Seanad Éireann debate -
Thursday, 14 Jan 1943

Vol. 27 No. 7

St. Laurence's Hospital Bill, 1940—Second Stage.

Question proposed: "That the Bill be now read a Second Time."

Parliamentary Secretary to the Minister for Local Government and Public Health (Dr. Ward)

The purpose of this Bill is to give legislative power to provide a new general hospital in or near the City of Dublin in place of the House of Industry hospitals. It is necessary to provide a site for the new hospital, and although the Minister for Local Government and Public Health is invested with extensive powers in relation to the existing hospitals, he has no power to acquire land for the hospitals. Neither does the board of governors possess that power. In fact, the board of governors is a body with very limited powers, to explain which it may be well here to make a brief reference to the history preceding the establishment of the board.

Houses of industry were established in pursuance of an Act of the Irish Parliament passed in the year 1771-2, which provided for the creation of a corporation in every city and county, with power to build hospitals to be called workhouses or houses of industry for the relief of the poor. The Corporation for the City of Dublin was constituted in the year 1773, and it established a house of industry in North Brunswick Street, Dublin. Subsequently buildings in the nature of hospitals were erected at the institution, such as a hospital for infectious and contagious diseases, completed in 1803, a surgical hospital provided in 1811, and a medical block in 1817. After the passing of the Irish Poor Relief Act of 1838, the portion of the House of Industry which had been used solely for the relief of the poor was converted into a workhouse, and became known as the workhouse of North Dublin Union. The medical, surgical and fever hospitals continued to function separately as hospitals, and became known as the House of Industry hospitals.

An Act passed in the year 1856, entitled the Dublin Hospitals Regulation Act, made special provision for these hospitals. The Act vested the lands on which the hospitals were situated in the Commissioners of Public Works in Ireland in trust for and to the use of the hospitals, and it gave the Lord-Lieutenant extensive powers in relation to the hospitals. The Lord-Lieutenant, with the approval of the Treasury Commissioners, was empowered to regulate as he thought fit the number and description of the officers and servants to be kept in the hospitals, and the salaries to be paid to them, and he could from time to time appoint and remove such officers or servants, and upon the occurrence of a vacancy make an appointment or otherwise as he thought fit.

This provision gave the Lord Lieutenant full powers of management over the hospitals, but he was given an additional power—he could, when he deemed it expedient so to do, direct that the management of the hospitals be vested in a board of governors to be partly nominated by him and partly nominated by the subscribers to the hospitals in such proportions as he determined from time to time, and he could from time to time fix the number of members of which the board should consist and the qualifications necessary for the members to be elected by subscribers.

The Act of 1856 also set out the powers in relation to officers and servants of the hospitals which could be exercised by a board of governors if and when appointed, and the extent of the control and supervisory power to be exercised by the Lord Lieutenant and the Treasury Commissioners in regard to officers and servants in the event of the appointment of a board. After the establishment of the Irish Free State, the powers and functions of the Lord Lieutenant under the Act of 1856 were transferred to the Minister for Local Government and Public Health and the powers of the Treasury Commissioners to the Minister for Finance. The first board established in pursuance of the Act of 1856 was constituted in the year 1857. As there were no subscribers to the hospitals, all the members of the board were appointed by the Lord Lieutenant. Subsequently, new boards were appointed at different times by the Lord Lieutenant and by the Minister.

As indicated above, the Lord Lieutenant was empowered to delegate the management of the hospital to a board of governors. He could not delegate any power beyond the power of management. The board were given no power to acquire land; neither was power to acquire land on behalf of the hospitals given to any other authority. The powers of management delegated did not include the power to erect buildings. Even the comparatively minor power to alter and repair the existing buildings was given to the Commissioners of Public Works. It is, therefore, proposed to ask the Legislature to give powers both for the acquisition of land and the erection of the new buildings.

The Bill which is now before the House proposes to empower the Minister to acquire land for the purposes of the hospital. He may acquire the land either by agreement or compulsorily, and for the purposes of compulsory acquisition the provisions of the Acquisition of Land (Assessment of Compensation) Act and of the Land Clauses Acts may be applied. The Minister may, before making an Order for the compulsory acquisition of land, hold a public inquiry at which any person interested may appear personally, or by counsel or solicitor, and adduce evidence. All land so acquired by the Minister shall be held by him in trust for or to the use of the hospital.

The Bill provides that the hospital to take the place of the existing hospitals shall be known as St. Laurence's Hospital. A new board, to be known as the Board of Governors of St. Laurence's Hospital, is to be constituted. The personnel of the existing board will become the new board. The Minister is given power to alter the constitution of the board, and to make appointments to casual vacancies on the board. The Bill contains the usual provisions in relation to the meetings and proceedings of the board. The appointment and removal of officers and servants, and the salaries to be paid to them are matters to be dealt with by the board, subject to the consent of the Minister, and the Bill contains a new provision which enables the Minister to delegate to the board full power to appoint, remove, abolish and fix remuneration in relation to any office. The board of governors are required by the Bill to prepare and submit to the Minister for confirmation a pension scheme for providing pensions and gratuities for or in respect of paid officers and servants of the board.

When the Minister has acquired the necessary land, the board must, with all convenient speed, prepare and submit to him a scheme for the erection and equipment of the hospital. The Minister may approve of the scheme without modification, or may modify it whether by addition, omission or variation, or he may require the board to submit a new scheme. After the scheme has been approved by the Minister, the board shall proceed to erect and equip the hospital. The unexpended balance of any moneys received by the existing board of governors under the Public Charitable Hospitals Acts, 1930 to 1932, and any accumulations on such moneys are to be applied by the new board towards the cost of preparing the scheme and erecting and equipping the new hospital. The Minister is required to pay the balance of the cost out of the Hospitals Trust Fund so far as in his opinion such cost has been reasonably incurred. The board of governors are given power, with the consent of the Minister, to extend, alter, enlarge or otherwise improve the hospital. The board are empowered to control and manage the hospital, and for that purpose to do all such things as the governing body of a hospital are usually authorised to do in relation to a hospital controlled by such governing body. Other powers given to the board of governors include power to invest funds in trustee securities, to accept real or personal property as endowment, to hold land and to borrow by means of bank overdraft or otherwise.

The property, debts and liabilities of the existing board of governors are transferred by the Bill to the new board. The officers and servants are also transferred. The Bill provides for the preservation of their status and remuneration. The lands upon which the existing hospitals are built are transferred to the Minister, and he may sell or dispose of the lands or any part of them. The moneys received by the Minister from the disposal of lands, after payment of the costs and expenses incurred by him in connection with such disposal, are to be paid into the Hospitals Trust Fund.

The transitory provisions of the Bill empower the Minister, when the new hospital has been erected and equipped and is ready for the reception of patients, to arrange for the closing of the existing hospitals in parts from time to time as he sees fit. It is not expected that it will be possible to close the existing hospitals entirely when the new hospital is completed. Having regard to the position as regards bed availability in Dublin, it may be necessary to keep portions of the hospitals open for some time. Furthermore, the provisions of the Bill will enable an outpatients' department to be continued on the existing premises so long as it is considered desirable. In regard to the portions of the old hospitals which are retained, the new board are empowered, subject to the provisions of the Bill, to do all such things as the governing body of a hospital are usually authorised to do in relation to their hospital.

Dr. Rowlette

The account which the Parliamentary Secretary has given of the history of the hospital, although interesting and no doubt accurate as far as it goes, hardly I think gives the Seanad a conception of what the work of this hospital has been for something well over 100 years—I think about 120 or 130 years—or of its position as a teaching centre. I listened to him attentively—I do not think he mentioned once that it is one of the great teaching schools of medicine in Ireland. It has had that reputation for a very long time, and, in making any provision for the future of such an institution, that is a consideration which the Legislature should have before it. They should make quite sure that, whatever changes may be made, nothing will interfere gravely with the possibilities of carrying on that distinguished school of medicine. The whole basis of the Bill as I understand it is that the House of Industry Hospital—or the Richmond Hospital to give it its familiar name—is a State hospital. I am not sure what the term "State hospital" means. I can quite understand what a State-supported hospital is, and what this hospital was at the time when it was mainly if not altogether State-supported. The possibility of justifying the term "State hospital" on that ground has, of course, vanished. It is over 20 years since the British Government repudiated the suggestion that it was a State hospital.

At that time the hospital had got into debt; by the generosity of the treatment it gave to the poor of Dublin, it exceeded the State allowance, and the income which it had apart from the State allowance was a very small proportion of the total expenditure of the hospital. At the end of the last Great War I think what happened was that the hospital found itself heavily in debt through excessive expenditure during the war years, and applied to the Government to meet the deficit in its accounts. The application was rejected, I think I might say with contempt. The Board were told that they had no claim whatever on the Government, that they were not a State hospital, and might do what they liked to foot the bill. As I understand it, what followed on that was that a number of people interested in the hospital—amongst others, members of the medical staff, who must have been, 25 years ago, wealthier than the medical staffs of the Dublin hospitals are to-day—put up a considerable amount of money to keep the doors of the hospital open, and they have continued to keep the doors of the hospital open ever since, with great advantage to the people of Dublin and to the country as a whole, as well as to the teaching of medicine.

I think the original State grant was continued until eight or nine years ago. I am not able to verify these dates and I am speaking approximately. It was continued until some eight or nine years ago, when the various Dublin hospitals combined together to attempt to get financial support from other sources than the Government and from other sources than the charitable people of the country. The charitable people of the country had to a considerable extent lost the means of subscribing to the hospitals, and there were very few rich people of leisure in the country—whether they were an advantage to the country is another matter—but for this particular purpose they were an advantage; they used to subscribe freely and generously to the various voluntary hospitals in Dublin. The Richmond Hospital, like other hospitals, felt the pinch of that falling off of these subscriptions, and with others they devised a method for obtaining money. The sums of money that came were beyond their hopes, and for some few years those interested in the hospitals believed that, if they were allowed to make proper use of the money that had been collected for them, they could establish a hospital system in Ireland —not merely in Dublin, but in the other centres—which would be as good as that anywhere else in the world. They did not reckon with the Oireachtas or the Government.

When there was a good deal of money coming to those charities, the Government saw that there was a chance of putting their hand in the till, and they put their hand very deeply into the till and, in the first instance, they diverted from the voluntary hospitals who, at their own risk, had collected this money, a proportion of it to the rate-supported hospitals in the country, thereby taking from the ratepayers of the country the responsibility they had ever since hospitals were started of providing the main funds for the building and support of those hospitals. That was not enough. There was still a good deal of money coming in and the Government looked again and said: "We will take our own pull out of it," and they took a very big pull, 25 per cent. out of the receipts. That, with other causes—undoubtedly there were other causes, increasing expenses and greatly diminished receipts, during the last few years particularly —have put the hospitals in this difficulty that, although they have collected several millions of pounds at their own risk and by their own work, the people who have got a very large proportion of that are not the people who collected it but the ratepayers and the taxpayers of the country. I am not suggesting that the majority of money collected for the hospitals has gone to the rate-supported hospitals, but a very considerable proportion of it has. I think I would be right in saying that probably one-quarter to one-third of it has gone to the rate-supported hospitals. I may be wrong in that figure and I do not wish to be bound by it or to mislead the Seanad on it.

The next step was that instead of allowing the hospitals to divide their own funds as they thought fit, the Government decided to appoint a commission to inquire into the needs of various hospitals and other activities which were defined as hospitals; not only that, but to advise on the distribution of the funds; not only that, but they made the Minister for Local Government and Public Health the person who would decide after getting the advice of the commission. The commission were only to advise, but the Minister was to decide after hearing the advice of the commission. What has happened, of course, is that the fund accumulated has gradually been depleted. The expenditure of hospitals has necessarily increased from various causes. The prices of ordinary commodities of use in hospitals and of use in our own households have increased enormously and were increasing before the war. Secondly, the hospitals, in the days of poverty, had got very behind-hand in their equipment and, as years passed, required more equipment. The only source for providing that equipment was this fund which has been collected for their advantage. The price of equipment of every sort, of course, has gone up enormously during the last few years, and consequently, the hospitals are getting into greater and greater difficulties although there is still a certain sum of money which was intended to provide for the future endowment of the hospitals after they had been put in working order.

The important point bearing on the present Bill is that the Richmond Hospital, in common with other hospitals, has got considerable grants from the Sweepstake funds and that the Minister is the person responsible for distributing those grants. The Minister, apparently, comes into this Bill with two entirely different claims. One is that the powers of the Lord Lieutenant of the past have been transferred to him—overlooking or forgetting the fact that the Lord Lieutenant, or those who employed him—the British Treasury—had renounced any claim to the hospital being a State hospital, and any further connection they had with it was purely, I think, automatic. The appointment of governors, and so on, was done automatically without the Lord Lieutenant, after that renunciation, exercising any real powers as to the appointment. What he had done in earlier years, I do not know, but probably he was advised by various people, including the board of the hospital, as to what appointments he should make to the board of governors. I think it highly unlikely that, after renouncing that the hospital was a State hospital, he continued to exercise that power. But the Minister comes along now, in the robes of the Lord Lieutenant, and asks us in this Bill to give him the same powers the Lord Lieutenant had in the past, but to a very much greater extent than the Lord Lieutenant ever had or that the British Government ever exercised, whatever powers they might have had by statute.

That is extraordinary enough, but what is more extraordinary is that part of that claim is based on the belief that because the Minister is trustee for the distribution of certain funds to a number of hospitals, up to 50 or more, in the country, thereby this hospital is a fortiori a State hospital. I do not know whether the Minister or the Parliamentary Secretary intends to exercise that claim in regard to the other hospitals which have been given varying sums, up to sums of many thousands of pounds, but if that be so —and the claim has been put forward in regard to the Richmond Hospital— then all the voluntary hospitals of the country are in greater danger than they anticipated. They have known for many years past that they were in considerable danger and, if this threat is over them, any confidence they have in the future will be abolished at once. I hope the Parliamentary Secretary will, at the earliest opportunity, renounce any such claim, that because a grant has been given from the funds of the hospitals to a hospital, that makes a hospital a State hospital or any more under the control of the Minister than has been provided in the various Acts which empower him to attach certain provisions to his grants from the Sweepstake funds.

The Bill appears to try to draw tighter and tighter whatever hold the State, or whoever represent the State— the Lord-Lieutenant in former days— have previously had on the hospital and to restrict the activity and authority of the board of governors more and more.

In particular, there is one clause which may be debated perhaps again on the Committee Stage, Section 21, which empowers the Minister, for the purpose of providing a site for the new hospital, to acquire, either by agreement or compulsorily, land in or near the City of Dublin. That proposal has been amplified by the definite approach of the Minister to the hospital, pressing on them, urging on them, almost forcing on them an acceptance of his view that the hospital should be transferred from a city site to a site in the suburbs or in the country near Dublin. As the Parliamentary Secretary explained the intention of the Bill to-night, he made it clear that it was intended to maintain part of the old buildings and use them for hospital purposes. He did not give any information, I think, as to the wish of his Department that the hospital should be transferred to another site. I move the adjournment of the debate.

Debate adjourned until Wednesday, 20th January.

The Seanad adjourned at 9 p.m. until 3 p.m. on Wednesday, 20th January.