake, the expenses did not exceed 10 per cent. The payment of promoters has been limited to 7 per cent. That was the amount paid for the first sweepstake but, since the first sweepstake, they have been getting less than 3 per cent. It is not proposed in this Bill to alter the percentages laid down in the preceding Acts.
Three bodies are primarily concerned with each sweepstake. In the first place, there is the management committee, which is primarily responsible for initiating the scheme; there are the trustees, who hold the deposit to secure the payment of the prizes, and there are the promoters, who actually conduct the sweep, who from the beginning have been a limited company —the Hospitals Trust—and with whom the management committee enter into the agreement. A further body—the Committee of Reference, to which I shall refer presently—has been set up under these Acts but this committee has nothing to do with the actual holding of the sweepstakes. Although the Bill repeals all the Public (Charitable) Hospitals Acts passed since 1930, it re-enacts in substantially the same form the parts of those Acts relating to the holding of sweepstakes. When a hospital, or a number of hospitals, wish to organise a sweepstake, they will have to appoint a committee to draw up a scheme for the sanction of the Minister for Justice and make a deposit with the trustees equal to the amount of the prizes. There is a slight change in the present Bill with regard to the period during which such committee shall continue in operation. At present, as I have said, a committee has to be appointed for each sweepstake about to be held. Under this Bill a committee can be appointed to hold more than one sweepstake. The committee will continue to act until such time as the Minister for Justice or the committee of the associated hospitals terminates its existence. The committee itself can also terminate its existence under the terms of the Bill.
Before explaining in further detail in what respects this Bill differs from existing legislation, I should, perhaps, direct the attention of the House to the extension of the definition of "hospital" in Section 1 of the Bill. In the Act of 1930, the word "hospital" was given the meaning that ordinarily attaches to it—that is, an institution for affording medical, surgical or dental treatment. In the two Acts passed the following year, it is provided that one-third of the proceeds of the sweepstakes be paid to the Minister for Local Government and Public Health. This third share was to be applied to the provision, improvement or equipment of institutions maintained by local authorities for the prevention, treatment or cure of physical or mental diseases or injuries and also for the benefit of nursing organisations who were given one twenty-fifth part of the allocation to the Minister.
The definition of "hospital" in this Bill covers all the types of institutions that could receive benefit under the previous Acts and it extends the definition so as to cover institutions for the blind, deaf, dumb and mentally defective. It also includes institutions for the care and maintenance of expectant mothers or mothers with children of less than five years. A few of these institutions have been set up in recent years. Under existing sweepstake legislation, county homes have not been considered eligible for allocations out of the sweepstake funds. The definition of "hospital" is extended in Section 1 of the Bill before the House so as to include the infirmary portions of county homes.
Senators who have any intimate association with the administration of these county homes, or with the class of patients who go there, will realise that in many of the infirmaries there are poor old people, who do not expect to be cured of their illness, and are not afforded up-to-date hospital facilities, even for the form of treatment that may be made available for them, so as to, at least, ease their condition, if it was not calculated ultimately to cure them. A good deal could be done for poor old people and for chronic invalids, who have no prospect of being cured but, whose condition at least could be considerably eased. It is intended for that reason, where infirmaries in county homes fall far short of what is desirable, and as the local authorities have not found it possible to finance the extensions and equipment which would be desirable, to include infirmaries in the scope of the Bill amongst institutions to which allocations can be made.
It is also intended to make money available from the Sweepstake Fund for research work. I need scarcely remind the Seanad that although clinical observation is of great value, an advance in medicine must largely come from new knowledge obtainable, to a great extent, by laboratory investigation. The necessity for giving financial assistance for research work has been impressed upon me by the medical profession. The Committee of Reference in its report referred to the importance of and the necessity for extending work under this head. Accepting in principle the fact that research is now closely associated with hospital work, it becomes a proper object for subvention.
I now come to the part of the Bill which proposes a departure from the existing arrangement for the distribution of the moneys. At first, when the management committee drew up a scheme they stated in what proportion the proceeds would be distributed amongst the bodies they represented. The surpluses of the first three sweeps were distributed in this way, and the promoters agreed on the allocation and the proportion that would go to the various participating hospitals. In 1931 the law was altered, and the Minister, when he sanctioned the scheme, was directed to set up a Committee of Reference consisting of three persons, to report to him as to the proportion in which the hospitals' share of the proceeds should be divided. The Committee was first appointed for the scheme under the Manchester November Handicap, 1931, and the report was published in the following May. I am sure Senators have read the report, in the course of which the Committee criticised the existing hospital system. I do not wish to over stress the criticism unduly, as it appeared in the report, but at the outset the Committee noted the lack of appreciation by many of the hospitals of proper lines of development in relation to the needs of the community. They stated that building programmes were hastily considered; without any survey of what was required in that particular area, that there was no general plan, and no attempt at co-ordination. They suggested that in most cases the main anxiety in the minds of the governing bodies of the hospitals was to obtain the largest possible award out of the moneys available. Of course one could understand that. That was naturally in the minds of those connected with the promoting hospitals.
With that report from the Committee of Reference before it, it appears to me that the Government would be neglecting an opportunity if they allowed things to stand as they are, and continued to make allocations on that basis, without trying to evolve some system of co-ordination, such as was suggested by the Committee of Reference. Until we have a complete survey of the hospital facilities, especially in regard to the facilities extended for the treatment of the poor, and of the needs of the community, or of that section of the community that is unable to provide its own medical treatment, it does not appear to be possible to decide in what proportion this money can be allocated, in order to secure the best results. This survey cannot be carried out in the course of a few months, or between one sweep and another. It is a matter that will probably entail investigation extending over many years. Obviously, if the report was rushed, and if we did not take due time to make a complete survey and examination of our hospital requirements, and of the existing institutions at our disposal, mistakes would be made. It would be too late to try to remedy the defects in our hospital system when all the money had been expended.
To meet that situation, the Bill proposes to set up a body called the Hospitals Commission to carry out the necessary investigations, to prepare schemes for improving and co-ordinating our hospital facilities, and in future to advise the Minister on applications for grants referred to him. On the setting up of the Hospitals Commission, and the passage of this Bill, the Committee of Reference will be abolished. The Hospitals Commission will consist of at least three persons, but, in the beginning, until a considerable amount of the preliminary investigation and survey has been carried out, it will be found necessary to have a larger membership than three. In all probability the normal membership of the Commission for some time, at any rate, will be five, and of these it is intended that two should be medical men and three laymen.
There is another departure from the existing arrangement regarding the disposal of the money accruing from the sweepstakes. It is not proposed to continue the division of the surplus on each sweepstake into the proportion of two-thirds being earmarked for voluntary institutions, and one-third to the Minister for Local Government. In future the proceeds of each sweepstake will go into a single fund, to be called the Hospitals Trust Fund, which will be held and managed by five trustees to be appointed by the Minister. All the proceeds of the sweepstake, up to and including those of the Derby, 1932, have been distributed. These are all that could legally be distributed at present, as the Committee of Reference has not yet reported on any of the sweepstakes held subsequent to the Derby of 1932.
Any surpluses that have not been distributed when this Bill becomes law, it is proposed to hand over to the national trustees, to be disposed of in accordance with the provisions of this Bill. The normal procedure will be that in future when the governing body of an hospital applies to the Minister for a grant, he will refer the application to the Hospitals Commission for investigation and report. There will be obviously some cases in which it will not be necessary to submit applications to the Hospitals Commission Applications from boards of health, mental hospitals' committees, and such local authorities in general, have had detailed examination by the Minister's technical advisers. Many schemes that have already received detailed examination are ready for operation. It will not be necessary to submit such schemes to the Hospitals Commission. In such cases the Minister will be empowered to make such allocations as he may consider proper.
Will the Minister be able to take any share except the one-third?
Under this Bill the one-third and the two-thirds disappear. It becomes one fund in future.
The Minister can still give more or less.
More or less. The Minister can attach conditions to the making of a grant. Perhaps it would be well if I explained the reasons for this provision at this stage. It will be found in Section 24 (5). The Public Charitable Hospitals Act did not apply to other hospitals. The Acts on the Statute Book apply only to hospitals in receipt of voluntary subscriptions, and that use 25 per cent. of their accommodation for free patients, or those who pay at a rate not exceeding 10/- a week.
These conditions are in the first Act. It was found that they operated to exclude certain institutions that were doing very necessary and very useful public work, and the Oireachtas, from time to time, by legislation, allowed certain hospitals to become participants in the benefits of the sweepstake moneys although they did not provide 25 per cent. of the beds free or comply with the conditions. The first amending Act of 1931 contained, for example, the names of six institutions to which the Act was extended, notwithstanding the conditions I have mentioned. The Bill does not re-enact these conditions. It gives the Minister power to specify the purposes for which a grant is to be expended and power to attach conditions for securing that it shall be expended on these purposes and, also, to attach conditions for attaining other objects, such as the provision of free beds, so long as the endowment lasts.
That is under (e) of Section 7, I suppose?
Section 24 (5). It is obvious that, before the Minister imposes any conditions, he or the Hospitals Commission will have to consult the body affected so as to satisfy himself that the conditions he is attaching to the allocation are reasonable conditions and conditions that are capable of fulfilment and which the institution is willing to carry out. The section has given rise to a certain amount of apprehension on the part of some of the voluntary hospitals. Some people appear to think that its real purpose is to enable the Minister to interfere in the day-to-day management of these voluntary institutions and that he might even interfere to control details of administration. I have, in the Dáil, stated many times, and, perhaps, I shall have to state it more than once in this House, that the Minister has no such intention whatever. The one object in the mind of the Minister, the object that we mean to achieve and to take such powers as will ensure that we can achieve it, is to secure that moneys will be used so that adequate provision will be made for the treatment of the poor, that the best equipment will be provided in these institutions to ensure that the very best that medical science can provide in the way of treatment will be at the disposal of the poor, free of charge, and it is necessary, I think, that we should take certain powers to attach conditions to the making of allocations if we are to safeguard the position of the poor in future.
An hospital may join with others in promoting a sweepstake but the fact that an hospital does join with others in promoting a sweepstake does not, of itself, give that hospital any right to any share of the proceeds. The claim will have to be established in the ordinary way on the basis of the work that the institution is doing for the community and it will have to be established to the satisfaction of the Commission and to the satisfaction of the Minister. As Senators are aware, the Public Charitable (Hospitals) Acts would, in the ordinary course, expire next year. The extent of the unsatisfied needs of the hospitals, as shown in the Report of the Committee of Reference and as we are aware of it in our records in the Local Government Department, renders it necessary, apart altogether from other considerations, to continue the Acts in some form. The Bill before the House does not fix any time limit and the reason we have not attempted to fix a time limit is that we cannot, at this stage, forecast the financial results of future sweepstakes. Neither are we in a position to know, until this survey we have in mind has been carried out, the approximate amount of money that would be necessary in order to produce the scheme of hospitalisation that we have in mind. The operation of the Bill can terminate in many ways. It can be repealed if and when it has served its object. The Minister for Justice may, at any time he is satisfied that sufficient money has been raised, withhold his sanction to a scheme, or the voluntary hospitals, if they are satisfied that sufficient money has already accrued for their purposes, may not set up a committee to promote a scheme at all, so that in a number of ways the operation of the Bill can be terminated. Over £5,000,000 has been made available, in the last three years, for hospital purposes by means of sweepstakes and about four-fifths of that amount has already been distributed to the hospitals or allocated by the Minister for Local Government. I have no doubt that, if the Oireachtas had been able to foresee the huge and astounding success of the Hospitals Sweeps, as a method of raising money, legislation such as this would have been introduced probably at the very beginning and some such machinery as we propose setting up now under this Bill would probably have been set up at the outset, but, at any rate, it appears to me that it is better to come along and try to get some co-ordination and to get our hospital development along some premeditated plan, even at this stage, than that we should continue to disburse money, not in accordance with the estimated needs of the community, but in accordance with the estimated needs of the individual hospitals themselves, which is an entirely different thing. The connecting link that has been established now by the Committee which has been set up to promote the sweepstakes will probably be found to be very useful in the future. We hope to have the full co-operation of the voluntary hospitals in trying to evolve the best system that it is possible to evolve and we hope to be able to allay, with the passage of time and with a reasonable and sensible administration of this Act, any suspicion that may be in the minds of the Committee of the Associated Hospitals at the present time.
This House has facilitated the Government, as far as possible, in extending the section by which the Minister for Local Government could apply towards prophylactic medicine—in this case, clearance of slums—the money subscribed by the sweepstakes. The position at present is that £5,000,000 have been subscribed, and the Dublin public are still as badly housed and as dependent on hospitals as ever they were. It is the most extraordinary example of stultification by success that I have ever experienced. Here we are with 50,000 people in one room tenements, and we have £5,000,000, and we are as far from relieving them as ever, and the need for hospitals is growing. There are about 19 hospitals in the city, with 19 slum areas round them, lowering the rateable value of their areas in the town. Each hospital creates a slum, and the slum requires an hospital. The Government, having wrung the neck of the goose, are now discussing its golden eggs, as if the sweeps were going on for ever—from success to greater success; the Government has peculated the sweepstake money just as chivalrously as a rogue who robs the till of a blind man's dog. They are killing the sweep as they killed our cattle trade. They should have known very well that the sweep only lives by publicity and yet they tax the source of the sweep's life—the British Press.
The "Daily Express."
And the "Daily Mail." If you wish to discuss this taxation of the Press further: for the first time in our history the Tammanyisation of this town came into being under the present Government and we have the owner of the "Irish Press" extracting taxes from the public pocket to preserve his private property. The public taxed for private property. If that is not corruption I do not know what is corruption. I will not go further into that matter. The point I wish to discuss is that this immense amount of money which has already been given has not, even under the powers we gave the Minister or tried to give the Minister, been applied towards preventive medicine in dealing with disease-producing conditions. It has tied the hands of those interested in public health. Everybody had good intentions but, apparently, the wording of the Bill is inelastic. There are instances in it at present where it is difficult to define definitely "facilities and equipment" in relation to the hospitals. It sets out that these shall be deemed to include provision for therapeutic or recreative benefits for patients. It is very necessary to have some provision for a general library, because most important in the convalescence of a patient is his recreation—the books he reads. Hitherto, books have been supplied in a very haphazard way. Their source has been public charity. People when they do not want magazines or when they become out of date send them to the hospitals. In certain cases, such as tubercular cases, in which there is a long period in bed and in which a patient's mind is very receptive and when the class of patient is at a receptive age, there is no suitable literature. In some hospitals, provision is made to give books of instruction only, but books of instruction, when recovering from an illness would bore anyone to death.
What I wish to ensure is that the section will be definitely made to provide for a central distributing library, such as they have in Denmark, England and America. I have a note here from a meeting held lately in Cambridge, in regard to hospital services, which says: "The hospital library is a solace to the patient and an aid to nurses and physicians and an indispensable factor in preserving hospital morale." It is possible, under two or three of the sections of this Bill, to extend portion of the money to the formation of a central distributing library, but I want to ensure that there will be no possibility of surcharge on any of the people responsible for the distribution of the funds through, for instance, the action of an over-officious accountant. Sub-section (7) of the second last section sets out:—
A grant made by the Minister under this section for the benefit of any existing or proposed hospital or nursing organisation may be made for all or any of the following purposes, that is to say:—
(a) the purchase of land or buildings, including any superior or outstanding estate or interest in land or buildings;
(b) the construction of buildings;
(c) the reconstruction, extension, alteration or improvement of buildings;
(d) the purchase of hospital, nursing and other equipment;
While I think that the Minister is in accord with the general purpose of that, he should make it definite that a hospitals' library can be instituted. After all, a hospital grant covers such a thing as a porter's uniform and it should be made clear that it could also be used for the purpose of endowing a central library—because some of the hospitals are small and cannot have a library equal to that of a richer hospital. The simplest way out, if it is not possible to combine all the Dublin hospitals in one, is, at least, to have a central distributing centre for books which would be available for them all. In England there are 200,000 volumes for the use of patients, and, in America, of course, there are many more.
The general principle of the sweepstake is a very excellent one. The only criticism I have to make is that the Government have done more damage to it in a short time than even loss of novelty of the sweepstake could be expected to do. I am afraid that the sweepstake has been very greatly injured not by the fact that people are getting tired of such investment, but by the steps the British Parliament have been incited to take by the action of the Government here. Some of these steps have already, without legislation, been put into practice. For instance, the Press of England—Senator Comyn a moment ago interjected a remark about "The Daily Express"—I did not refer only to the "Daily Express," though it is a very excellent and widely distributed paper, whose proprietor has not had to resort to Parliament to buttress his property by protective duties. That newspaper has already withheld notices of the £100 prizes. That is a writing on the wall, or off it, rather! The Betting Com mission recommended that the newspapers should not give publicity, which is the breath of life to our sweepstakes. When that is withheld it will be a very serious blow to the sweeps, because you cannot expect the British public to subscribe to a sweepstake which cannot publish results. The British public do not necessarily want any excuse of charity more than that which is provided by the hospitals to buy Irish sweep tickets. Had these hospital sweeps been extended to the clearance of the slums in our city the charity would be greater, more called for, and more direct. I do not suppose there are in Europe more uncomfortable or more insanitary conditions than we have here in the City of Dub lin. It is a monstrous thing to think that this city should be served by so many hospitals with their overlapping laundries, X-ray departments, apothecaries' departments, and so on, when the cause of disease and the need for hospitals are unchecked. We know very well the reasons why the hospitals cannot be merged. There is one explanation which, if pushed to its logical conclusion, is that there has grown up a vested interest in disease. It comes to that and nothing else.
I think the Bill should be extended and a section inserted so that the Minister would be empowered to spend money for the prevention of disease and for the alleviation of conditions conducive thereto. I think that measures should be taken now to introduce such a section. A sum of £5,000,000 has been provided to spend on hospitals in a country that has not a population of 3,000,000 people. It would be far better for the Government to use their powers and say: "We have spent enough on hospitals and we are now going to get rid of unhealthy houses. We are going to give our citizens healthy homes and healthy schools and playgrounds for the children." The first thing to do is to define what is a slum, and secondly to take a census of the people in the slums. Steps will have to be taken to ensure that, when a slum area is cleared, it is not filled up again by people coming up from country towns, who, although healthy and strong when they arrive, will, because of the surroundings in which they find themselves, soon succumb to disease. That very well managed and philanthropic institution—Guinness's —has had much experience of the physical condition of its employees. It found that well developed, strong young fellows when they came up from the country after a period of residence in unhealthy surroundings in the city quickly succumbed to disease. It met that by good housing. That is a lesson that is fifty years old, but it has not been taken to heart by the Government. We have our 18 or 19 hospitals in Dublin but we still have fifty thousand poor people living in sub-human surroundings. This country has already got from the sweeps £5,000,000. I will support any Government that will take the whole of the sweep money, even if it ignores the hospitals in the future, and apply it instead to getting rid of the slums.
Senators may not be aware that a large part of the city is under the high tide level of the River Liffey. I cannot at the moment recall the details that were given in the engineers' report, but when the main drains were being put in it was discovered that a great part of the subsoil of the city is infiltrated by high tides. The people living in these areas of the city are simply fodder for hospitals. You cannot expect to have healthy children reared over such damp earth. Healthy people come up from the country, but within a very short period, if they are unemployed, they merge into the slum population. Therefore, what we are getting is a population of patients. Is there to be no end to this vicious circle? The first thing to be done is to stem the tenement population. That must be done by taking a census. It is an appalling thing to permit people to go on living in kitchens and areas 14 feet under the ground. When people leave these slum areas to live in the new houses at Fairview, Cabra, Bath Avenue, etc., and in the other centres where there are new houses, these old tenement houses should be knocked down or sealed up. What is going on at present is that you are simply putting people through a process of health reduction in order to make hospitals indispensable in perpetuity. I do not think that subscribers to the sweepstakes would lessen their subscriptions by one farthing if they knew that this Government had sufficient foresight to see that it is more necessary to have good houses than good hospitals. Is it the Government's ambition for the Irish people that they become perpetual patients of hospitals supported by British sportsmen? Has our race no better destiny than that? I know it may seem a fanciful suggestion. But really are hospitals to be looked upon as Valhallas or paradises for our citizens? If the houses of the country were well provided one hospital would be quite sufficient. If those who are interested in hospitals were not well looked after, then one might say that one hospital might be too many! After all, the great Empire of Austria had only one central hospital. It was so thoroughly managed and well administered that people went from the ends of the earth to study there. Generally there are more than 3,000 people in the Dublin hospitals, but students could not see them without extensive journeying and this prevents Dublin from being a great teaching centre to Europe as it is to its own students.
This Bill is really strangling the intentions of the Government. I know that, apart from the scandal that the Government itself benefits from the sweeps, otherwise its intentions are good, but this Bill will stultify its object if it is limited strictly to hospitals, as if it were never to be realised that the thing to do is to enlarge the scope of the measure so that the Minister will be able to deal with the slums which are the factories for hospital cases. I have very few ambitions in life, but one is to see an end to the scandal of the Dublin slums. We have money enough to build a new city for our people—no: they are to be given hospitals! Reference has often been made to the fact that in this city we have 50,000 people living in one-roomed tenements. Life in such conditions is going on at present and the hospitals are getting £5,000,000. In Grafton St. between some of the drapery houses and jewellers' establishments there should be an exhibition window containing a slum room so that all might see the hidden horror of our city. It is in such surroundings that many a citizen rears his five or six children. That is the kind of horror we have here. In that kind of paralysis our people are losing the rights of human beings. People are being so sapped in their energies and so beaten down that they accept discomfort and disgrace and do not realise that they have a right to the decencies of ordinary life, to a share of the £5,000,000. The miracle is that people living under such conditions are as good as they are and that they have not degenerated long ago. It is more important to get rid of the cause of hospitals than to keep them going. The Bill proposes to meet some of the difficulties that I have in mind, but I think that the Government is not sufficiently alert towards making it clear for instance that the fund provides for books. Books are more important than porters' uniforms. In the case of patients convalescing it is desirable that some interesting food should be provided for the mind and that steps should be taken to collect and to sort the kind of literature that is sent in to patients, and to exclude literature of the haphazard type that is not at all suitable for them. Periodicals are circulated and within reach of children that are not suitable even for adults in a state of convalescence. I think a section should be introduced in the Bill which will clearly and unequivocally make provision for the establishment of a central distributing library. I propose to move such an amendment on Committee Stage.
I welcome the introduction of this Bill. Certain amendments to it will be proposed on the Committee Stage, and if these are accepted the Bill ought to still further improve our hospital system. Notwithstanding all the money that has been given to the hospitals, very little has been done for the relief and cure of cancer. During the past five or six years very great strides have been made in England, on the Continent, in America and other places in the treatment of cancer by radium and X-rays. In England a few years ago an appeal was made to raise funds to purchase radium. The Government of the time offered to give a pound for every pound that was subscribed. As a result something like £300,000 was raised. That was for the National Radium Committee. A few years before that the British Empire Cancer Research Campaign raised about £300,000. These two big organisations, with their large financial resources, have done a great deal in England for the establishment of radio-therapeutic centres. Neither of these two bodies has any functions as far as the Irish Free State is concerned. It, therefore, devolves on us to devise means by which something similar may be done here. Perhaps I should explain what I mean by a radio-therapeutic centre. It is a hospital with special equipment in charge of experts who give advice and treatment in cases of cancer. There is a great dread of cancer, although patients suffering from it in the early stages have no pain. They conceal their condition from their friends and in this way very often the stage at which they could be benefited has passed. It is in the early stages, when patients do not suffer pain, that their condition might be more easily improved and cured. If such an institution were established here it would bring hope to thousands of persons who are suffering and would be the means of curing a large proportion of them. There is nothing but despair at present.
Up to the present practically the only treatment for cancer in the Free State is by surgical means, whereas in other countries, in England, Wales, Scotland, the Continent, America and Canada, there has been treatment by radium and X-rays, in addition to surgical treatment. Many of the Continental centres have been started and continued by Government grants. The Irish Free State is a long way behind all the progressive countries in the world in its treatment by radium, which has now practically taken the place of surgery in the treatment of cancer of the mouth, cancer of the tongue, cancer of the skin, and certain diseases of women. Even in incurable cases radium treatment gives the patients great relief from their suffering, prolongs their lives and makes them more comfortable in other respects.
I hope the Seanad is not going to allow those suffering from this most painful and dreadful disease to be in a worse position than those afflicted with it in other countries, more especially as this Bill gives them the power to provide a fund to make the necessary provision. This is a national question and there should be no delay. If this matter is referred to the new Hospital Commissioners, it will delay the matter possibly a year, and even then owing to the pressure by various interests they may be prevented from allocating adequate funds for this purpose. In the meantime there are nine persons suffering from cancer dying every day in the Free State and their places are being taken by nine new cases without hope of receiving the best advice and treatment. It is estimated that there are 5,000 to 6,000 persons suffering from cancer in the Free State. This large army with their ever-increasing suffering are moving continually to the only goal where relief is possible, that is by death. This is not a question of supplying funds to purchase radium, as there is more radium in the Free State at present than is being used, thanks to certain donors. Senator Sir John Griffith has given £2,000 and other parties have also made contributions for the purchase of radium. That is not what we want. What is urgently required is to provide a properly equipped institution for giving advice and treatment and for providing facilities for training medical men in the use of radium and X-rays. Radium is one of the most wonderful, most expensive, most dangerous, and most potent therapeutic substances known to medical science and, therefore, should only be used by those who have the necessary training and experience. It requires great experience to avoid doing an injury to a patient and more knowledge and experience to treat a patient successfully.
I might mention that one of the earliest, largest and best radium institutions is in Paris and was established by Government funds. Belgium has four radium institutes, all established by Government funds, and it is organising another, which will provide facilities for radio-therapeutic treatment of both charitable and private patients, for teaching and for research. These will have 14 times as much radium as there is in the Free State, although Belgium has only about twice the population. In Stockholm there is a thoroughly equipped institute established by Government funds, and patients are conveyed there from all parts of Sweden free by rail. There are between 20 and 30 radium institutes in England, Wales and Scotland. The one in Manchester —the Holt Radium Institute—has 14 medical men on the staff. Half of these give their whole time to the institute. I hope the Minister will accept an amendment to provide funds for the establishment of such an institution on the lines of those in England, Paris, Belgium and Stockholm. I should like also to suggest that funds should be made available for a pension fund for nurses and midwives. Nurses and midwives, particularly nurses, largely assist in running our hospitals. They have a very severe training and they are very badly paid. They have no possible means to provide for their old age when they are not fit to work. I think it would be very proper to allocate a certain amount for this purpose and I hope that if amendments are brought forward for that purpose they will be accepted.
I beg to move the adjournment of the House.
I would suggest, notwithstanding the ramblings of Senator Dr. Gogarty, that there is general agreement on the Bill and that we should give it a Second Reading this evening.
Cathaoirleach
We need not conclude it this evening.
I fancy this debate will go on for a very long time and I think it should be adjourned.
I do not suppose that there is any real opposition to the Bill and the only object the Seanad would have in continuing to debate it would be to make certain recommendations to the Minister.
The discussion will not necessarily be shorter because the Bill is not controversial.
I have no objection to adjourning, but in case we adjourn now, would it not be better, in order to prevent that clog in legislation which we have frequently approaching the end of the Session, if after the Second Reading terminated, we proceeded immediately to the Committee Stage?
Cathaoirleach
We could not do that. I take it that we shall meet to-morrow if we do not finish the Second Reading to-night. If we sit until eight o'clock we may possibly finish it to-night.
My objection to proceeding now is not by reason of any opposition to the provisions embodied in the Bill. I think some form of regulation, which I dislike so much in other matters, is necessary in the case of these hospitals and it should have come before now. The individualistic element under the new conditions has got totally out of hand. It has been necessary for some considerable time past, in view of this utterly unexpected windfall that there should be some check on the waste and demoralisation that is inevitably involved in these schemes. I do not mean, by saying that I hold these views, that I cease to be a believer in the individualistic method but in view of the new conditions some check is obviously necessary. There is only one other point I wish to make and that is in relation to the method by which the commission on the sale of tickets is calculated. I objected before, and I object again, to the provisions in the old Act, and repeated here, by which the commissions given on the sale of books remain undisclosed. The ordinary member of the public in buying a ticket or a book of tickets imagines that the only reward sellers get is two free tickets. Those who have even an elementary knowledge of what goes on behind the scenes know that that is not a fact. I think that those who participate in a sweepstake have a right to know what the odds are. Their odds cannot be ascertained unless they have a complete knowledge of the commissions given or, failing that, some statement on the part of the auditors of the total number of tickets in the drum. We know that that is unpopular and that the hospital people do not like it. But I consider that in a lottery like this which is run under State auspices, if not directly under State direction; there is a responsibility to those who take part that they should know the odds with which they are faced. That can only be done if the commissions are disclosed or the number of tickets published. I propose at a later stage to put down an amendment with the object of securing that information.
Senator Sir John Keane is so very often in a minority of one in this House that I am not going to allow this opportunity to pass of assuring him that he is not in a minority of one on this occasion, that there are at least two in the House of the same opinion. The Bill in general I think has to be discussed in two parts. The part which deals with the utilisation of the funds that go into the possession of the Hospitals' Committee is, I think, deserving of all support. I think it is acknowledged by everybody that there should be some proper co-ordination of the hospital services of the country. On the question of the raising of the funds I am of the opinion I had when the original Bill was introduced. I said it was the antithesis of the doctrine which preceded the establishment of the Free State. It is the antithesis of the doctrine of Sinn Fein, of self-reliance. It is asking the people of other countries to pay the cost of the social services which the system of civilisation under which we are living imposes on the people concerned. I think that is a bad essential principle. However, it is with us. I want to support Senator Sir John Keane's point in regard to the publicity that is needed. This Bill will repeat for the public information and edification, the fiction I was going to say, that the whole of the scheme is State governed and controlled. I am not making the slightest suggestion that the conduct of the hospitals sweepstake is at all unworthy in any respect so far as those who accept the principle of sweepstakes is concerned. But the Bill imposes upon the promoters of a sweepstake the obligation to present a scheme to the Minister. It places upon the Minister the responsibility of approving of that scheme and the clauses which deal with these two matters suggest to anybody reading them that this is a matter wholly under the control of the Minister. That being so, I suggest that the scheme sanctioned by the Minister ought to be made public, in the first instance, and after that, that the results of the sale of tickets ought to be made public.
We are assured that there is an audit of accounts. Of course, there is an audit of accounts, but of what accounts? Of the accounts concerning the expenditure of the money that comes into the possession of the Hospitals Committee. Section 6 (e) indicates that the scheme must contain the prices intended to be charged for tickets in the proposed sweepstake. That means that the public are to be informed that the price—if the Minister approves—shall be, say, 10/-. Surely, that is an indication to the purchaser of the ticket that that 10/- is to be accounted for. It is not accounted for in the audited statement sent out to members of the Oireachtas. Because that clause is in the Bill, the audit of that 10/-, or multiple of 10/-, should be made known to those concerned. If it is not to be made known, then that clause ought not to be in the Bill. I made this criticism before. I have stated it in this way now to show that Senator Sir John Keane is not alone in his criticism.
I am one of those who spoke and voted against the Sweepstake Bill when first introduced, holding, as Senator Johnson holds, that if we could not improve the lot of the sick poor by voluntary effort, the next best method would be to do it by way of taxation. Having said that and holding that view, I wish to say that, in my opinion, the sweepstakes are being conducted in a manner absolutely beyond any valid criticism. They have been conducted in a perfectly straight way. Everybody gets a chance. We all know, notwithstanding what Senator Sir John Keane and Senator Johnson have said, that the vast preponderance of people who take a ticket go in for a flutter or a gamble on the off-chance of getting rich overnight. If they do not get rich, they say: "Better luck next time," and they go on again. We all know what human nature is.
I think that the Bill is an admirable measure and my only regret is that nobody anticipated the extraordinary success these sweepstakes would be so that arrangements could be made, as in this Bill, for devoting portion of the moneys to co-ordination, research and such things as the Parliamentary Secretary outlined. Indeed, I think that the only advantage we would have got from adjourning to-night would be the opportunity of reading in full the very admirable statement made by the Parliamentary Secretary in explaining the Bill. I wish to join with Senator Sir Edward Coey Bigger in the plea he made with regard to a cancer hospital. I have made inquiries as to the institute of this type in Manchester, and I am told that it is doing extraordinary work in connection with the cure of cancer, so far as one can apply the term "cure," because it is not regarded as a cure if there is a recurrence within five years. Even in cases where a cure is impossible, it robs this frightful disease of a great many of its terrors. I think there is also something to be said for the plea that a certain portion of the fund should, if possible, be devoted to the provision of pensions for nurses who are superannuated or lose their health in what must be a very exacting calling.
I have one other remark to make about a matter which causes me some misgiving. I should have no misgiving of course, in the case of the present Minister for Local Government or his Parliamentary Secretary but I can imagine a Minister or a Parliamentary Secretary such as Mr. Hugo Flinn or Mr. Hogan of the late Administration. We know that modesty is not their predominant passion and when we are doing away with that limitation of a third of the fund for hospitals under the Department of Local Government and Public Health, I fear lest, by any mischance, the Minister or his Parlimentary Secretary be transferred to another Department and their successors be of the nature and quality I have mentioned. The Minister might, I think, in that regard, reconsider the putting of some limit on the amount to be taken by the Minister for Local Government and Public Health. Otherwise, I think this measure is wholly admirable and I am only sorry it was not introduced much earlier.
When the original Bill was introduced I, like Senator Dowdall, opposed it most strenuously. One of my reasons for opposing it was that we were giving the credit of the State to an organisation that might be mismanaged. This Bill has received general support in the Seanad. The main reason, I think, is that the organisation in regard to which we had misgivings has proved itself most efficient. The sweepstake has been conducted in a way which has commanded the admiration of the world and it undoubtedly deserves the phenomenal measure of success that has attended it. A great many wise suggestions have been made in the course of this debate by Senators, beginning with Senator Gogarty, who, by the force of his genius, was able to introduce a number of irrelevancies. He recommended one wise thing to the Minister—that suitable books should be provided for patients. After all, the object of all treatment of disease is the benefit of the patient. My friend Senator Johnson reminds me that the hospitals are to get a revenue outside the proceeds of the sweepstake. I do not know whether their revenue is likely to increase as a result of the knowledge of the people that the sweepstakes have been so productive but I do think that the provision of books, if the suggestion commends itself to the Minister, would be desirable. Senator Sir Edward Coey Bigger has recommended that a central cancer hospital should be established and thoroughly equipped. He has given reasons for that suggestion and I take the liberty of reinforcing, so far as I can, the arguments put forward by Senator Sir Edward Coey Bigger.
Senator Johnson is not alone in his support of the suggestion put forward by Senator Sir John Keane. I think that the credit of the State is involved in this Hospitals' Sweepstakes scheme. The State does not take direct responsibility, but still it is known all over the world that this sweepstake is conducted under the authority of an Act of Parliament and under the supervision of the State. It seems to me that an account ought to be given of the commission which is paid in respect of the sale of these tickets, or in the alternative—a worse alternative, I think—that the total number of tickets that go into the drum ought to be given. My sole reason for saying that is that the credit of the Government is involved in this matter. We have legalised and legislated for these sweepstakes and we take portion of the money. There may be reasons why Senator Sir John Keane's recommendation cannot be complied with, but they would need to be very strong reasons to void the force of the statement which he has made. The object is not to provide bricks and mortar, not to build hospitals, not to provide for the persons who run hospitals. The real object is the care of the patient.
The persons concerned with the care of the patient ought to be considered to an even greater extent than they are in this measure. Senator Dowdall has referred to the nurses. They give the best years of their lives to the care of patients. They are badly paid. They can make little provision for old age. Nurses find in their profession that advancing years tell more heavily against them than they do upon people engaged in other walks of life. I think that provision for nurses could very well come within the scope of this measure and that the seven objects set out in the Bill—provision of land, construction of buildings, extension of buildings, purchase of equipment, endowment of hospitals, payment of maintenance charges and discharge of debts—should be extended to include provision for nurses on whose attention a good deal of the comfort of the patient depends. Seeing that the Seanad is almost unanimously in favour of such a provision, I recommend it to the consideration of the Parliamentary Secretary, if it can be brought within the terms of the Bill.
I desire to deal with a few points only. I shall deal with them very briefly. Most of the points raised could be more appropriately dealt with on Committee Stage. Senator Gogarty raised the question of the provision of library facilities in the institutions covered by the Bill. As I understand the Bill, Section 24 (7) (d), which refers to the purchase of hospital, nursing and other equipment, would cover the provision of library facilities. I think that the Senator had in mind something more elaborate than the provision in a hospital of a room with books that would be called a library. He had in mind, I think, something like a central institution. I am quite impressed, as any medical man must be and as most intelligent laymen would be, with the curative and therapeutic value of library facilities in hospitals. I think it would be a great boon for these patients to have proper library facilities—the best we can provide. We will have the matter looked into, but it would probably necessitate some slight amendment to provide a central library such as Senator Comyn and Senator Dowdall have in mind.
I need not follow Senator Gogarty. There are some places into which I should not like to follow him. It is open to a good deal of argument in an interesting debate whether better results would not be got if this money were applied to other purposes, such as removing the causes of illness. That question is not before us now. The Government has given very generous financial assistance, particularly towards a solution of the housing and slum problems. I think the housing problem is well on the way to solution if local authorities make use of the generous financial facilities placed at their disposal. Senator Sir Edward Bigger raised an important question regarding the provision of a special radium institute. When Senators have a little more time to look into the terms of the Bill they will find that most of these things are possible under it. The Minister could make an allocation to endow an institution, or to set up a new institution, to be called a Radiological Institute, for the prevention, treatment and cure of human diseases. If it does not come under the heading of "cure," it could come under the heading of "prevention" or, at least, of "treatment." That could be provided within the terms of the Bill.
As to pensions for nurses and midwives a very difficult problem arises as to the class of nurses that Senators have in mind. Nurses in the employment of local bodies may be inadequately paid. Many of them are inadequately paid but, if they are, it is the fault of the local authorities, and salaries should be increased, if they have not a living wage. Take the case of midwives who are paid salaries by local authorities. The suggestion, apparently, is that we should allocate money to increase the pensions. At present they can retire after a certain number of years' service with two-thirds of their salaries as pension. If the hospitals provided an additional sum to be added to that you would have reached the position where it would pay midwives to retire, taking two-thirds of their salaries, and whatever they got from another fund, than to remain in the service. These are some of the difficulties. I think the solution of them is to pay these people reasonable and adequate salaries. They have ordinary pension rights. In the case of private nurses they have an earning capacity and are paid reasonably well. If a private nurse is employed, and I hope that Senators never needed to employ nurses, the standard amount would be paid. I do not want to be personal but I doubt if Senators who made the plea for private nurses would themselves pay more than the ordinary standard fees that private nurses charge. There are many people in public employment at the present time who are paid considerably less than private nurses are paid for their services. If it is a matter of relieving destitution I say in all sincerity that there are many sections of the community in greater need of relief. In the definition a nursing organisation to which the Minister can make an allocation it is set out
... means an institution or organisation in Saorstát Eireann which has for its sole or principal object the nursing of, and providing of nurses for, poor persons suffering from physical diseases, ....
If the main purpose of a nursing organisation is looking after the poor we come to their rescue out of the Hospitals Sweep Fund. I think our primary concern ought to be for nurses devoted to the nursing of the poor. Let me put another aspect of this matter. Supposing we decide that we should pension all nurses I do not know where that is going to lead to. I think it would immediately lead up to doctors. How many poor doctors are there? There are plenty of them. There may be poor Senators, and there may be poor doctors in the Seanad.
The doctors are employed when they are old, but the nurses are not.
Then there are wards-maids in hospitals who devote their lives to the nursing of the sick. Are we to pension them also? I have a good deal of sympathy with a badly-paid nurse, but I do not think the solution is by making funds available from the sweepstakes. If people are not satisfied with the salaries that public authorities are paying nurses, they should bring pressure to bear on the public authorities to increase the salaries.
Make it a condition of a grant.
Cathaoirleach
We are promised an amendment on this question, so that we will probably have to discuss it again.
By giving a somewhat detailed explanation of the points that were raised I hoped to be able to satisfy the House that many amendments are unnecessary and, in the light of the facts, that many others might not be moved, thus saving the time of the House at a future stage. As Senator Sir John Keane is not present now I do not think I need deal with the points he made. Senator Dowdall has some anxiety about the one-third and two-third proportions. That difficulty is already dealt with in the Bill. He need not have any anxiety in that respect. Senators should bear in mind that were it not for the introduction of this Bill the sweepstakes would, in the ordinary course, come to an end next year, and the hospitals, apparently, would have to be satisfied with the money that has accrued. We are extending definitely the period for the operation of sweepstakes in the hope—and a very optimistic hope it is that sufficient money will accrue to give our hospital problem if we get time to work it out. The difficulty about the one-third and two-third proportions is this, that we have, through our technical advisers in the Local Government Department, many schemes ready for operation, that have had the necessary detailed examination, but we cannot operate them, and the local authorities cannot proceed, until we are able to say how much money we will be able to give them. We could release these schemes to-morrow if we could lay our hands on a little more money. I admit that, for the present, we will encroach beyond the one-third previously allocated to the Minister. The problem of the local authorities is one that will be solved in the near future. When it is solved, not only the two-thirds, but the entire fund will be available. We have no anxiety whatever that voluntary hospitals will suffer.
Question put and agreed to.
Committee Stage ordered for Wednesday, 28th June.
The Seanad adjourned at 8.10 p.m. until Wednesday, June 28, 1933.