As unfortunately I was not able to be present at the Second Reading, I would like to ask whether the policy involved in these duties is in general that of restriction and an increase of duties or that of a diminution of duties and freer trade?
Imposition of Duties (Confirmation of Orders) (No. 2) Bill, 1939—Committee and Final Stages.
Section 1 agreed to.
SECTION 2.
Question proposed: "That Section 2 stand part of the Bill."
A certain number of Orders have been made in consequence of the London Agreement of 1938 and as a result of certain references which were before the Prices Commission and recommendations thereon. So far as some of them do represent a diminution of duty I suppose they do represent freer trade.
Question put and agreed to.
Question proposed: "That the Schedule be the Schedule to the Bill."
There are some points in regard to reference No. 3 in the Schedule to which I wish to direct the attention of the Minister and the House. It is the reference which deals with the imposition of duties on sutures and ligatures used for surgical purposes. Before speaking at all on this matter I wish to make it clear that I do not desire to raise any criticism on the quality of the home-produced material. It would be unjust to make such a criticism until there is a chance of proving their value. As far as I could get information from those who have used the home-prepared material, it has given entire satisfaction. I want to make that clear, as I have some comments to make on the manner in which this Order is introduced and on the effect it has, which might be regarded as carrying with them some criticism on the quality of the material.
As far as I have been able to learn, the quality has given entire satisfaction to those who have used these Irish sutures and ligatures. I think, however, the House would expect that, before imposing an Order of this sort dealing with a highly technical matter, some persons who had knowledge based on their own experience of the effects likely to be produced by this Order would be asked their opinions and would be consulted in the matter. I do not know whether the Department or the Minister at the time did seek advice on such matters, but it is clear that in his own Department he had no one who could give him any advice from the technical point of view. He may have sought advice through other persons in conference. The Minister may be able to answer that query; but, as far as advice from any representative body which could have spoken on behalf of the surgical profession as a whole or with the expert knowledge that only surgeons could possess, I think neither the Medical Union, which represents the whole profession, nor the Royal College of Surgeons, which represents particularly the surgical branch, was consulted. The first that the ordinary operating surgeons or hospitals knew about the Order was when it came into effect and when they found a very considerable increase in the prices of materials which they had been accustomed to use. It has to be admitted, of course, that the manufacture is carried out under strict Governmental control and that otherwise no manufacture of any therapeutical substances is allowed in this country. Whether produced in this country or elsewhere, those therapeutical substances are not allowed except under licence of the Minister for Local Government and Public Health and upon its being proved to his satisfaction that the methods of production and that the premises where the production is carried on comply with very strict regulations. That applies whether the manufacture is inside Ireland or in another part of the world. I know the Minister's inspectors have visited, not only British factories where therapeutical substances are manufactured but also American factories which are licensed to import them into this country.
From these two points of view—that of quality and control—I have no complaint whatever to make. I think, however, it is a principle of which the House should not approve that an imposition of a duty like this should be made without consultation with those persons best fitted to give advice. This Order has been brought in without consultation and even without the knowledge of surgeons, until they learned from the dealers that they had to pay nearly double what was paid before for certain products.
I think it is important to point out some of the effects of the increased cost on certain parties concerned. Prior to the imposition of this duty— which took place, I think, about six or seven months ago—the price of a dozen tubes of catgut for a particular purpose of surgical use, of British manufacture and allowing for discount, was 11/2. The price of the American product was 9/7. From June to October the prices were raised by the imposition of a duty of 75 per cent. in the case of the American and 50 per cent. in the case of the British produced goods, and they have risen from 11/2 to 16/8 and from 9/7 to 14/5 respectively. From June to October the Irish product came on the market and was produced, allowing for discount, at 9/7 for the same quantity of the same material. That is to say, there was a very direct inducement—more than an inducement, almost a compulsion—put on surgeons and hospitals using this material, to use Irish materials.
In November and at the beginning of December the prices rose further, and the British price now is 17/7 as compared with 11/2 before the Order was introduced. The American price is 14/5 as compared with 9/7 before the Order was introduced. The price for the Irish goods since the 1st November has been raised from 9/7 to 12/—roughly a 25 per cent. increase, so that the natural result of this Order has been not only to raise the prices of imported goods but to give the manufacturer here the power to raise his own prices after a few months' control. These are the figures so far as I have been able to-get them; I took them from the most trustworthy source I could. It is a serious matter that, in the case of any substances such as these which are essential to the carrying on of surgical work, there should have been such a high percentage increase in cost.
Who has to bear that cost? The greatest part of that cost has to fall on the general hospitals and these get very little consideration now, as people think that they have an unlimited source of demand for any money they want. That is not their own experience. This increase also falls on the nursing homes, which are trading institutions run for profit and carrying on a service very essential to the community. The private hospitals or nursing homes have very considerable difficulty in meeting costs as it is, without having to pay any increased cost. The costings have to be done by the manager or proprietors with very great care. The individual surgeon, of course, will also have to meet these increased costs in cases where he has to supply material for private patients outside nursing homes. Ultimately the cost to a considerable extent falls on the patients; in the nursing homes it must fall on the patients if the nursing home is to continue.
Although that is an important point, it is not the most important. The most important point is that compulsion is put on the surgeon, on other than professional grounds, to use certain goods. His choice is limited. A surgeon of experience who has tried various substances recommended to him and who has decided in his judgment and in the interests of his patients—he has no personal interest more than that—that he prefers to use a certain material, now finds that compulsion is put on him to a certain extent either to increase the cost to his patient considerably or to use an article with which he was previously unfamiliar.
That is a point to which attention was drawn in the debate in the other House, and the Minister used some phrases which I think showed the danger of this procedure. In column 668 of the Official Debates on the 29th November, on the subject of the exercise of choice by the surgeon, he said:
"It may be that a certain element of prejudice may enter into these things."
No element of prejudice can enter in. The surgeon's only object is the protection of his patients, and if this is to be called prejudice, call it prejudice, but it is a misnomer. He is certainly loath to use an article which he has not tried, of which he has no report and no experience, when he knows that another article has given every satisfaction in the past. The Minister went on to add almost a paraphrase of what I have just said:
"Naturally, surgeons who have relied for a long time upon the satisfactory products of other manufacturers may not be disposed readily to change, but I think Deputy Cosgrave will agree that it may sometimes be necessary to induce surgeons to look at the products of alternative manufacturers."
I submit that it is not necessary for the Government to induce—call it induce, but put it in inverted commas —surgeons to change from the materials which they have found useful to patients and in which they have confidence. The word "induce" is misplaced in such a sense. The effect of the Order is almost to put compulsion on surgeons in certain cases to adopt these. So far any harm may not have been caused by the use of this particular product, but the principle involved is bad. Where interference is being made by a tax which affects the lives and health of people who have to submit to surgical operations, I think it confirms my view that the advice and opinions of the responsible authorities should be invited before such an Order is made.
There is one other point which I think is of some importance. I do not desire to cast any reflection on the status of this company. I believe it is the only company which is carrying on the manufacture of these products in Ireland, but, according to reports in the Press, it has been registered with a capital of £100. I have no doubt that there is plenty of money behind the company, but its nominal capital, as reported in the Press, is £100. Accidents may happen with the best product, and a patient who suffers injury, or the friends of a patient who suffers death following the use of ligatures or sutures, might conceivably bring an action for damages. We saw recently a case tried in Dublin in regard to a deplorable accident of this kind which occurred in Waterford. We saw how certain persons, who considered themselves aggrieved, took an action against an English manufacturing company of the highest repute, for damages. They did not succeed in their action, but that point is irrelevant. What is the possibility of a patient or the friends of a patient recovering damages against a company whose capital is limited to £100? That seems a very grave matter for the Government Order to have made possible. There are alternative courses of action, of course, for the patient or the friends of the patient to consider. They may take an action against the surgeon or against the tradesman who sold the products he has got from the manufacturer. That would certainly be an injustice to the surgeon, who has no opportunity of testing the materials except by experience, even under the "inducement" put to him by the Department of Industry and Commerce. If an action is taken against him, he may have a good defence, but he is put to considerable trouble, and his reputation is at stake. Probably he will have to bear his own costs.
A similar statement would be true in regard to an action against a trading firm which has sold the goods. They simply buy them in bulk from the manufacturers and sell them retail. It would be grossly unfair if they had to suffer any penalty for an accident arising from the use of articles which they had only handled in packages and when they were not in any way responsible for the quality of the material supplied. It might be urged, as it might have been in the Waterford case, that by selling these materials they guaranteed them. That might or might not hold with the jury, but, in any event, it is not just that a trader should be put to considerable expense and risk in that way. I should be very glad if the Minister could assure us that no such accidents could happen.
There are three points which I should like the Minister to explain. The first as whether he can say if any consultation was held by his Department before this order was made, and, if such consultation was held, why was it not held with some representative body that could speak authoritatively for the medical profession? Secondly, can he give any justification for the increased expense entailed as a result of this order, and thirdly, can he say why the company was registered with such a small capital as £100?
Can the Minister give us incidentally some idea of the financing of the question— the value to the Exchequer of the duty imposed, and the total quantity of the Irish alternatives which are used?
I think, Sir, that I should emphasise a point which Senator Rowlette has made, that so far, at any rate, the products of this company have afforded no ground for complaint, that they are of a quality which would be generally and almost universally accepted by the members of the surgical profession. I think I should also stress that the whole process of manufacture is under almost constant supervision by the Department of Local Government and Public Health.
Once in six months.
I think more frequently. I am informed that batches of samples of catgut are submitted to tests by the State authorities and that, in fact, the products of this firm are supervised in exactly the same way as the product of any British or Continental firm would be. Therefore, I take it, it is rather unlikely that these products would be the cause or the occasion of disease, and that it would be a very difficult matter indeed to convince a jury if such a case as the Senator has mentioned were to be brought before them, that sutures and ligatures manufactured by the firm were the source of any infection which a patient might contract. I am only making that point to show that at any rate the profession is not asked to use an article in the preparation and manufacture of which any less care was taken than would be taken in the manufacture of any alternative product. Furthermore, I would suggest that a person who suffers by reason of the fact that a surgeon was to some extent forced, or induced, to use this particular article is not likely on the whole to be at any loss merely by reason of the fact that the capitalisation of the company concerned seems to be inadequate.
I take it that if a case like that arose, and that it was clearly ascribable to some carelessness in the manufacture, that for its own protection the firm involved would make some reasonable amend, so far as a monetary amend could be made to the person concerned. I am saying that not because I feel that the position is satisfactory, because I, personally, do not think it is. I feel that if a company is carrying on a manufacture of this sort it ought to be a substantial concern in every way. On the other hand, it is not, I think, correct to say that the nominal capital of this concern is only £100. There are two companies involved. There is the primary concern manufacturing at Castlebellingham, which makes catgut, and the firm which carries out the process of sterilisation. The latter has a capital to the order of £100, but the company manufacturing at Castlebellingham is more substantial. At the same time, I feel myself that it is a matter that will have to be looked into. I shall ask my Department to examine and see whether we cannot create a more satisfactory position so far as the capitalisation of the undertaking goes.
Now, it is not correct to say that no members of the profession were consulted before this Order was made. The Department of Local Government and Public Health was consulted at, I think, every stage in the preliminary investigations and, naturally, we have to assume that the medical staff of that Department is competent to advise us in regard to this matter. As well as that, I understand that arrangements were being made to receive a deputation from the Irish Medical Union. They asked to be received in regard to this matter, but, for some reason or another of which we are unaware, the Union did not proceed with its request. In fact, the reception of the deputation fell through. That would seem to indicate that the matter was not felt to be such a very important one as the Senator has represented it to be here.
On the question of price, perhaps I did not hear the Senator quite correctly, but, as I understood it, prior to the imposition of the duty the price of a dozen tubes of British manufacture was 11/2, and of materials of American manufacture, 9/7. Between the date of the imposition of the duty and June, the price of the British manufactured article was increased to 16/8 per dozen tubes, and the price of the United States manufacture to 14/5.
From June to October, when the Irish manufacture came on the market, it was priced at 9/7 for a dozen tubes, so that the position then was that the Irish manufacture was procurable at a lower price than the British tubes would previously have been. It is quite true that the price of the foreign manufactured articles was artificially raised, but at the same time the surgeon had a choice. He was not precluded from using this if he felt the Irish manufactured article was so much inferior to the British or American manufacture as to warrant his paying the difference in the case of any operation.
Personally, speaking as a layman, I cannot see that any great hardship was imposed on the surgeon. It may be that I underestimate the quantities of the material which would be used in any critical operation, and that perhaps these figures will impose a much heavier monetary burden upon the surgeon than, on the face of them, they would appear to do. As I say, that is a matter on which I am not competent to speak, but on the figures the Senator has put before me I do not think, if the matter were a really serious one, that the element of compulsion on the surgeon is a very great one. I may be quite wrong in that regard, and I speak subject to what the Senator will have to say in relation to it.
After the 1st November there was apparently an increase in the price of the Irish goods. I wonder if there has not been a commensurate increase in the price of the foreign manufactured article as well.
Not in the American, and only slightly in British.
Nothing of the same order?
Only since the 1st of this month.
It may be that the price of the manufacturing material has risen more rapidly here than in Great Britain, or that the cost of the materials may have been subsidised in Great Britain, as some articles in more common use have been subsidised.
The Minister, I take it, is not talking about Indian meal?
I was talking, for instance, of the price of flour, which has been heavily subsidised in England.
But there is not any evidence, I think, that Indian meal has been subsidised.
I am not talking of that. It may be that the raw materials of which these articles are made have been subsidised in Great Britain, or it may be that heavy stocks of them were held in Great Britain, and that some sort of stand-still order operates there. I gather, at any rate, that while the price of these materials was increased on the 1st November last, the price of the British materials has been increased since the 1st December, so that apparently the same cause has been operating in both countries to increase price, the only thing being that there was a lag of one month in Great Britain as compared with this country. I am prepared to agree with the Senator that there is something unsatisfactory in entering into arrangements of this sort without consulting the people who will be most closely affected by it, but yet if such consultation had taken place, I think that perhaps the result might have been the same.
I am afraid so.
I am afraid so, too, because the position that we would be put in would be this: that we would have to allow one, two, or maybe ten dozen surgeons simply to veto a product of this sort. As the Senator can see, that would be rather a difficult position for us to find ourselves in, because we either had to make up our minds that it was feasible to establish a manufacture of this sort and apply the same sort of inducements to surgeons as have had to be applied to consumers in this country in regard to a considerable number of manufactures, and that have had to be applied to consumers in other countries, including Great Britain, in regard to certain manufactures there, to induce them to take our products, or else we have to abandon these projects altogether. I think, perhaps, in regard to projects of this kind, where only certain vital considerations enter, it might be possible for us to make an emergency order, and then before the actual moment has been reached to continue that order as a duty during a period of manufacture, and have consultation with professional societies. I will look into it to see if it will be possible to do that. I would not like to hold out hope that it would be done with the idea that these professional organisations would have a veto on the project. It would be necessary to listen to their representations to see if anything could be done to meet them, before the manufacturers had entered into commitments for sites, plant, or matters of that sort.
As I said at the outset, and as Senator Rowlette said very emphatically, I do not think the quality of these products can be impugned. I gather that they are generally acceptable, that great care is exercised in their manufacture, and that as close supervision as is regarded as being normal is exercised over them. With regard to the question of price I suppose that is the root of the whole policy. If we make the price the determinant I am afraid we will have to abandon the policy of industrial development altogether.
I thank the Minister for the assurance he gave at the end of his speech that he will give consideration to the question of consulting suitable organisations in advance in future. He referred to reports made by the Medical Union and to correspondence with his predecessor. The Order was not issued by the present Minister. I understand the position was that the Order was in force, and was carried out by the trade for three or four months before it came to the notice of medical men. They cannot read all these Orders. Some of us do not understand them when we do read them. There was talk of raising the question, but when they found that the Order was in force they took the view that the Minister takes, that it would be useless to meet the Minister or his staff, as it would be hopeless to expect them to reverse an Order that they had made. The point I want to impress upon the Minister is that consultation should take place in advance and before the Order is issued. He suggested that they could not meet a deputation with a view to accepting its views. No deputation would be so foolish as to expect that. What they hope for is that their views would be considered by the responsible Minister, or by the Department, before a definite decision was taken, not that a decision that had been taken should be altered, unless it was something very unusual.
The suggestion was that the opinion of expert advisers should be considered in advance and should carry weight. I have had to meet a good many Ministers through the years, and sometimes they accepted the views put before them and sometimes not. I do not think anyone goes on a deputation expecting a Minister to accept everything suggested. It was stated that advice had been taken on this matter from the Department of Local Government and Public Health. What in the world would they know about it? There is no surgeon on their staff. There is probably not a medical man on their staffs who has touched a ligature for 25 years. I am saying nothing against the officials. They are not experts in this matter and could not be. It shows a gross misunderstanding of the position by the Department of Industry and Commerce that they should think these people experts on such matters. They are experts in regard to other matters, such as inspections and ensuring that regulations are carried out. I interrupted the Minister rather precipitately when I said that the supervision is occasional. I was thinking of actual inspections of factories and the taking of samples in the city. As far as that goes it is all right.
In my previous remarks I made no suggestion that there was anything wrong in the course of manufacture. I emphasised that, as far as was known, everything was going well. In regard to the prices quoted, what I was emphasising was the relative prices of the home produced article and the foreign article. It is quite likely that this article will make its reputation and get trade on the merits. I would be glad of that. At the beginning it was getting trade on the degree of compulsion exercised by a Department which really had no expert knowledge on the question. I am grateful to the Minister for the consideration that he has promised to give the matter.
Schedule and Title agreed to.
Bill reported.
Question—"That the Bill be received for final consideration"—put and agreed to.
Bill ordered to be returned to the Dáil.