I agree with most of the remarks the Minister has just made, and particularly the remarks he made at the close of his speech. Without any authority to speak for my colleagues in my profession, I think I am not misrepresenting them in saying that they would welcome the establishment of a bed bureau. Their difficulty is not one of principle. They recognise what the Minister has just said, that such an institution could be of great help in facilitating and hastening the admission of patients to hospital. Their hesitation is due rather to the admitted fact that the number of beds is entirely inadequate for the people requiring hospital accommodation, and until those beds are provided—as they should have been provided, were it not for the interference, not of the Government, but of successive Dála and Seanaid—there is considerable hesitation on the part of those who are familiar with the hospitals, from the point of view that such a bureau will not have the material to work on. The bureau is designed to guide people to beds, and, if there are no beds, the people cannot be guided to them.
When I refer to the matter of beds and say that the inadequacy has been due to the greed of successive Parliaments, I refer to the fact that although the institution of the sweepstakes was by and for the voluntary hospitals, much of the funds has been diverted, by Parliamentary authority, to the relief of the rates and to the relief of State funds. One Government alone is not responsible. Successive Governments have been equally vicious in regard to this accumulation of money. At first, a considerable proportion of the funds collected for hospital purposes was diverted from the voluntary hospitals to rate-supported institutions, thereby relieving the rates and making our necessary national institutions parasitic on the charity of the gamblers of the world. Later, another Government devoted an enormous proportion of the receipts from sweepstake funds to the public Exchequer. were it not for these diversions of funds raised for the voluntary hospitals, there would have been an adequacy of beds, certainly in the City of Dublin and in the greater cities of the State. It is to that inadequacy that most of the hesitation of members of the medical profession and those concerned with hospitals is due. If the Minister is able to proceed in the near future, I trust the difficulties that face him may be got rid of.
With regard to the general view of the successful functioning of a bed bureau, I want to say, quite sincerely, that those who are interested in the hospitals must be very grateful to the Minister for the consideration he has given to the various criticisms offered to him, sometimes not in the kindest of terms, within the last couple of weeks, and I agree with him that the Bill as it reaches this House is certainly a much better Bill than it was as circulated a fortnight or three weeks ago. He has removed many of the points which, naturally, gave rise to considerable anxiety, so that the Bill—and I hope he has not said his last word in regard to certain clauses —certainly does not cause the same anxiety to those interested in hospitals as the original draft did.
A great difficulty in dealing with this Bill which faces us still, and which certainly faced the Dáil a couple of weeks ago, was that it deals with two entirely different topics. It contains certain purely legal provisions to make it possible to carry on the sweepstakes and thereby to keep them in existence and to collect some more money, not perhaps, for capital outlay, but to help to pay the running expenses of the hospitals in the months and years of stress still facing us. Such provisions were necessary if the sweepstakes were to go on and they could have been presented to the Oireachtas and have received approval in both Houses in the course of an afternoon. Instead, they were incorporated in this Bill for what reason I do not know. No explanation has been given why those noncontroversial and urgent provisions were associated in the same Bill with highly controversial provisions. A few moments ago, we heard criticism of another measure because it dealt with entirely different subjects, but, whatever may have been cognate between those two subjects I cannot find anything cognate between the two subjects dealt with in this Bill. The result has been that the initiation of a sweepstake to be held, it is hoped, in August of this year has been delayed and the sale of tickets held up and the funds consequently diminished, all by this association of these provisions in the same measure with the establishment of a bed bureau. We who are interested in the hospital situation have had the difficulty that we had either to accept the Bill as it stood a fortnight ago or hold up the sweepstakes by spending time in criticising the Bill, or, on the other hand, possibly sacrificing what seemed to us to be the essential principle of the voluntary hospitals. The Minister, by his consideration, and his conciliatory attitude, has done away with a great many of these difficulties but still the loss has been incurred of holding up the sweepstakes unnecessarily for some weeks.
Another matter which raised a good deal of anxiety was that it was pretty well known that a previous scheme had been drawn up for the establishment of a bed bureau. This was agreed on after long consideration between the Minister and officers of his Department on the one hand and representatives of certain groups of hospitals on the other. Agreement had been reached and it was hoped and expected that, agreement having been reached on such a scheme after full consideration with the Minister and his advisers, it would form the model of any future plan for a bed bureau, but the scheme published two or three weeks ago and included in the original draft of this Bill was as different from the agreed scheme as a tiger is from a kitten. All the claws had come out. The Minister has since pared off some of thtm, and I hope he will pare off a few more. Every single safeguard in the agreed scheme, for the independence of the hospitals, for their protection from interference by officials, and their independence of conduct, apart from poor patients, disappeared in the Bill. These matters have made approval of the Bill a matter of great difficulty. It is all the more credit to the Minister, and I am quite sincere in saying that, that he has been able to dissolve a great many of these fears and doubts.
I have also to make a few suggestions. I am not making any that will touch on any points of principle that the Minister has in the measure before us. In looking at the clauses as we read them, and as he has explained them to us, there are a few points which require more explanation, and there is some hope that he will consent to amendments. A technical point occurs in Section 2 which leads one to ask: "What is, at the moment, and what is to be the future constitutional position of the Hospitals Commission?" Up to the present, as far as I know, it has been a body to consider and advise on the various hospital questions and to make recommendations to the Minister as to how he should allocate the funds which, by statute, are under its control, the funds that come in from the sweepstakes. Does it become a permanent body? This is, I think the first Bill which seems to give it a permanent status. I am asking this simply to have the section clarified and not from the point of view of any criticism.
Many of us thought that if the Hospitals Commission had been permitted to advise the Minister directly, as was the intention of the Oireachtas, when that Commission was first appointed by legislation, that they should be constituted as his advisers in regard to the development of voluntary hospitals. If that had been permitted to take place, many of us thought it would have been a better method than what was actually adopted. What has followed? It is that the Commission first advises the Department and then the whole thing begins all over again and the Department considers various schemes put up by the Commission and rejects them or accepts them and they then become advisers of the Minister. Here we have the Department put in between the Hospitals Commission, which is given a special task to perform, and the Minister. That inevitably causes delay. It is difficult to believe that the Department—the permanent advisers of the Minister—could give the same amount of study to the hospital question as members of the Hospitals Commission could, who have been devoted specially and entirely to that subject during the period of their membership. I wish the Minister would clarify the position of the Hospitals Commission in the future. Is it not unusual for any commission, which is subordinate to a Minister, to make regulations? I understood that the making of regulations with binding power was confined to Ministers, though I may be wrong in this. I am not objecting to the Hospitals Commission making these regulations, though I would prefer if it were not merely after consultation with, but on the advice of the advisory committee. An advisory committee is one thing: it has power to give advice; but I would prefer if the commission were bound to accept that advice or, otherwise, to refrain from action, that they should not have power to make regulations of their own after consultation with the advisory committee, although only with the consent of the Minister.
There is another point in this same paragraph. Section 2, sub-section (3) is not quite clear. In any previous discussions with the Minister's predecessor it was understood that the functions of the hospital bed bureau would be concerned solely with a certain number of beds to be fixed by agreement with the Minister the admission to which was to be through the agency of the bed bureau. In this section, however, and as I think in subsequent sections, it seems to be assumed that the bed bureau can function in relation to all or any beds in the hospitals which come under its purview. There was a clause in the preview vious agreement which said that the function of the bed bureau would be ancillary to, or supplementary to, the ordinary method of admission to the hospitals; but, so far as I can judge from the scheme as it reaches us now, the bed bureau may concern itself with every single patient admitted to the hospitals which come under the purview of the Bill. I hope that the Minister will be able to give us assurance on this point; possibly he will accept an amendment to make that clear. If it is to be understood that there is any danger that the ordinary methods of admission to the voluntary hospitals, which have been in force for anything up to 200 years or more, are to be suspended or given into the control of the bureau, I think it will rouse not merely great anxiety but considerable unwillingness to have any further dealings with the sweepstakes grants.
Further down, in Section 4, which deals with the system of investigating complaints, the terminology is extremely loose and I think it would be impracticable in working. It says:
"Where the Hospitals Commission ... complain to the Minister that any person was refused admission as an intern patient..."
"Any person" has no right unless he comes there with some authority. He may be unsuitable but, under this section, no matter how unsuitable he may be, he could lodge a complaint and the matter would have to be considered. I am sure it would never reach the Minister, if it were an unreasonable complaint, but the Hospitals Commission has to consider it and the appropriate advisory committee has to consider it. Unreasonable people who would like a week's rest sometimes arrive at a hospital and ask to be admitted. They may have no complaint requiring hospital treatment, but I can well understand such a person, if refused admission, at once putting the advisory committee, the Hospital Commission and the management of the hospital to the trouble and expense of investigating his complaint. I am not talking idly. I have had experience of a case where a citizen of Dublin, who thought he needed a week's rest, walked into a hospital, climbed into a bed and could not be evicted unless the police were brought in and carried him bodily out into the street. He was not a suitable case for hospital treatment, but I have seen him in hospital on more than one occasion by that procedure. He was a member of the City Council, but I will give no name. The point I am urging on the Minister is that the term "any person" is far too wide. It should be "any person who requires treatment" or "any person who has received an admission order from the Hospital Bureau" or "any person who has received a recommendation for admission from any medical practitioner". I think the term "any person" will involve these bodies in trouble and expense.
With regard to the whole section dealing with complaints, it has evidently been founded on the procedure at present used in conducting a sworn inquiry by officers of the Minister's Department. I think there is a false analogy between this case and a sworn inquiry by officers of the Minister's Department—which can only deal with institutions directly under the Minister's control as Minister, a rate supported institution, or an institution under the authority of a local body, and where the people concerned are salaried servants of the local authority. The procedure should not be the same where the work is done by voluntary workers, as is the case in the voluntary hospitals. A surgeon or physician in a voluntary hospital is not in the same position as a salaried officer of a county hospital or a district hospital under the control of a local authority and I do not think there is any reason to suppose that the procedure should be the same. I am quite ready to admit—as I am sure the Minister will say—that these complaints will be few, and that not many of those lodged will be likely to get as far as a sworn inquiry. It is not right that a person who is giving his work voluntarily and gratuitously to patients should be asked to spend some of his time—perhaps a day or two—attending a sworn inquiry.
There is another point about the inquiry which seems to require clarification. The procedure laid down here seems to take no account of the privacy of the personal affairs of a patient. This is not a matter of personal professional privilege on the part of a medical man. It is a question of privilege for a patient to keep his private affairs to himself. Medical attendants and nurses should not be made subject to a public inquiry or be dragged into the light of such an inquiry. There are great objections to a private inquiry and there are also objections to a public inquiry.
I think the Minister should consider that matter. He could probably deal with it under the regulations and I should be quite satisfied if he did that, so as to prevent any trespassing on the privacy of a patient who seeks treatment in any one of the hospitals. Remember information of that sort may do grievous injury to the patient himself. The patient may be in employment and it may injure him grievously if the nature of the complaint becomes known by any such publicity to his employer. I have been invited by employers myself to tell them what was wrong with particular employees who happened to be under my care in a voluntary hospital, and I have always declined to do so. Sometimes my refusal has been the cause of great anger. When I ventured to ask one employer to picture himself in the place of the employee and asked him if he would be willing to allow me to disclose the nature of his complaint, he agreed that I should not do so. Yet he could not see that there was any parity between the two questions. I ask the Minister very seriously either in the Bill itself, or by regulations made under it, to take steps to prevent any publicity on such matters regarding what are at present and what should be, the private affairs of a patient. The patient very often cannot choose for himself. He must go to the hospital, and if he does so and has any cause for complaint—he would have a legitimate cause for complaint —he would have his private affairs dragged into the light of day. I do not think that is fair.
There is only one further suggestion that I wish to make to the Minister. In Section 7 he is providing himself with machinery for getting information, to which I think he is entitled, with regard to the manner in which a hospital carries out any conditions attached to grants which it gets from funds under the Minister's control. He is being given power to employ an officer for purposes the performance of which were previously limited, if I am not mistaken, to the Hospitals Commission. I am not quarrelling with that. I think he is obliged, if he has control of certain funds, and if he attaches conditions to a grant of moneys out of such funds, to know whether such conditions are being fulfilled. It might be an advantage to him to be able to send an officer into a hospital to get such information, but I think that the powers of such an officer should be very carefully defined. Perhaps the Minister when it comes to the Committee Stage would accept an amendment dealing with that matter or would consider bringing in such an amendment himself by way of a fresh sub-section after sub-section (2) of Section 7. The sub-section might contain such words as these:—Provided that nothing in this section shall give authority to such officer to interfere with the control or management of any voluntary hospital.
The Minister is giving nothing away in that. I am quite sure that it is not his intention that such an officer should interfere with the control or management of a hospital. I think I know the answer he gave to this point when it was put to him before in this House—that he claimed no such power but that he did not wish to put into the Bill anything which would indicate something which there was no reason to fear. I would ask him to consider that some authorities are extremely sensitive about visits of this nature. Certain hospitals are very sensitive, unduly sensitive if you like, and fear that such an officer coming in might claim some power to interfere with the control or management of the institution. The purpose of sending him there is to get information on certain points but certain hospital authorities, as I say, are extremely sensitive on this matter and I think the Minister would not be depriving himself of any authority which he wishes to have, or any authority which he has at present, if he were to accept the suggestion which I have now made. It may be that there is no justification for such fears but nevertheless I think that the fears of these people should be considered, particularly when there is no principle involved. I would ask the Minister to consider that matter and, if he cannot deal with it in the Bill, I think he should have power to deal with it when it comes to the framing of regulations.
I have said all I wish to say by way of comment. I do want to say very seriously that a very anxious few days were spent by those interested in the control, management and working of the voluntary hospitals when the original draft of the Bill was issued. Those to whom I have spoken are very grateful to the Minister for the sympathetic consideration he has given to the various suggestions made to him both in public and in private. I shall just say one more word on the topic: that I am glad he was willing to receive representatives of the general body of the medical profession in the country and to discuss the matter with them in an entirely friendly way. He has established a precedent which I hope he will follow. He will find if he does so, that the members of the medical profession are anxious to be helpful to him in every way. He will find that while the representative body wishes to be helpful to him it is very unwilling to be spurred or irritated. That experience of one pleasant meeting will I hope encourage him not to make it a solitary example. This may be hardly relevant to the Bill but I think I can be excused for having said so much.