I move:—
That the Seanad requests the Government to set up a commission to inquire into and make recommendations upon the matter of hospital finance generally; and, more particularly, upon the relations between the voluntary hospitals and the State, with a view to the establishment of the organisation best suited to the efficient operation of the whole hospital system.
For some time past I have felt that a motion of this kind was overdue, and I felt it especially when we were discussing the St. Laurence's Hospital Bill. A number of questions arose there which really raised a wider issue than that which the Bill itself covered, and although, through your indulgence, Sir, we were allowed to discuss certain things that may not have come within the scope of that Bill, I felt that I could not deal with a number of matters, within the scope of that Bill, in a properly comprehensive way. Accordingly, I have drawn up this motion in general terms —terms which appear to me to admit of the widest possible discussion of hospital finance and policy. I need hardly say that if the Government were to accept the principles involved, it would be necessary to consider, in much closer detail, of course, the terms of reference that would go before any commission that may be appointed.
Now, my reason for feeling that an inquiry, on the lines of the motion, is necessary, suggests that I should refer very briefly to the background of this whole hospital question. Up to the time that the Sweepstakes were established, a certain practice had grown up as a result of experience. We had the old traditional system of voluntary hospitals, arising out of the necessities of the poor, and which were intended, mainly, by their charitable founders, to give treatment to the poorer classes of the people. As a result of that system, over a large number of years, you had hospitals founded which were supported, in the main, by voluntary subscriptions. Certain hospitals, such as the group with which we dealt in the recent Bill, were financed, mainly, by State funds. Then, as time went on, the needs of the sick poor were not adequately covered by the voluntary system, and, going back to the early days of the poor law system, you had the dispensaries and other services provided by local authorities. As I say, the whole hospital service developed, more or less, on those lines, until the Sweepstakes came along; and the Sweepstakes came along largely because the source of voluntary contributions proved to be inadequate for the services required. Certain hospitals were getting into financial difficulties owing to increased expenses and declining subscriptions, and it was felt that some other form of assistance should come to their aid, and, as you all know, the Sweepstakes came into existence.
Now, in the early days, the Sweepstakes were a comparatively modest affair, but they grew to such an extent that it became necessary to regulate the new position that they brought about. I quite agree that it would have been quite impossible to allow the, if I might call it so, unseemly scramble that took place among certain hospitals in the beginning of the Sweepstakes to get funds and spend them as they thought fit, whereas other hospitals were excluded. The result was that the whole thing became almost a national problem, and I quite agree that the State or some other authority had to step in and regulate and control the distribution of these considerable sums of money that had, somewhat unexpectedly, and rather surprisingly, come in. A committee was set up, therefore, to deal with that matter, but I say that the present system is only an improvisation brought about by some exceptional needs resulting from the advent of these Sweepstakes funds.
The present system is in the nature only of an improvisation; it never has had in view the wider needs of hospital treatment and medical services for all classes of the community. That is a much bigger problem, which I feel, in preparation for post-war conditions, now falls due for comprehensive examination. Those of us who feel that inquiry is necessary have to ask ourselves: is the present system of control—brought about, as I have said, largely by the Sweeps—satisfactory? If it is a regulated and co-ordinated system, capable of meeting the needs of the future and the new conditions we will have to face, well and good; I would then be the last person to ask that it should be changed. But, personally, I have grave doubts—many people with whom I have discussed the matter also have doubts—that the present system is best suited to the very important work that lies ahead, to the new conditions that we are likely to have to face, and to the general desire to provide better services for the sick among all grades of our community, not merely the very poor, who cannot afford to pay, but those of small means who can afford to pay a little, and those of larger means who can afford to pay a good deal more.
The system at present—I am speaking mainly in regard to general hospitals—is in this form: you have in existence the old hospitals under the voluntary system, a number of them teaching hospitals under their own peculiar regulations, some attached to universities, and, which is only right and proper, all with their own special characteristics arising out of their origin. Then you have, as a result of the control that became necessary when the Sweeps money came on the scene, a body called the Hospitals Commission. That body is not an executive body. It is an advisory body; I think I am right in saying it is merely there to advise the Minister as to the needs of existing hospitals, mainly with regard to the distribution of the Sweepstake funds. I should be the last person to suggest in any way that that body has not done very admirable work. One has only to look at their reports to see the vast amount of information they have collected, in many cases the very valuable suggestions they have made, and the enormous industry shown by the large volume of statistics they have compiled, but we realise that that body has no responsibility to anyone except to the Minister in an advisory capacity. As I said, it is not an executive body, but it is one that imposes an element of worry, and, I would suggest, a certain element of delay in reaching final decisions which are the responsibility of the Minister.
I should like at this stage to make certain references to the publications of that commission. We have a series of reports dating from 1933-34. In the course of a rather detailed inquiry I was met by certain not very important but puzzling features. I am a little bit puzzled because, in respect of the forwarding and acknowledging of the reports, I am met by the Irish language. Elsewhere in the reports I am dealing with my own tongue, but in regard to the forwarding and acknowledging of them I am a little bit puzzled as to the exact particulars. I notice that the 1933-34 report was forwarded without date, and it was acknowledged in Eanair, 1936—I do not know what that month is—by the Minister's Department. The next report I come to is for the year 1935-36. It was forwarded in Deire Foghmhair, 1937. Again, I do not know what that month is. You will note that it was forwarded in the year following the report, and it was acknowledged in the same year. Both those letters were dated. Then we come to the year 1937. The report was forwarded in Meitheamh, 1938. Now, here is a curious thing; it was forwarded in 1938, and was acknowledged in a Ministerial letter without a date. It is rather strange to find an undated letter issuing from a Government Department. Then we come to the report for the year 1938. It was forwarded— here I am almost sure I have correctly translated the name of the month—in July, 1939; it is given here as "Iul, 1939." Again, it is acknowledged without a date, so for two years in succession we have an undated acknowledgment. It is a small matter, but it is puzzling.
After that, we have no more reports; the last report is for the year 1938. I would ask the Minister to tell us why, after having had consecutive reports covering a period of five years, each forwarded within the year following the period with which it dealt, we then have a complete blank for a period of four years, four years during which important work must have been done by the hospitals? It is a great handicap to anybody who wants to discuss hospital policy to be without those valuable reports for four years. On the St. Laurence's Hospital Bill, I asked the Minister why this was so, and he rather expressed surprise that it had been so. In any case, he said he would inquire into it. Presumably, that was the first time he knew that there had been this long delay in publishing these reports.
I do not want to make invidious comparisons, but it does seem strange that some Government Departments are much quicker than others. For instance, we already have the report of the Land Commission with reference to last year's activities. We also have the report of the Electricity Supply Board, a very complicated organisation covering a vast field of commercial activity. We get that report with extraordinary regularity and punctuality. In the case of this commission, there has been no report for some years. I cannot help feeling doubtful that the commission is entirely responsible for this delay. This commission, for five years, presented its reports punctually, and then suddenly in 1938 it dried up and has remained dried up ever since. I think we are entitled to a full explanation of the delay.
When you examine these commission reports, you find an extraordinary volume of statistics. I welcome statistics, but I always like to be satisfied as to the purpose they serve. Statistics collected merely for the sake of collecting them, and which do not appear to be capable of much use, are, to my mind, an unnecessary waste of time and money. I doubt the value of some of the statistics contained in the large volume covered by some of these reports. For instance, you have, in relation to the general hospitals, a segregation of expenditure under a number of headings, such as provisions, surgery, domestic, miscellaneous, and so on. You have then in relation to the total number of occupied beds, covering two or three pages, and in relation also to the total number of beds available. I am not an expert in hospital management or control, but I fail to see how anybody, however expert and however closely concerned in hospital control, would require such a large volume of statistics set out separately both for occupied and for available beds. We might like to know the total number of occupied and available beds, and we might like information as to the degree of occupancy—that is all separately set out—but why there should be so many statistics under other headings, puzzles me.
I also question whether, when certain information is not given, very much value can be got from these statistics. For instance, looking at surgery and dispensary, I notice in the case of two hospitals, the Adelaide and the Drumcondra, that no figures are available. I can understand that the Adelaide, not being associated with the Sweepstakes, does not consider itself under an obligation to present any figures, but the fact that there are no figures does make a serious gap in any investigation. I come now to an extraordinary discrepancy. In one hospital I see that the cost per occupied bed is £16; the lowest is £14, and the highest is £41. I feel that cannot be so in reality, and that there must be some rational underlying explanation of a discrepancy of almost £30 in regard to an occupied bed. There is no explanation given for that, however, and, in the absence of any explanation—looking merely at the bald figures—I doubt if such a large volume of statistics is really worth all the trouble taken in its compilation.
I pass on to the appendices, the statistics of illness, and I am interested to find there a new feature in our Government publications. I find three languages—rather a hopeful sort of international outlook. I notice the omission of Irish as a heading—I do not know that that matters very much. We have English, French and German headings for these various categories of illness. Perhaps they may be valuable for foreigners studying hospital statistics; it might be interesting for foreigners to notice the incidence of disease in Kerry County or in Cork City, but I question whether the whole thing is of any practical value. I am rather driven to this conclusion, and I say so with all due regard to the valuable work that the Hospitals Commission has done, that I am afraid it is a body that is growing into merely a statistics-collecting body and, to a certain extent, these statistics are drawn up merely to justify existence, without regard to need. I do not feel that the work this body is doing is worth the money that must be spent upon it—I do not mean all the work, but I do mean the minute statistical work—and I cannot escape the feeling that that body is, to a certain extent, collecting this large volume of figures merely to justify its existence.
One thing I should like to refer to in relation to statistics is the total absence of any costings. I find—and I hope the Parliamentary Secretary will agree with me—that the only statistics that are of any use for the purpose of control are statistics got out on a unit-costing basis. There is nothing of that kind being done. I know there has been difficulty about it, but I feel that over the period of eight or nine years some attempt might have been made to give some figures which would carry confidence as showing the true costings.
On the question of finance, speaking in round figures, up to the year of this last report, 1938, the hospitals had received a total of approximately £13,000,000 from the Sweepstakes. At the present date, approximately £8,000,000 remains as a fund under the control of a vesting body, the Hospitals Trust. The titles in these cases are rather misleading, but I am referring now to the body having control of the investments.