Health Bill, 1947—Second Stage.

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

On the motion that the Bill be read a Second Time, I may say that the purposes of this Bill are, in short, to bring the law relating to the health services up-to-date, to simplify the administration of these services and to add to them where they have been found to be deficient.

The law now governing the health services is very complex and is intertwined with the codes relating to such sanitary services as water supply, baths, washhouses and bathing-places and burial grounds, as well as with the general law dealing with local government. Senators who wish to study the intricacies of this law will find a convenient list of the various Acts and sections of Acts dealing with the health services in the First Schedule to the Health (Transfer of Departmental Administration and Ministerial Functions) Order, 1947, which has been presented to the House. That is the Order under which the functions proper to my office were transferred from the Minister for Local Government. Forty-six complete enactments and portions of 14 other Acts are listed in that Schedule. These include parts of the Public Health and Local Government codes and various Acts dealing with infectious disease, tuberculosis, maternity and child welfare, school medical services, medical registration and similar matters under a wide variety of titles. Some of these enactments are now out of date and the powers given by them have not been used for many years.

The most important provisions still in use are contained in the Public Health Act of 1878 and the various Acts which amended and extended that Act. These Acts deal mainly with sanitary matters which remain proper to the Minister for Local Government and the title of the code is being changed by the Local Government (Sanitary Services) Bill, 1947, to the Local Government (Sanitary Services) Acts. The provisions in the code which relate to the health services, together with the out-dated unused enactments and provisions in other codes dealing with health, are being repealed in the Bill and re-enacted where needed in a modernised form.

The Bill does not purport to codify in one Act all the law dealing with the services for which I am the responsible Minister. That, I think, is scarcely necessary and would hardly be practicable. But, when this Bill becomes law, almost all the legislation relating to my Ministerial responsibilities will be contained in a modern series of Acts which will include, as well as the Health Act, the Mental Treatment Act of 1945, parts of the Public Assistance Act of 1939 and some self-contained Acts dealing with such matters as the registration of members of the medical, dental and nursing professions. We will thus have gone most of the way in disentangling the law dealing with the health services from other codes and in simplifying and bringing it up to date.

Now, as regards the simplification of administration, I have, since being appointed Minister for Health, been struck by the complications in the present local structure of the health services. First, you have the sanitary authorities (the county borough councils, the urban district councils and, for rural areas only, the county councils) who, as well as being charged with the responsibility for providing water supplies, sewerage and other sanitary services, are also responsible for the control of infectious disease, for maternity and child welfare, for certain services relating to food supplies and for the appointment of district medical officers of health.

Then you have other health services (including the school medical service, the tuberculosis service and the venereal disease service) administered by the county council in the entire county. The county medical officers of health appointed and paid by the county councils, are also charged with the responsibility of supervising the health services administered by the urban district councils. This division of responsibility for the health services between two sets of local authorities has hindered their proper development and, in particular, has prevented any close integration of the maternity and child welfare and school medical services.

It is now proposed that the urban district councils should not be left any functions in connection with the health services. The county and county borough councils will be given the sole responsibility for the local administration of this Bill. There will thus be a much simpler framework on which to build up the services which will be developed under its various provisions.

So much for the legal and administrative provisions of the Bill. Now, as regards the services which will be set up under its provisions, these must of course be governed by the extent of our local organisations. By improving the quality and quantity of our personnel and institutions we hope to provide an optimum service in the time to come. In the meantime we shall try to give effect to the schemes as far as we can do so with the organisation at our disposal. Consultation with the various professional interests involved and, in particular, with the National Health Council will also be necessary before regulations are made and promulgated to give detailed effect to the administrative schemes for which statutory authority is being sought here.

Part II of the Bill contains a series of provisions relating to health institutions. Health authorities are given power to establish institutions themselves or to make agreements with the persons managing other institutions. Provision is made for the transfer of institutions from public assistance authorities to health authorities and for the joint use by health and public assistance authorities of institutions such as dispensaries. These provisions are necessary until the final step in the severance of the health services from public assistance administration can be taken. Under Section 16, the Hospital of Saint Margaret of Cortona will be transferred to the Dublin Corporation. This hospital, formerly known as the Westmoreland Lock Hospital, may then be developed by the corporation as an integral part of their scheme for the control and eradication of venereal disease. There is also power in this part of the Bill to enable a health authority to purchase compulsorily for a voluntary hospital in their area any land required for the extension or improvement of the hospital.

Part III of the Bill, dealing with the mother and child service, contains the most important proposals in the measure and I will therefore explain in some detail what exactly are the powers sought in this part of the Bill and secondly how I propose to implement them.

Sections 21, 22 and 23 impose a duty on health authorities to arrange for safeguarding the health of mothers, children not attending any school and children attending certain types of schools. In the exercise of their powers under these sections, health authorities will be governed by regulations which will be made by the Minister under Section 28 of the Bill. Before making these regulations, I intend to have full discussion with the National Health Council and to obtain the views of the various professional bodies which will be affected. That does not, of course, mean that I will be bound to accept in full the suggestions offered.

There are various ways in which we could set about providing a service of this nature. We could, for instance, base it, as the present maternity and child welfare and school medical services are based, on a special whole-time public health staff. While, from the administrative point of view, this would be a convenient method, I think that it is very desirable to ensure that the mother and child service should not be divorced from the ordinary general practitioner service provided at present by the dispensary doctors. Such a procedure would permanently divide the whole system of general medical care into two artificially created branches and it would deprive the local practitioner of a portion of his paying patients without creating any justification for an increase in his salary. It is my intention therefore to seek by negotiations the co-operation on agreed conditions of the district medical officers. Such conditions would of course include an appropriate increase in these officers' salaries. I appreciate, of course, that many of the present dispensary districts will need to be divided and that, in some cases, assistants to the dispensary doctors will be needed when the service is brought into operation. A comprehensive survey of the present dispensary districts and of the medical facilities available in each is at present being conducted in my Department to find out what divisions and changes of districts would be needed to arrange that no doctor would be called upon to undertake too much.

The district medical officer, in the administration of the service, will be helped by a maternity nurse, who will attend to mothers and infants, and a child welfare nurse, who will look after children over one year of age. Clerical assistance will also be available where necessary. It is intended to provide in each county adequate facilities, including health centres and clinics, for use by the medical and nursing staff for inspection and treatment.

Provision will be made for the care of the teeth and for eye treatment by dentists and ophthalmologists employed by the health authorities.

Consulting obstetricians will be appointed to attend women who need their special attention. Arrangements will also be made for the provision of other specialist services. It is hoped that, when the service is fully developed, there will be full provision for the prevention and treatment of ailments of the ear, nose and throat, orthopædic defects, juvenile rheumatism and other defects calling for specialist treatment.

The general administration of the service in each city or county will be supervised by the city or county medical officer.

Much criticism has been directed to this part of the Bill on the grounds that it entails undue interference with the rights of parents to provide for the physical needs of their children. I would like, therefore, to make clear at this stage the extent of the compulsory powers sought. First, I must emphasise that no power is contained in Section 22 or Section 23 of this Bill which would allow a health authority to provide medical or surgical treatment for a child against the wishes of its parents. If such a drastic power were sought it would be necessary to be quite explicit about it in the Bill—just as we are explicit about compulsory inspection, compulsory immunisation and compulsory detention of infected persons.

Treatment, therefore, will not be compulsory. The various facilities for the treatment of defects of which I have just given an account will be available for use by any child whose parents wish it. The State or the health authority will not be able to use any stronger methods than advice and persuasion to try to get parents to allow their children to avail of the service.

That is the position in so far as actual treatment is concerned. Medical inspection to ascertain defects is another matter. That may be made compulsory in particular districts and for particular periods. Section 25 of the Bill provides that, where an inspection is arranged for a child, the parent shall either submit the child to that inspection or else produce a certificate signed by a registered medical practitioner stating that he has examined the child within a prescribed period preceding the time fixed for the inspection by the health authority. In other words, a parent will be obliged to have his child seen regularly either by a medical officer of the health authority or by a private doctor.

This section will not be applied automatically throughout the country when the Bill comes into operation. It is provided that it shall have effect only in any county or county borough as respects which the Minister has made an Order applying it. The extent of the statutory provision proposed by this Bill in relation to compulsory medical inspection is, therefore, that, if the Minister applies Section 25 to any area, parents in that area will be required to have their children inspected at fixed intervals either by their own private doctor or by a doctor employed by the local authority. I am sure the House will agree that that does not mean that the health authorities are to take over entirely the responsibilities of parents in relation to the physical health of their children.

Personally, I am entirely in favour of voluntary methods in medicine and I do not intend to apply this section except where it is quite clear that there is persistent neglect in a given area to have children submitted for inspection under the voluntary system and that the health authority for the area have used persuasive methods to the utmost without success.

I may be asked what is the justification, even in the special circumstances stated by me, for compulsory medical inspection of children. I think that it does not require much thought to convince oneself that non-intervention by the public authorities cannot in modern circumstances be contemplated with equanimity. It would be all very well if each family were a self-contained, isolated unit but where children of all families are daily mixing in schools and streets, and travelling from place to place in buses and cars, the State has, I submit, the duty to find out if the physical condition of any child presents a danger to his companions or to the public. It has been found, from experience of the present school medical service schemes, that it is the children with infectious or verminous conditions who are generally kept away from school on inspection day. The ascertainment of the non-infectious ailments such as bad teeth, defective eyesight or diseased tonsils or adenoids has met with little opposition. I do not think that compulsion would be justified if the purpose of school medical inspection were merely to find defects of this nature. But the school medical service must be related to the services for the ascertainment, prevention and eradication of infectious disease and verminous conditions, which are in the interests of the community as a whole and not of individuals alone. Furthermore, apart from infectious disease, conditions might exist in an area which might be a danger to all children living in it and which could only be conveniently found out by ascertaining whether any children have been affected by such conditions. I am referring to such things as mineral deficiencies in certain districts which might give rise, for instance, to widespread goitre or to other deficiencies causing certain types of malnutrition. If the health authority are in a position to ascertain whether there is an abnormal incidence of such diseases or conditions in any part of their district it will be possible for them to take steps to remedy these deficiencies with consequential benefit to the local community as a whole.

Finally, the inspections under the mother and child service will enable the health administrators to find out what areas in the country and what classes of children are particularly prone to various types of ill-health. This type of research will have a very great value as a basis for improved administration and for the introduction of special schemes of amelioration.

Part IV of the Bill deals with infectious disease and infestation. Many of the clauses in this part are re-enactments of existing law. Others are additions to that law rendered necessary by modern conditions. Power is given to the Minister to specify what are infectious diseases for the purposes of the several relevant provisions in the Bill and to make regulations for the prevention of the spread of such diseases. It is intended that the diseases so specified shall include tuberculosis and venereal disease.

The regulations may include provisions requiring adult persons to submit themselves or the parents of children to submit such children to measures of protection or immunisation against any disease but there is a clause under which anyone who objects in a prescribed manner will be exempted, except where the Minister by Order directs that compulsory immunisation is necessary locally to eradicate an epidemic.

I think it well to refer at this point to the repeal of the Vaccination Acts by this Bill—a matter on which there has been much misunderstanding. Senators will be aware that these Acts provide for the compulsory vaccination of all children against smallpox and that the service provided under them has been instrumental in eradicating that disease in this country. While it is intended to repeal these Acts in this Bill, the power to require compulsory vaccination will be retained. Smallpox will be placed on the same footing as other diseases. If the Minister is satisfied, after consulting his medical advisers and the National Health Council, that vaccination should remain, then he can arrange for it in the regulations under the Bill just as effectively as if the authority were still contained in those old Acts which are being repealed. I have no intention of abandoning the existing machinery for smallpox vaccination as long as there appears to be any danger of the disease recurring in this country.

This part of the Bill also contains provision for the compulsory detention and isolation in institutions of persons who are probable sources of infection and who cannot be properly isolated at home. Section 38, which deals with this matter, extends to over two pages of the Bill and contains a very detailed set of safeguards which, I think, should prevent any unjust or unnecessary detention under it. This provision is not entirely an innovation. There have been various clauses in the health laws since 1878 enabling infected persons to be removed to hospital, and since 1940 the Minister has power to order detention under an Emergency Powers Order. The laws which conferred the existing powers are being repealed in this Bill. I do not intend to apply Section 38 to any but the most dangerously infectious diseases, such as smallpox, some forms of tuberculosis, typhus, enteric, diphtheria, infantile paralysis and venereal disease.

There is also provision in this part of the Bill for the rehabilitation of persons suffering or recovering from infectious disease. This section will be applied particularly to tuberculosis, where it is often essential to follow actual treatment with training for work suitable to the condition of the recovered patient and such as will enable him gradually to resume his proper place in the life of the community. Section 44 of the Bill provides for the maintenance by health authorities of dependents of persons suffering from infectious diseases and of persons who, although not themselves diseased, are compelled to take precautions to prevent others being infected.

Part V of the Bill will supplement the existing law relating to the purity and standardisation of food supplies. It is intended to give the Minister power to make regulations to ensure that the public health will not be endangered from the careless manufacture, preparation and sale of food and to standardise foods which are of special nutritive importance. I am sure it will be welcomed by honest manufacturers, traders and caterers who are at present at an economic disadvantage in relation to less scrupulous persons who do not take proper hygienic care in the presentation of their products. I intend to have full consultation with the trade before making regulations under this part.

I do not think that I need add much to the explanation of the remaining parts of the Bill which was given in the memorandum which was circulated with it. In the Dáil, new sections were added in Part X to allow health authorities to provide a home nursing service, to make it clear that residences could be made available for officers and servants working under the Bill and to allow any modifications of existing enactments rendered necessary by the passing of the Bill to be made by the Minister.

As regards the National Health Council, I would like to say that, while I have not made up my mind as to its exact composition, it will include representatives of the medical, dental, nursing and allied professions and other bodies interested in the matters which will be dealt with by my Department. As far as possible, I will appoint to this council and to any subsidiary advisory bodies, persons nominated by appropriate vocational bodies. While the Minister must retain his responsibility to the Government and the Oireachtas for the policy in relation to the health services and must, therefore, make the final decisions on their administration, I can say that every opportunity will be given to the members of the National Health Council and any other consultative councils to put before me their point of view—or perhaps I should say their various points of view.

As regards the financial provisions, Section 27 provides for a 50 per cent. State grant for the mother and child service and Section 44 contains provision for a similar 50 per cent. recoupment of expenditure on maintenance of persons suffering from infectious disease and the dependents of such persons. There is already provision in the Estimate for a 50 per cent. grant towards local expenditure on the prevention and treatment of tuberculosis and for recoupment of 75 per cent. of approved expenditure on venereal disease. The greater proportion of public health expenditure by local authorities (including institutional and medical expenditure which is for the time being treated as part of the cost of public assistance) is not subvented from State sources except in a minor degree by certain grants or parts of grants which pass through the local taxation account and are specifically referable to these items of expenditure.

It is proposed in the White Paper which will shortly be published to review the future position of these financial relationships. The White Paper is being pressed forward for publication as quickly as possible, but it was not found possible to have it available for discussion in connection with the Bill or with the Department's Estimates when they were before the Dáil. When questioned on the Committee Stage of the Bill in the Dáil, I did, however, intimate that I contemplated a readjustment of liability, which would mean that the local rating authorities would not be made liable for additional commitments for some of the services under discussion for a long time to come.

I have now got a stage further in the negotiatíons which I have had with the Minister for Finance, and in the submission of my proposals to the Government, and I am now in a position definitely to declare that the health programme will be so financed that it will not involve local health authorities in any expenditure additional to what they are contributing from the rates at present until such time as the State grants will have reached a very much higher proportion of the total expenditure than they amount to at present. This means that the Government is willing to meet, for a considerable number of years to come, the whole of the additional revenue expenditure that may be involved in implementing the provisions of this Bill, and in giving effect to the further proposals for reform which will be outlined in the White Paper. Capital expenditure will continue to be met under the existing system whereby the local hospitals building schemes are financed partly from the Hospitals Trust Fund and to a lesser extent by loans raised by the local authorities.

It will probably require legislation to give effect to these proposals and a Bill on the matter may have to be introduced before the close of the present financial year. In the meantime, I am sure that my announcement will be welcomed by local authorities and that it will prove an incentive to them if such is required, to co-operate in giving full effect to this Bill and to the further proposals for reform which will be made in due course in the White Paper and in the legislation based thereon.

I think this is the first Bill which the Minister, in his new capacity as Minister for Health, has brought before this House. I would like, therefore, to take this opportunity of welcoming him here in his new capacity. He has, of course, been here many times before, but on those occasions he was always dealing with matters about which I knew so little that I did not even attempt to propose an amendment to one of them.

The Senator has him now.

I have, however, kept my eyes open and, notwithstanding the remarks that were made at the commencement of our proceedings to-day, I can say that he is one of the Ministers that one can talk to; he is a Minister that one can go to with proposals in the belief that they will get fair consideration. Even if that were not so, it would still be our business to take a Bill of this kind, to consider it and to produce all the advice, for what it is worth, that we can possibly offer. The fact that we must accept the position that this Bill is urgent and that we have to go ahead with it now before we adjourn, does not mean that we have got to adjourn in a week or ten days. It seems to me that, in the case of a Bill of this kind, if we are to carry out our duties in a serious way, it will have to be discussed at very considerable length in Committee.

Now,prima facie any Bill dealing with public health should be, and must be, welcomed on all sides of the legislative Assembly. So far as this Bill is concerned, my knowledge in regard to many of the matters with which it deals is very limited. I am in no sense an expert. I have read the Bill and studied it, and my point of view on it is that of an ordinary member of the public. It seems to me that most of its provisions are such as will meet with general approval, and that consideration of it, in general, will be entirely from the point of view of seeing how far it can be improved and bettered. I imagine that that will be the attitude of every section in the House; at any rate it will be my attitude and the attitude of those I have consulted and who sit near me.

There are a number of somewhat strange provisions in this Bill and some provisions which, though perhaps not strange, give me a certain amount of uneasiness, but which I would rather discuss in Committee than at any length on the Second Stage. We have a rather peculiar type of legislation. It appears in more than one place in the Bill, but it is exemplified in Part III. If you turn to Section 21, you will find that a health authority shall, in accordance with regulations made under Section 28, make arrangements for safeguarding the health of women in respect of motherhood and for their education in that respect. We are passing a law saying that the health authority shall do this, but when we turn to Section 28, which I immediately did on reading that, I find that Section 28 provides that the Minister may make regulations applicable to every health authority as to how they are to exercise their powers under this part of the Bill. We are, therefore, asked as a legislative Assembly to say that health authorities shall do certain things, which include not only safeguarding the health of women, but also their education in respect of motherhood without any idea whatsoever as to how they are to do it, no indication in the Bill as to how it is to be carried out, and not even anything limiting the power of the Minister.

Under the regulations in some other part of the Bill, where you have similar provisions, there are limits. In this case, there is nothing whatever to restrict or guide the Minister. He has complete powers under Section 28. Everybody would like to see Section 21 operating satisfactorily; but I doubt very much if Parliament should be asked to pass this as something which a health authority must do, when we have not the slightest idea of what these regulations are to be. I could conceive regulation in respect of education with regard to motherhood which would be extremely controversial. I do not think the Minister is at all likely to be foolish enough to bring in regulations which would be controversial, but, from the legislative point of view, that is what we are asked to do. I doubt if that is a good type of legislation.

I do not propose to go through the whole of the Bill, because, in the main, I think it would be a matter for Committee. I am raising one or two matters because I should like to hear the Minister's comments on them. I turn to a totally different matter. I find in Section 55, unless I read it wrongly, that power is to be given to the Minister to make regulations for the licensing of grocers. I have no idea how many grocers there are in this country, but I imagine there are 20,000, 30,000 or 40,000 of them; the number is very large. During the emergency we have had a system, which may or which may not have been desirable, by which the Minister could, by Order, provide for licences and could revoke them, thereby providing a penalty in addition to the penalty for a breach of the law which would be imposed through the courts.

Section 55 seems to me to empower the Minister, because there is no restriction that I can find, to provide that not only manufacturers of food, but also distributors, which means grocers, shall only operate after being licensed. I presume that means that the Minister must have power to take the licence away; in other words to deprive a person of his livelihood. That may be desirable, but it seems to me that as permanent legislation it should be done only through the courts; that any removal of a licence should be done through the ordinary course of law; that however it might be justified during an emergency, it should not be made permanent legislation. I, therefore, view Section 55 as it stands without any restriction with some uneasiness. I should like to know how the Minister seeks such extremely wide powers under Section 55 as he seems to seek.

The Bill is, in accordance with general Government tendencies, a Bill for more and more centralisation. Local health authorities will have certain limited powers but, as far as I read the Bill, every section provides that they will be more and more under the central authority. That is a modern tendency. Personally, I am not sure that it is a good one and that uniformity in all respects is desirable. At the same time, I think anyone with commonsense must recognise that in health matters in a country of this size there are matters on which there will have to be uniformity. The extent to which compulsion should be applied in health and medical matters is one of very considerable difficulty. Speaking generally, it seems to me that compulsion should be applied only to prevent persons from injuring other people; that if I want to live with some infectious disease and can so manage that I can do it without being in contact with anyone, in principle I should be allowed to do it. But, if by so doing, I become a danger to somebody else, then it seems to me the State is more or less obliged to intervene and use some element of compulsion. It is obvious from the Minister's speech, and I think from a careful reading of the Bill, that he does not want more compulsion than is necessary. It is a matter which will have to be carefully considered in Committee, on an examination of the various sections, whether in some places he has not gone further in the matter of compulsion than is absolutely necessary.

In that connection, I would be glad if the Minister could tell me if there is any provision for a conscientious objector. I know that in some cases, where it is a question of examination, the person can say, "I object." But I am dealing with a case where the Minister makes an Order and where a person cannot say "I object." I should like to know if there is any provision, say, for a Christian Scientist. There are a number of these in this country. I have no connection with them and no personal sympathy or agreement with their views. But there are people who might conscientiously object to a specific type of treatment. Personally, I do not see how we can recognise a conscientious objection to the extent of allowing a person to go about with a disease and infect other people. But I think we ought to be careful before we use the whole might of the law against a person in relation to provisions applied to himself or his young children. I do not intend to go through the whole of the Bill. Generally, I welcome it. But there are two other points I should like to put to the Minister. One is, can he tell me whether industrial schools will come under the provisions in relation to schools in this Bill?

The other is that I would be glad if the Minister would explain before the Committee Stage the distinction between Orders and regulations. Most of the things in the Bill are to be done by regulation; a number of things are to be done by Order. I could not find any underlying principle as to what was to be done by Order and what was to be done by regulation. The principal difference, as far as I can read the Bill, is that if it is done by regulation it will have to be placed on the Table of the House, and that if it is done by Order, apparently it will not. I should like to know the reason for that before considering amendments, because it seems to me that there are some things in the Bill which are to be done by Order and which I think ought to be placed on the Table of the House.

In general, my principal criticism of certain sections of the Bill is that it leaves matters open to be done by regulations which are really matters of legislation and not matters purely of administration. I illustrated that in connection with Sections 21 and 28. Regulations, where there are regulations, will be laid on the Table of the House and can be discussed or annulled, but the very great fundamental difference is that a Bill, when introduced, is circulated to all members, whereas a regulation laid on the Table may lie there, unless some member is sufficiently interested to read it and draw attention to it. That is a wise provision for matters which are only matters of administration— it would be highly undesirable if every administrative Order or regulation were to be discussed—but where the regulation is almost an Act, or what would normally be included in an Act, it is, I think, a pity that it is not circulated. Having made these remarks, I leave it to others more competent than I to deal with details and merely say that the Bill generally should be welcomed.

This Bill is so very important in aims and so momentous in consequences that I do not think we need waste time in talking about that aspect of it. We can take that for granted and can say that we all welcome the Minister and the Bill in a spirit of hopefulness and relief—with hopefulness because, if this Bill achieves even one quarter of what it sets out to do, it is going to change the future of our country very much indeed for the better and later generations will look back and say what wise people we were, and with relief, for two reasons, first, it follows the Public Health Bill of last year which got shot to pieces, was repaired again, amended and reamended—and I think we have profited by our experiences with that Bill and can start work on a freshly ploughed field—and, secondly, the whole subject is so important that it transcends ordinary politics, that it is in the serene atmosphere in which we can look down and get a sort of aerial view of the subject.

For the purpose of a brief aerial survey, not taking any individual parts, I should like to touch on costs, compulsion and compensation. I chose three C's so that I would remember them easily. With regard to the expenses of the Bill the ordinary person cannot make any prediction, but I should like to have the Minister's acknowledgment that it will be a very expensive venture, if it is to succeed. The answer to that is that national ill-health is much more expensive than national health, and, as this measure comes into operation, it will cost more and more as treatment improves and as the staffs increase, the consequent national gain being better health, better working capacity and, what is perhaps even more important, better desire to work. There are many people in the world willing to work, but a great many more willing to let them work, but the healthy person wants to work. Anything that raises the national health progressively will, in the long run, pay for itself, so that I hope to see the Act self-supporting in that respect.

There is one point about which I am a little in doubt. We are inferring that free treatment is to be made available for certain sections of the community, irrespective of class distinction. There is to be no means test which is perfectly right. I do not think that, because children belong to wealthy families, the parents are necessarily more intelligent than others, and many children of middle-class parents, or even richer parents, can be just as badly in requirement of medical inspection and treatment as those of the poorer classes; but I do not see anything which makes me feel certain that the treatment is free and always will be free. We speak of "providing for treatment" and "providing treatment," which do not mean the same.

Would it be a terrible risk if the Minister were to define "provide for treatment" in the definition section and set out something like this: "The treatment, where possible, will be free or at the minimum cost"? I raise that point because treatment is becoming more and more expensive with many of these modern drugs. Many of them are desperate remedies to meet desperate diseases, they say, but they are certainly desperately expensive and will make the modern application of these medicines more costly, so that I can see that the time may come when it will not be possible to give the best treatment free. That sounds very unsatisfactory and I wonder how that would be effected by order or regulation. Is it possible to have a regulation setting out a certain charge for a particular type of treatment? I have in mind certain forms of treatment, but I do not want to go into details. That is the comment I should like to offer on the question of the cost of the venture.

The second matter is the matter of compulsion. It produced the most remarkable reactions in the Lower House—the relationship between compulsion and medicine. I think that a certain amount of it depends on the way in which you submit your claim for compulsory inspection. Putting it pleasantly, it merely means that the State will require that every child citizen shall have the benefit of regular medical inspection. The Bill has been criticised for having the desk point of view. In this respect, I should be very much worse, because I have the test-tube point of view, and I feel that, without compulsion, you cannot do anything in these surveys, if you are to be sure of getting your set of facts. At the same time, whether, in a particular situation such as this, compulsion may be applied at all as rapidly and as drastically as in other situations is very much more debatable.

That was evidenced very clearly in the Lower House in connection with what was to me the very surprising suggestion that these compulsory inspection clauses infringed the Constitution. Rereading that document, it seemed to me that one could almost say that compulsory medical inspection was latent in Article 42 (5) of the Constitution, which, I remind the House, says:—

"In exceptional cases where the parents for physical or moral reasons fail in their duties towards their children...."

How can you tell if they fail in their duties unless you see the children?

Personally, I am apprehensive about these compulsory powers for two totally different reasons, one of which, I think, was exemplified in the Lower House, the other not being touched on at all. The first reason is misunderstanding. It may prejudice the working of the Act if misunderstandings are widely circulated and exploited. I noted down a possibility which might happen. I know that it would not happen with any gentle politician, but there are a few politicians who are not quite so gentle, and who, by stressing the parent-child relationship, could give a very distorted picture indeed. They could say at a general election: "This Government, if you put them in, propose to take your boy or girl and have him or her stripped and searched periodically by a Government official. They will be graded like cattle and combed out like lice." They may take up that line and it is just as well to be prepared for that attack. Otherwise, we may find that we are quietly building up here an atomic bomb which will be used at the next general election. That is all right in politics, but I am not interested in the political side of it and I am tremendously interested in the health and welfare of my country. If an Act is unduly prejudiced by that type of propaganda, it will scarcely make for the general progress of health legislation and health development and I should like to see that type of artillery anticipated and examined in time. I can foresee things being pursued along that line.

My own great apprehension with regard to the introduction of compulsion is that it may represent the adoption of premature powers. We have not, at present, I think, the personnel technically trained and tactfully trained to apply compulsion, unless very carefully watched by somebody else.

We have, at the moment, a venture, a very important one, going on, and that is the great nutritional survey of this country which is being carried out for the first time. That is not being done under compulsion; it could not be; it is being done by the very careful application of tact, by a team of workers so tactful that one would not hesitate to tell them everything he had done in the preceding 24 hours. It is possible that this compulsion clause, as the Minister hopes, will hardly ever be invoked, but, in case it is necessary to retard its appearance, I noted down four possible points that I respectfully submit to the Minister for his consideration. The reason for raising these points is that, supposing the compulsory clause comes into operation and there is one unfortunate case, one unsympathetic medical officer who falls out with a parent or a child, or supposing there is the inevitable martyr who wants to go to prison rather than let his child be examined, then there is a fearful scene.

One of them would be to reserve the compulsory power by regulation until the operation of the Act shows clearly that it is necessary. If the Act shows it is necessary, that will be the end of the whole thing and we shall have to have it. The second possibility would be to employ a method of indirect compulsion, such as the withholding of allowances or other grants in the case of children who have not been submitted for medical inspection. I do not know whether the Minister has considered that. The idea is that the allowance for the child would be withheld until it qualified by having submitted to the inspection. The difficulty might possibly be overcome in that way. The third point is supposing you give a parent or guardian the right of being present at an enforced compulsory inspection, and the last one is supposing, instead of extending the compulsory age from 0 years to 16 years, you stop short and say 12 years.

If you go to 16 years, you get into that difficult period of the young adolescent and it is quite recognised that many of those young adolescents might resent very much a compulsory medical inspection by some unsympathetic medical officer or attendant. On the other hand, supposing the growing child has grown to like his inspector and has made friends with him, or with her as the case may be, he would very gladly go to the medical inspector and require no compulsion. That is the fourth suggestion and I submit all those suggestions for the Minister's kind consideration.

I presume, incidentally, there will be consultation with the schoolmasters of the non-national schools with regard to the working of the scheme. I have not observed a reference to that, but I am sure they have a certain number of interests to safeguard and important suggestions to offer.

As a member of a profession which I preach rather than practise, I should like to refer to the question of safeguarding the medical interests and to the question of compensation. On this will depend the very harmonious and easy working of the Bill. The medical profession can do a great deal to help things and can do a certain amount not to help things. Supposing a compulsory inspection starts from 0 years to 16 years, making a rough guess, that means that the State will become responsible for the systematic inspection of 400,000 citizens. I do not give these figures as exact, but they do, I think, represent the order of magnitude. These 400,000 will be examined possibly twice a year and perhaps more often. In addition, there will be, of course, treatment for another large but rather unpredictable number. That will mean an increase in medical work which will fall partly on the ordinary medical service and partly on the medical practitioner who will be employed by parents who do not wish their children to go before the ordinary medical practitioner. If anything like that should happen, there will be confusion. I am convinced that the Minister does not intend anything like that to happen, but there will be a period of stepping up and stepping down and there is the possibility of a gap.

The point is, will the increased employment of the medical practitioner compensate for his undoubted loss of practice owing to the expansion of free medical treatment? There is a subject that requires a very full and documental discussion with the medical practitioners, who should have certain facts and data before they discuss it. It also means that there will be, as the Minister indicated in his remarks in the Lower House, a considerable development of the general health system. I wonder if they are not gradually evolving from the old dispensary system, which had many excellent qualities and many kindly qualities, to a national health system, a sort of Eire medical system, where we will have to recognise the need of a new type of medical practitioner who will receive a post-graduate training in this work and a diploma, and who will only be registered when he has conformed to the necessary medical qualifications.

I submit that such matters should be discussed with the representatives of the medical profession before this Bill becomes law. That is important, because it involves the universities, the various training colleges and those most important people, the nurses—we cannot overlook the present nurses' famine—and the underpaid midwives and also the setting up of a secretariat to relieve these people of the enormous burden which might easily fall on them of card-indexing and keeping and submitting of records.

There are other points that can be dealt with separately in Committee. There are many of the sections that I am extremely glad to see. With regard to Part IV which deals with infectious diseases, I imagine we will have to consider the possibility of plane-borne infection and in that connection it would be essential to have co-operation with the United Nations Organisation in order to form an international body. By that means we will be informed of an outbreak of a particular disease in a particular part of the country serviced by planes arriving here and necessary precautions can be taken. That is a matter for an international network and it would work out automatically in the course of time.

Part X I welcome most heartily. I suggest that the council should be provided with a central health office somewhere in Dublin and a library, and these regulations that have been worrying me as they have been worrying Senator Douglas could be made available at some central place like that. Some form of propaganda and literature will be required to keep those intimately concerned abreast with changes and developments. Again, I support Senator Douglas in trying to clarify the distinction between regulations and Orders. I suppose we will not reach the state of affairs that Samuel Butler envisaged in his novel, when people who became ill were sent to prison and criminals were sent to hospitals although they had rarely something wrong with them. But I think we are moving towards a condition when we have got to learn a great deal more about how a country is run as well as being run by a country and, in the process of learning, we sometimes find it hard to collect the facts. That is the difficult thing in a Bill which involves a great deal of governing by regulation. People will say: "You are not giving the Minister a blank cheque; you are giving him a blank cheque-book." That is all right if we have the counterfoils. I should just like to know what provision is going to be made to have the counterfoils easily accessible.

I am also very anxious to see some kind of central health office where the National Health Council will meet and where you will have this reference data. When a former member of this House was over here recently, ex-Senator Oliver Gogarty, he expressed a great interest in our progress. Since then the eyes of the medical world are upon us. Dublin is at present the venue for cenferences of members of the profession, so that we are being watched. I had an opportunity of discussing various parts of the Bill with various people. I have had the advantage of hearing a very large number of different opinions, and really I think most of them cancel out. I am narrowing this preliminary survey to a final recapitulation of the things that strike me most forcibly. There is, firstly, the question of cost, but the Bill, while being expensive, may pay for itself. It might easily prove very troublesome, but that might be mitigated. The future of the medical profession is, I think, the most uncertain part of it and I believe that is the part that members of the medical profession should concentrate on in trying to assist passage of the Bill, in which the Minister, of course, has the support of all men of good-will.

I think the Minister can be congratulated on his good luck in coming with this Bill to the House rather than with the first Bill that was produced, to deal with the present and future public health services of this country. I was most interested in the latter portion of the Minister's statement, that is, with regard to how the expenditure on this measure is to be apportioned between the local authorities and the central authorities. We are all concerned about the health of the people of the State as we are about their general well-being, but we can only have those things for which we can afford to pay and the dimensions of this Bill, so far as one can judge by what has been proposed, will mean a very considerable addition to our national expenditure. The expenses of local authorities have so mounted in the last few years that they would be scared out of their lives if they were compelled to undertake additional services for which at the moment they are unable to pay. Therefore, I think there will be a general feeling of relief amongst local authorities that they are going to have a breathing space, at least before some of this burden will fall on their shoulders. Perhaps, it may be that Senator Fearon's hopes will be realised very quickly, and that our standard of life will so improve that the expenditure on it will fall and that later on the initial investment will bring us a very good return.

I think it very important in examining the proposals embodied in this Bill to look at the conditions generally as we see them to-day. The Minister's proposals are in part curative and in part preventive. It seems to me that the first action that should be taken before we embark on this scheme to any extent would be to make some kind of survey of the origin of disease. Before we decide on a very considerable expenditure let us examine how far some of the major infectious diseases which we will have to treat are preventable and how far they can be eradicated by treatment that has not yet been applied. On the whole, what is causing most dismay throughout the country is the existence of tuberculosis. That is so everywhere in the rural districts, just as in the city. A great deal of the thought put into the drafting of this Bill, and the expenditure that has to be incurred in future, have in mind the situation that is confronting us to-day in that regard. I must say that I should like to think that some effort was made to survey that situation as it is and as it has developed, especially throughout the country, to discover how far we could trace the origin and the wide extent of the existence of this disease of which we have experience to-day.

I suppose in the last analysis, where people have good food, good homes, and hygienic conditions, the standard of health is high, not necessarily so in all cases, but generally that is so. I suggest to the House and to the Minister that the increase in tuberculosis throughout the country is to-day largely a problem of deficiency in food, and I suggest that the best way to attack the problem is to go in for a policy of enlightening the people on health matters. If my theory is correct, I think if the Minister will cast his mind back to the time when he occupied the chieftancy of another Ministry he will recollect that in the early days of the war, when I was urging higher prices for certain commodities, I did suggest the dangers to the health of the people of a fall in the quantities of essential foods that would be available to our community. I think there can hardly be any doubt that the proper approach to the improvement of the health of the community, with a consequent reduction in the amount of money spent on curative treatment, is to look after the food which these people have available to them. I think in that regard a propaganda campaign is highly essential.

I believe myself that amongst the great body of our people not anything like sufficient information is available about the relative values of foods. Even in very well-to-do homes, the lack of knowledge as to the real values of different foods sometimes astonishes me. For one thing, my own opinion about rural Ireland is that not anything like an adequate supply of milk is made available in a great many rural homes. I think that aspect of our economy and social existence has to be examined and stressed very forcibly. I suggest that if you went into many of our rural homes to-day, where young people have contracted tuberculosis, you would discover that the consumption of milk in these homes was disgracefully and scandalously low when milk was available in abundance. I suggest that aspect of our health problem must be examined and attacked immediately. I think other members of the House who probably have a somewhat similar experience will confirm my view. It does seem to me that a survey of the causes of the decline in our health standards is the most natural and the most effective approach to any policy of improving our health conditions. Indeed it is a step antecedent to any other plan with regard to our health services. One could address oneself to a variety of matters in this Bill. It is, unhappily, true to say that the spread of venereal disease to-day is very disquieting in respect of the conditions with which many of our officers of health are confronted. That is very disquieting from many angles. Another disease which is not infectious but is a source of great trouble in rural Ireland was not the subject of many references in the other House. Anybody who comes from a country district is aware of the extent to which rheumatism is debilitating the health standard of many of our people and will also be aware of the lack of facilities for its treatment. I wonder how many members of this House have escaped attacks of that disease. Practically nothing is being done in the country with regard to it. Due to our climatic conditions, the continuous wet seasons, the soil conditions and the poor type of clothing available to many of our farmers in recent years, the health of the people in the country has been appreciably impaired and there has been a considerable increase in rheumatism. Here in the city—I have personal experience of this—there is a clinic where treatment is available but I do not think that there is a similar service anywhere else. That service is one of the most urgent needs of the day. It is a highly specialised service and I think that members of the medical profession have not, so far, addressed themselves to it with any great feeling of urgency.

I have been speaking of the importance of food in regard to health. The Minister is taking certain powers in the Bill to make regulations regarding the handling and sale of food. I do not know whether butchers' shops are included in the licensing system proposed. I do not know how far our meat supplies throughout the country are to be subject to inspection. There is such inspection in the City of Dublin but there is no such inspection in the greater part of the country. On that point, one cannot help observing meat, which has been inspected, taken out of the abattoirs and sent around to the shops in coverings which would not induce a member of the public to use the meat for his mid-day meal. There is no more glaring example of the disregard of the health of our people than the fact that, after examination to ensure that animals are in good health before they are slaughtered, the carcases are taken away in covers which have, probably, been doing service for ten or 20 years. That is a spectacle which can be witnessed every morning in the city and it is not by any means appetising.

The Minister indicated that, with regard to the extension of these services throughout the country, there is to be a breaking-up of districts. I do not see anything in the Bill which would enable one to understand what exactly is to take place. There will be a great increase in the number of patients to be treated by the dispensary doctors in the larger urban centres and I should like to have further information from the Minister on that score. Is it the intention to have a grading of the medical services? Is the system to continue whereby men are paid regardless of what treatment they have to give or the number of patients which has to be treated or will there be a reconstruction of the system on the basis of the numbers to be treated? In the larger centres, this measure will add enormously to the work of the dispensary doctor.

Senator Douglas said that the whole tendency of this measure is towards increased centralisation—if it is possible to have any more centralisation. Sections in the Bill authorise the Minister to order local authorities to do certain things which will involve the spending of money. I do not know whether that money will be refunded to the local authorities or not. The Minister has power to make an Order compelling a local authority to do certain things. The doing of those things may involve expenditure and I want to draw attention to that aspect of the matter. It is my experience that public representatives have ceased to have any function with regard to public health. That is very undesirable. As the law stands and as the administrative machine works, I do not see how it is possible to get over that. We have a new county medical officer of health in my area—at least, he is new to me. He has been there for a few months and I have not seen him yet. I do not know the gentleman even to see and I do not think that any other member of the local authority knows him either. I do not think that one of them has spoken to him yet. I am not finding fault with the distinguished practitioner who got the post as against a number of others but I want to point out that the conditions, as they exist, are highly undesirable.

An unfortunate situation has developed out of the mechanism of the managerial idea in which local people have really no contact with the health services in their county. I do not know whether there is any greater contact in other counties than there is in mine. I doubt that there is. That is not due to any fault on the part of the county manager or to any desire on his part to separate local people from the administration of the health institutions and services. But that is how things are working out. I think that that is wrong. Before the passing of the County Management Act, the local authorities had to consider health problems and had contact with the health services of the county. To-day they seem to have no responsibility in that connection. Hence it is that we have a certain number of individuals handling that whole service, and it is difficult sometimes to discover to whom they are really responsible. It seems to be beyond the art of any local authority to make an occasional incursion into the handling of these health services and to effect improvements in the manner in which they would desire. I do not know where this is going to lead us in regard to the extension of the health services in the country. I think we are rapidly coming to the state when, in so far as the local authorities are concerned, they will have no say whatever in the matter and when quite definitely the whole problem is going to be so handled and so resolved by the central authority that the responsibility ought to be on the central authority altogether for the financing of these schemes.

This Bill, when it is made operative, is going to cost a great deal of money. I am all for improving the health of our people. I think, as Senator Fearon does, that any money invested towards that end will bring in dividends. However, I consider that we have to cut our cloth according to our measure and that the amount of money which is going to be spent on this service should be related to what we can afford. As I said in the beginning, I am convinced that if we survey the causes from which ill-health springs and if we make an attack on them we will do much to eliminate a number of existing diseases and we will, in consequence, considerably reduce the amount of money which we must inevitably spend on our health services. If we ignore the causes of disease and try only to treat the diseases when they affect us I consider that we are not acting wisely.

Finally, I want to say that, while in no disagreement with the principle of the Bill, one has to fear the implications of all the regulating that is going to be done under this measure with regard to the lives of our people. I think the Minister generally, to give him his due, has a rather diplomatic way of accomplishing his ends. He can manage to do something you do not want him to do and he can do it in such a way as almost to convince you that he is doing something you want him to do. I feel that, generally, there can be no cause for complaint with regard to his handling of this matter but I would not like to think that some of the other people who occupy responsible positions in the Ministry of Health would be given the powers that are vested in the Government under this measure. That is what one has to fear. This Minister will pass, as others have passed, and the law will be there after him. I find it difficult to determine how one is to restrict Ministerial authority and yet get effective improvements with regard to disease. I would like to have had ample time to look into the matter and to make a decision. However, I wish to say with regard to the general provisions embodied in the measure that, with those Senators who have already spoken, I welcome them and I hope they will give us better health conditions than those we experience in the country to-day.

Mr. Hawkins

Like the previous speakers I wish to welcome this Bill and in particular those provisions relating to school medical inspection. Those of us from the country who know anything about this system know that up to the present, while much good has been achieved, it had one great drawback. Take, for instance, a large county such as County Galway. The county medical officer of health and his assistant can visit, at most, each school only once in every four years. I consider that if the scheme is going to be a success more frequent visits will be necessary and I am glad to see that provision is made in this Bill towards that end.

I think we were all pleased to hear the Minister's closing statement with regard to financial assistance which is to be given to local authorities for the first few years in order to enable them to carry out the various schemes. The point I wish to raise in that connection concerns Section 100 which, as explained in the memorandum which was issued, provides that a health authority will be required to pay compensation in respect of any injury to person or property caused in the exercise of their functions under this Act provided, of course, that that injury was not brought about as a result of wilful negligence on the part of the person himself. When this Bill is in operation quite a large number of people up and down the country will be brought under its many schemes. Some few months ago I saw in a paper a report concerning a person who was receiving medical attention in a hospital—I think it was in County Cork—and because the person was not a paying patient he was sent in by the local dispensary doctor. I think the particular case concerned the removal of varicose veins. In that operation some mishap occurred with the result that the patient lost his eye. The case was taken to court and the decision, as far as I remember, was that because the local authority had fulfilled its function in providing the institution and in providing fully qualified nurses and doctor this particular person had no claim for injury against the local authority. I think that if a position of that kind exists it should be rectified, particularly as a much larger section of the people will be brought under the public health schemes in the future. I consider that if, through the neglect of the officers operating the schemes, such an accident should occur—more especially if it should occur to a young boy or a young girl going to school, as in the case I have mentioned—it would be a terrible thing if a child or adult had not some means of recovery for any damage that might be done. I would like to know from the Minister if this section really means that, because I think it does. I think that in such cases the public health authority should be in a position to provide compensation for any injury that may occur.

I would like at the outset to compliment the Minister on his method of approach to this particular Bill. It is a decided advance on the 1945 Bill which was withdrawn. I am quite satisfied that before the present Bill becomes law any contentious sections that arise under it will be smoothed out as a result of the considerate manner in which the Minister is handling the measure since it was introduced. Several social workers argue very strongly that this Bill is a wrong approach to the question of public health. Senator Baxter pointed out too, in the course of his address, that the remedying of the causes of ill-health should first be aimed at, namely, malnutrition, low standard of living and bad housing. Social workers contend that these matters should first be attended to before any public health Bill would be brought in. They contend also that if these causes of ill-health were sufficiently attended to we would not need such a comprehensive measure as this Bill undoubtedly is. I am, however, quite satisfied that the Bill is justified if for no other reason than to codify, as it intends to do, the many enactments concerned with public health from 1878 to 1931.

The measure, as I said, is a broad comprehensive one, and no detail directly or indirectly concerned with public health has been omitted, but personally I am very sceptical as to the possibility of the Bill when it becomes an Act being given effect to. If I express doubts in that respect, I feel that I have reason to do so, in view of our experience with regard to other beneficial measures which went through this House, notably the Mental Treatment Act. I am not aware of any changes having been brought about in the antiquated system of dealing with mental patients following the passage of that measure. It provided for mental clinics, the segregation of the different types of mental malady and so on, but so far as I know, speaking of certain institutions in the West in which I am interested, there has been no change in the method of treatment of these mental disorders. What I am afraid of is that, when this Bill becomes law, we shall have a further period of inaction. For many years, people anxious to improve the various public health services have always been informed that they must wait for the Health Bill which was to revolutionise all these matters, but if this Bill is as slow in effecting changes as the other Bill to which I refer it is no wonder that I have doubts about it securing the changes which it is designed to effect. I am convinced that, even under existing legislation, much more improvement could be brought about in public health service than is the case at present.

Take, for example, the manner in which tuberculosis is approached. In County Mayo, we have annual complaints by the medical officer of health about the inadequate accommodation provided in the institutions there. In the last report issued, he says:—

"As in previous years, I have to report that the number of beds is entirely inadequate. Despite the reduced death and notification rate, bed accommodation for patients has now proved more inadequate than ever, because there is a very definite increase in the demand for treatment."

That is something to be commended— that people are not fighting shy of the facilities afforded for treatment and advice with regard to this ravishing disease, but, even though they are coming forward, the doctors have long waiting lists, because bed accommodation is insufficient.

The medical officer goes on to say:—

"It is, in fact, now amongst the better-off classes that concealment is found rather than amongst the poorer sections of the community."

Some time ago, legislation was passed for the provision of regional sanatoria, but, beyond the fact that sites have been found in the different centres selected, I do not know that any building has been carried on. Talking over the matter with people in these particular areas, I am told that the reason that building has not been gone on with is the lack of building materials, and the difficulty of getting the necessary materials to enable them to go ahead. It is extraordinary that, even in remote areas in the West of Ireland, one sees palatial cinemas and dance halls being erected. There seems to be no shortage of materials so far as these institutions, which are certainly of doubtful benefit to either health or morals, are concerned. Something should be done and we should not have to wait for the time when this Bill becomes law to give immediate attention to this matter.

I know that there are certain provisions with regard to separate housing accommodation for people afflicted with tuberculosis, but I am very doubtful whether these provisions can be effective. No matter how you provide for the isolation of these people in their homes, some supervision is necessary to ensure that they will not be allowed to intermingle with those who are not affected. Whatever excuse there is and whatever the difficulty may be for people in the same household afflicted with this disease intermingling with healthy people, there is no justification whatever for allowing people afflicted with tuberculosis in institutions to intermingle with those who are not affected. I remember reading a letter in the public Press some time ago in which a nurse in a mental institution commented on the fact that there was no treatment for tubercular patients in that institution and no effort made to keep them segregated from the other people in that institution. That should not be allowed. There should be treatment for these people in such institutions and there should be no difficulty in ensuring that they would not get in contact with other patients who are not afflicted with lung trouble.

There is one section of the Bill, Section 35, with which I am very pleased and I trust that, when the Bill becomes law, there will be no difficulty in giving the benefits of that section to those unfortunates dependent on them. The section provides for the payment of burial expenses in respect of patients undergoing institutional treatment who died there. I have had the painful experience of meeting families, the members of which, one by one, were taken to these institutions and who, being too far advanced to respond to curative treatment, eventually died there, and were buried from the institutions at the expense of their relatives. Burial expenses, even from people's homes, are rather high, but when buried from an institution, and the responsibility for the costs of burial devolving on the relatives, these expenses are very high. I am delighted to see provision made by which these expenses will in future be discharged by the health authority.

So far as school medical inspection is concerned, much improvement could be effected also without waiting for this Bill. When, from time to time, attention was drawn to various flaws— and I have drawn attention on a number of occasions in this House to the inadequate provision made for this very important service—we were informed that these would all be provided for in the Health Bill. This Bill makes adequate provision for the inspection which is absolutely necessary. In County Mayo, we have 360 schools for a school-going population of 27,000, and the doctor, onerated with the important duty of school medical inspection, has this duty in addition to 13 others. He has a litany of 14 duties to carry out. I have been present on a few occasions during inspection by the county medical officer of health, and I could not adequately praise the manner in which he carried out his work. Unfortunately, because of the wide area he has to cover, the results obtained are not as good as they could be if there were a follow-up service. In 1942, the Mayo County Council, adverting to the flaw in the system, had a scheme drawn up through which the dispensary medical officers in the county would follow up the inspection of the county medical officer of health and co-operate in the service, but the Department of Local Government turned down the suggestions on the plea that the dispensary medical officers had not the necessary training for the work. Although the particular service is not without good results it is not giving the results which it could give if the service was adequately staffed.

I would like to emphasise the popularity of this service in County Mayo and to stress the manner in which parents, school managers, teachers and children co-operate with the county medical officer of health. There is certainly no need for compulsion or compulsory measures in County Mayo as far as that particular service is concerned. On the occasion of medical inspections, in most cases the attendance at schools is higher than on any other day. That is not confined to a particular type of school. It applies to all schools. A school having 154 pupils on roll, which would be considered a large school in rural Ireland, had on the occasion of the medical inspection 150 children inspected. In a school having 103 on roll, 94 were inspected. In a school having 102 on roll, 93 were inspected. Taking smaller schools, in one having 35 on rolls, 33 were inspected and in one having 20 on rolls, 21 were inspected—I presume some child who was not on the roll was brought in for the occasion. I mention these figures to show that the service is popular and to point out that, with judicious propaganda similarly carried out in regard to the treatment of tuberculosis, there would be absolutely no need for the compulsory measures which are objected to. Although I know that these measures cannot be resorted to unless an Order is made by the Minister, I submit that the present Minister may not be always in office. There may be another Minister some other time who would not be so humane. It would be just as well that every other method would be tried to educate the people in regard to the benefits to be derived from these services and to leave compulsion to the last.

As I have said, this is a very comprehensive measure and, as Senator Hayes said when speaking on another matter, it makes for streamline efficiency in health services. But one particular consideration is omitted. that is, how the service is to be financed when the Bill becomes law. My attention was directed to an item in a local newspaper where the county manager stated that the Health Bill in a particular county would mean an annual addition of £37,000 to local taxation. I know that the Bill provides for recoupment of 50 per cent. in certain cases. I have no idea what the cost of implementing this measure will be but, having regard to the present high level of taxation and the increase in rates, I fail to see how the huge amount involved will be raised unless economies are effected on other services. I am not putting that forward by way of destructive criticism or in a spirit of fault finding. It is a matter that must be faced and which it is appropriate to discuss while the Bill is going through. I trust that the measure will become law as soon as possible and I wish it Godspeed.

This is a brilliant attempt at disentangling the confusion which existed between the Departments of Local Government and Public Health. We have now separate Ministries for Local Government and Public Health and the relevant administration is divided between two Ministers and two sets of officers. I feel that this arrangement will be eminently satisfactory in the matter of the general health of the community. The Bill must be regarded from the points of view of finance and administration. I have already brought certain points to the notice of the Minister and he has assured me that they will work out all right.

Section 55 has been referred to by Senators. I wish to express my satisfaction at the introduction of that section. There was no such section in the previous Public Health Bill. The necessity for this section was clearly demonstrated to any official who had duties to perform in connection with public health matters, especially during the emergency. Food was being prepared in premises which were absolutely unsuited to the purpose. There were firms established during that period that were not previously engaged in the manufacture of food products. The result was that a good deal of food was lost. I refer principally to ersatz coffees, which were prepared at that time, and to many salad creams. Certain food products that were scarce were prepared under very unsuitable circumstances, and the products also were unsuitable. This Section 55 gives the health authority power to register all premises in which food is prepared and stored. I would even suggest that the word "packed" should be included. It is not in the section. It includes a provision for the licensing of those handling food. The freedom from infectious disease of persons handling food is necessarily entirely a matter for the medical officers, but certainly there is a great need for the registration of premises in which food is manufactured, stored or deposited for sale. It would mean the registration of every butcher's shop. I have said on a previous occasion that, as the law stands at present, a butcher can open a shop anywhere he wishes. He can even open it on a dunghill, as long as his product is fit for sale. There is supervision of the meat which he sells, to see that it is not diseased and that it is sound and wholesome, but the premises in which he sells are not subject to any specific supervision. There is no supervision, for instance, to enforce the provision of a water supply, wash-hand basins, suitable towels and soap. Under this Bill it will be possible to eliminate the criticisms that Senators could make as to the supervision of public health matters as they stand at present. The trouble is that there is no power to see that these things are done.

Senator Baxter, looking at me, referred to the manner in which meat is transported through the City of Dublin. Well, it is a case, possibly, of fools rushing in where angels fear to tread, because it is only by systematic education and a little bit, or perhaps a big bit, of intimidation that we have got as far as we have in securing that meat especially is suitably covered when passing through the streets. It is not because the covering looks to the onlooker to be dirty that it is, in fact, dirty. It must be canvas and it, necessarily, must be waterproof, and it is not because it is black and tarnished looking that it should be assumed it is not hygienically clean. I grant that any system of transport like that is not satisfactory and that beef and mutton should be transported in covered vans so as to avoid altogether the use of any cloth or canvas material. I want to mention that it is not so easy to have everything as Senators would like to have them, especially when there is no power at present to do these things. I certainly am very pleased that Section 55 of the Bill is calculated to give the Minister power to make regulations to deal with the matters which have been referred to by Senators, and particularly by Senator Baxter, in relation to the transport of meat through the city.

There is one other point that I would like, in passing, to mention, and it is that the Bill caused considerable perturbation amongst the members of the veterinary profession when they found that their position was being altered entirely practically by its terms. Part V deals with the supervision of almost every article of food used by man, other than drugs or water. It covers actually every living animal intended for food. The members of the veterinary profession interpreted that to mean that the members of the medical profession were to take over complete control and supervision of every living animal used for human food, as well as of all articles used for human food. The Schedule to the Bill contains a list of the enactments which are to be repealed. These include Sections 18, 19 and Sections 21 to 23 of the Local Government Act of 1925. Section 22 of that Act, which is being repealed, provided that at least one of the sanitary inspectors of each sanitary authority should be a veterinary inspector. His duties were to include the inspection and examination of meat, the inspection of cattle and of dairies and other similar duties. Each local authority had to appoint a veterinary inspector for the supervision of meat and milk. Now, that section is being repealed. I am assured—and I hope, that it will pan out correctly, and that this is simply a method of doing what I have already referred to—that it is a disentangling of functions as between the sanitary authority, which will come under the Sanitary Services Bill, and of the health authority, which will come under this Health Bill.

There is also a question to which I should like to refer briefly, even though it may not be quite in order on this Bill. That is the co-ordination of veterinary services under the Department of Agriculture so that the Minister for Agriculture would be the appropriate Minister to supervise the work and employment of veterinary inspectors, whether under the Department of Health or the Department of Agriculture. I believe that these things will pan out correctly. As I said at the outset, it was felt that this Bill was going to cut across the work and the national service which I maintain the members of the veterinary profession have been giving to the people. There are some other points which I do not propose to deal with now because I realise that they can be more satisfactorily discussed in Committee.

Before I conclude, I should like to draw the Minister's attention to Section 5 which empowers him to make regulations "in relation to anything referred to in this Act as prescribed". There is no section or sub-section giving power to revoke or alter those regulations, though later, under Section 7, power is taken to make Orders and to revoke or alter those Orders when made. In practically every section of the Bill power is taken for the making of regulations. I want to draw the Minister's attention to the fact that he ought also take power to revoke or alter those regulations.

I think that, if the Senator refers again to Section 7, he will find that there is power to do what he suggests.

I have already referred to Section 7 which gives the Minister power to revoke or alter any Order made by him under the Bill, but, as I have pointed out, Section 5 gives him power to make regulations "in relation to anything referred to in this Act as prescribed". There is no mention, however, that the Minister is taking power to revoke or alter regulations, and, as the text of the Bill will show, there is a difference between regulations and Orders. I think that the Minister should take the power that I suggest so that he will be able to alter or revoke regulations if the necessity to do so should arise. These are the only matters I want to deal with on this stage of the Bill.

I do not propose to offer any opinion on the medical aspect of any of the matters contained in this Bill. I leave that to those whose opinions on medical matters count. A number of Senators have spoken in laudatory terms of the Bill. I propose to touch, briefly, on its economic aspects as well as on its reactions on the members of the rural community whom I represent here. Since the advent of national Government, many social reforms have been carried out in this country, and very properly so. But the ever-increasing social reforms seem to continue indefinitely and to superimpose extra taxation and rates principally on the rural community. From 1935 to 1943 the rates in rural Ireland increased from £2,729,988 to £4,132,106. I do not like to paint a pessimistic picture of the condition of our people, but I am supported in my contention by remarks made during the closing days of the Dáil by no less a person than the Taoiseach, who appreciates the condition of the rural community and the fact that it is disappearing.

This Bill has been carefully gone into in a documented and careful statistical return compiled by no less a person than the county manager of my county. He states that the new Health Bill will put £37,000 on the county rates. There was a mis-statement by a Senator here that, of course, the Government would meet that. The county manager states that when this Bill becomes an Act, it will cost £75,000 to operate in the County Limerick, 50 per cent. of which will be recouped by the Government. Therefore, the amount that will be chargeable upon the rural community, in the main, in my county, as a result of this Bill, is £37,000. That is not a figment of the imagination. It is a carefully considered and deliberate statement after a careful review by the County Manager of Limerick.

Look at the condition of our people. In 1938 this Government were presented with two very serious reports. One was the report of the Commission on Currency and Banking and their reactions on the community. The commission warned the Government that they should make effective and drastic changes in their policy. But the worst of all, and of course we must accept it on undisputed authority, is the report of the Registrar-General, an appalling report, the accuracy and the authenticity of which cannot be questioned. What does he say? Three hundred rural schools closed; 78,000 fewer children born in the period 1926 to 1936; 60,000 fewer registered on the rolls of rural Ireland. Add to that a statement made here by the Minister for Finance at our second last meeting when he was checking up on some statement that was made by a Senator. The number of emigrants was perhaps exaggerated from these benches, but he said the number was 220,000.

Mr. Hawkins

On a point of correction, the figure given by the Minister was 120,000.

I am glad to be corrected. That is an appalling figure. I do not propose to go into the medical aspects of this Bill which have been condemned in strong terms by medical men in my county as an invasion of the rights of the person and the family. Is there to be no end to these social services? Are these social reforms to keep coming on, creating a kind of wicked spiral with tragic consequences for our rural community? Why are the people fleeing from the land? One of the reasons is the continuing increase in rates. Last year, which was a reasonably good year, we made many appeals to the Minister for Local Government to extend the time for the payment of rates. Do you think we did that lightly without any definite or specific reason and without a case to justify the appeal made by us?

Now, we are complacently asked to pass this Bill, which may affect a great national reform, which may be very essential from the point of view of the health of our people, and which unquestionably is something to be applauded and accepted. Whatever the good intentions of the Bill may be, it will react seriously on the people in the rural districts who, in the words of the Taoiseach, are disappearing from the land. They are disappearing from the land because it has ceased to be an attractive means of livelihood, owing to the ever-pressing load of local taxation. Do you think the county manager lightly or complacently made the statement that this Bill, with all the laudation that it got here to-day, will superimpose on an already over-pressed people a sum of £37,000 per year? That is only the minimum; God knows what it will be. Is the cycle of social reform to continue indefinitely until we have a wicked spiral reacting seriously on the economic condition of our people? These people are flying from the land because there is no outlook and no future for them on the land. That is the position from the economic point of view. Senators cannot contradict my statement about the people fleeing from the land. Suppose they could go to the United States, how many of the youth would you have left? People of my age probably do not matter. I farm about 120 acres. If our children are gone and we cannot get men to work the land, it is a terrible problem. Hence I stand here alone on a completely different line from those who spoke up to now. I say that local bodies have a perfect right to raise the objection I have raised. The provision of preventoria, clinics and so on will mean a lot of nurses and doctors who must be supplied at considerable expense. The growing tendency of local government is to call the tune, without any idea as to who is going to pay.

It would be very interesting to know how much money comes from rural Ireland into the Government hospitals to maintain them. It has been said, very properly, that 75 per cent. of the wealth of this country circulates within ten miles of Nelson's Pillar, and we know that one firm in Dublin last year had a turnover of £350,000. In proportion, that is equal to, if not greater than, the turnover from the 4,000 holdings in the same year in the Newcastle-West rural district, which is 30-miles long by 18-miles wide. There should be some way of getting at the central funds and giving a more equitable distribution of the charges. I hope the Minister will consider that particular aspect. I have plenty of material if I wanted to take up the time of the House in talking about it. I press the Minister and the Government to consider the serious economic reactions which this and other Bills must necessarily have upon the rural community, of which all bemoan the disappearance. I was delighted the other day to read in the Official Report that the Taoiseach has appreciated what an awful disaster it is that our youth is going. The Government is helping them to go, by creating this continuous wicked spiral and this extra taxation, which the people are unable to bear.

Tá an Bille seo molta ag an méid sin daoine nach gá domhsa cur leis. Ba mhaith liom eolas a fháil ar rud nó dhó ná brathaim a bheith sa mBille agus gur chóir go mbeadh soláthar éigin ann ina gcóir. Ó théarmaí an Bhille, beidh mórchuid oibre breise le déanamh ar shaghas áirithe seirbhísí leighis— dá bhrí sin beidh gá le hoiliúint nó tréineáil speisialta i leith cuid acu san, go mór-mór oiliúint ar fhreastal lucht eitinne agus oiliúint ar shláinte leanbh. Is áirithe go bhfuil fhios ag an Aire a dheacra agus atá sé do dhochtúirí óga, gur mhaith leo oiliúint speisialta a fháil sna brainsí sin, é d'fháil in Eirinn fé láthair. Níl ann ach 3 no 4 ospidéil fé láthair in a bhfaighid dochtúirí óga oiliúint ar fhreastal galar na heitinne.

An bhfuil sé beartaithe ina aigne ag an Aire go mbeidh caoi gan cosc ag na dochtúirí óga chun an tréineáil sin d'fháil? Mar is eol don Aire, níl ach fíor-bheagán daoine gur féidir leo áiteanna d'fháil in oispidéil tréineala fé láthair chun cúrsaí a dhéanamh agus teastas nó cáilíocht d'fháil. Rud is ea an teasnamh caoi sin go mbraitheann a lán dochtúirí óga a bheith ina chúis gearáin géir acu. Is measa fós atá an scéal maidir le héinne gur mhaith leis teastas nó cáilíocht d'fháil in eolas ar shláinte leanbh. Níl, dar liom, ach ospaidéal amháin anseo gur féidir d'fhearaibh dul ann, agus ní feidir ach le duine nó beirt sa turas dul ansan féin. Is áirithe go raibh an cheist sin in aigne an Aire nuair a bhí sé ag cur an Bhille seo le chéile. Ba mhaith liom a fhios d'fháil uaidh an bhfuil aon athrú ar scéal na tréineála do dhaoine mar sin ina aigne aige.

Leis an scrúdú éigeantach a déanfar anois fé théarmaí an Achta so is áirithe go bhfaighfear fios ar chuid mhór eile daoine go bhfuil eitinn orthu agus gur gá dhóibh freastal nó fónamh in institiuidí chun a leighiste. Mar is eol dúinn fé láthair, níl go leor leapan sna institiuidí sin chun freastal ar an méid daoine gur fios don tseirbhís leighis, nó dhóibh fhéin, go bhfuil an eitinn orthu. Conas atá beartuithe freastal ar an méid mór eile go mbeidh eolas fachta orthu, agus go mbeidh lorg ar áiteanna dhóibh um a luaithe tar éis an tAcht a theacht i bhfeidhm? Sé fírinne an scéil fé láthair nach bhfuil go leor spáis sna hinstitiuidí mar atáid anois chun freastal ar an lucht eitinne go bhfuil eolas cheana orthu.

Sa tseirbhís phoiblí leighis faoi láthair, tá soláthar fé dhlí na mBocht do chuid áirithe den phobal a gheibhcann seirbhís in aisce ó dochtúirí dhlí na mBocht ar fuid na tíre. Tá éigeantacht anois ann go gcaithfidh gach uile dhuine—scoláirí scoile go háirithe—dul fé scrudú na ndochtúirí a ceapfar fén Act Sláinte seo. Beidh orthu san clann daoine go mbeidh ceart acu fé Dhlí na mBocht seirbhís leighis d'fháil in aisce, ach beidh scrúdú, leis, dá dhéanamh ar chlainn daoine eile ná fuil ceart acu freastal leighis d'fháil in aisce. Má cuirtear an scrúdú d'éigean orthu nach nádúrtha a mheas go n-éileoidh siad freastal in aisce d'fháil ar na galair nó na gearánta a aimseoidh an scrúdú ionta. Ná beidh claonadh coitian ag an gcuid den phobal, nach daoine bochta do réir na dlí iad, chun feidhm a bhaint as an Acht so chun freastal leighis a gclainne d'fháil in aisce? An bhfuil baol ann, leis an Acht so, go mbeidh cailliúint tuarastail dá dheascaibh le fulang ag dochtúirí ina gcleachtadh phríobháideach?

This Bill has been greeted from all sides of the House as a laudable and courageous effort, on the side of preventive and curative medicine, to improve the health of our people. I am not in a position to criticise its various sections; indeed, I must confess that I cannot form a very clear conception of how many of its provisions will work out. That makes me anxious that the Minister, if it were possible for him to do so when the Bill goes through the Oireachtas, should give us a radio address explaining how he envisages the effect of the Bill throughout the country when it becomes operative. One of the provisions of this Bill relates to the dissemination of information and advice about health. That is a real need. It is really pitiable how much sickness is caused through ignorance. People will allow themselves to catch cold. Through neglect many of them will not change their wet clothes. Young men and girls often do that. Very often consumption develops in such conditions. In most homes there is very little knowledge of sick nursing. The Bill proposes to deal with many of these things.

I am interested particularly in Sections 21 to 28, which deal with mother and child services. I would like to know more clearly how these proposals will work out. While we greet this Bill as a laudable and courageous effort on the side of curative and preventive medicine, we must not forget that the health of the people is really formed in the homes and what we must aim at is having good homes. Reference has been made by Senators to the need of proper food and properly cooked food, and emphasis has been laid on the need of better housing.

This is one advance in the direction of ensuring the better health of our people. Another most important factor is housing. In addition to those things, we want full employment at such a rate as will provide an adequate standard of living. Above all—and here I come back to the tune the Minister has often heard from me—we want our women trained to run our houses as they should be run. This Bill will help a great deal. The provision of nurses will help our women to deal with many things that are problems at present.

We are a very healthy race. There has not been very much need, until in recent years, of doctoring at all, but there are new diseases, and new dangers have crept in, particularly tuberculosis. Preventive medicine and knowledge on the part of the people are our best securities against the spread of tuberculosis. There is no use in spending money in the manner envisaged by this Bill unless we have proper schools. Where is the use of having children examined for health purposes in schools that are actually a menace to their health? That is a matter that has to be seriously tackled.

This Bill is largely a Committee Bill. Its provisions must be carefully examined. I join with those who have welcomed it, and I wish the Minister God-speed in his good work.

During the preliminary skirmish, as one might call it, the Minister said that this Bill was largely an enabling Bill. To that extent I agree with him, and the real meat of the measure will be revealed only when we see the regulations that will bring certain sections into operation. I think it is very unfortunate that we have not got certain standing machinery that enables such regulations to be examined in a systematic manner. Senator Duffy raised this question some time ago and I think he got a rather lukewarm reception from the Taoiseach, who was speaking for the Government, and also from this House.

We have reached a stage now when the really essential part of legislation is frequently in regulation form and that is illustrated by this measure, where we see that certain developments in preventive medicine will be taken up in the form of mother and child services. It is most important that we should know more, that we should examine more than just that general aspect, and that we should see what are the details under which a service like that will be brought into operation.

All through this measure the House will note that services and controls are highly centralised. I tried to count the number of times in which the phrase "with the consent of the Minister," appeared, or where a phrase somewhat on these lines "the local authority may," occurred, or "if the Minister so ordains"—that is not the exact wording, but it is something along that line, and where we meet the word "shall".

I fail to see what discretion, beyond very minor points, the local authority will have in the operation of this measure. In so far as it is mainly a consolidating Bill, and only to a minor degree breaks fresh ground, there is not very much the Seanad can do to it. But do not take me as approving of the proposal that the Committee Stage should be hastened in any way and that we should not after the Minister has spoken have ample time to prepare any amendments that we may think fit. At this time of the session we always reach this most unsatisfactory stage where we are asked to consider measures under the shadow of the recess, where we are told that it is not desirable to use our usual deliberation in regard to the interval between the Second Reading and Committee Stage and where it is also suggested that it would be most inconvenient to bring back the Dáil to consider any proposal we may make. Although I know that we are, as you might say, constitutionally free and that there is no power to prevent us, if we see fit, taking all the time we like, there is that sort of tacit understanding that we must not be as deliberate in our considerations as we would be if we were dealing with the measure earlier in the session.

In looking at this question of public health in a somewhat bigger way than this Bill actually prescribes, I ask where can one get proper information about the activities of health authorities? The first thing that occurs to me is that I should find a good deal of what I want in the Report of the Department of Local Government and Public Health. I go down to the Library and ask for the report. What do I find? I find the latest report is for the year 1943-44. I have no doubt there are all kinds of reasons. We have had them on other occasions—"officials are so busy", etc.—but that should not be so. In an efficient Department we should get these reports within a reasonable time. Think of a public company that did not issue its report for nearly three years after the close of the year. Am I wrong? I am quite prepared to accept any correction about the information I got in the Library. Think of a public company that does not issue its reports for three years after the closing date or compare this Department with a certain Government utility, the Electricity Supply Board, which, with commendable promptitude, gives a public report on a subject which, I imagine, is just as intricate and with accounts running into very considerable sums of money, within a few months—about three months—of the closing date.

This is not the first time I brought up this matter. It does show—I do not know what the right word is—a certain apathy; I think "slackness" is not too strong a word—or a certain defective organisation which in a Government Department which should be businesslike keeps legislators who want to examine the matter seriously delayed for three years before they can get an official record of what has transpired. Heaven knows, the Government is costing us enough. The public Estimates, speaking generally, in the last ten years doubled and yet there seems to be no acceleration whatever in this important matter of Government reports. Incidentally, may I refer in the same connection, because it has a bearing on public health, to the Report of the Hospitals Commission? I have not looked it up lately, but I should not mind saying at a hazard that their report is every bit as late as the Report of the Local Government Department. I hope the Minister will seriously consider this matter; he is new, I know, and he cannot personally be held responsible perhaps, but there is a corporate responsibility on the part of the Executive Council in these matters and I do hope that the Minister will realise that it is not businesslike and it is not right, that this long period should elapse before the relevant information upon a matter on which we are legislating is forthcoming.

Passing from that, I wish to make certain references to the matter of the financial provisions. I do not want to narrow this matter of finances down merely to this Bill. I want to relate this whole question of finances to the entire range of public health services. I understand—I do not know that I heard him correctly—that in his opening statement, the Minister said that the contemplated grants would meet the whole of the additional services contemplated under this measure. I did, unfortunately, hear only the end of Senator Madden's speech where he drew attention to the heavy and increasing burden thrown by health services on the rates—I would say more than "thrown"—imposed by health services on the rates because such is the system of these Grants-in-Aid under which health services operate, and such is the system of centralisation in the Department under which health services are governed, that local authorities have little or no real say in what shall be provided. I see the Minister, advised by experts, fully versed in the latest developments in modern medicine asking for all kinds of expensive buildings and equipments, saying to a local authority: "You have got to provide—you have got no choice —some expensive institution." The Minister may say to me that before that is done there will be a sworn inquiry. There may be a sworn inquiry but we will not be allowed to see the report of the inspector who conducts that inquiry. It really has a much wider bearing, as Senator Madden suggested, than merely the health of the people. It affects rural life. Senator Madden made a very good point when he associated the drift from the land with the heavy burden of local rates. They are connected.

Under the present system, a large portion of the rates are mainly voted by the local authority but they are imposed by the Minister, the pill being sweetened, perhaps, by a central grant. Is there any way by which that most unsatisfactory system of diarchy —divided responsibility—can be improved? I think that there is. I mentioned this matter before. It runs through the whole system of our local finance and involves the question of direct and definite responsibility. It would be quite possible to take certain services completely out of the rating system and say that they would be the responsibility of the central authority. The local rates and the local officials could be used as the machinery for carrying that into effect but payment would be made from the central funds. The other services might be the entire responsibility of the ratepayers and they could deal with them as they pleased. That would be a logical system and would bring us back to the axiomatic position of taxation and representation. Under the present system, taxation and representation are entirely divorced. That accounts, to a great extent, for the lack of interest taken in local affairs. The question requires examination. We must not simply be satisfied with it because it has always been there. It is no use saying that we can drift along and that we shall muddle through somehow. There comes a time in every healthy organisation at which it is necessary to stand back from the picture and ask oneself: "In the light of modern developments, is that system now applicable?" Since events got so bound up in the pedestrian routine of the moment, it is not possible to get any new outlook on these questions. We might have something in the nature of a general staff. It may not be an apt analogy but, when the Germans were considering the preparation of a modern war machine, they kept the thinking department quite apart from the operating department. They placed their general staff separate from the people who were running the army. We require a thinking department, completely free from the day-to-day work which proceeds in Government Departments, for the purpose of examining these matters and coming along with a fresh outlook. I shall have something to say in a moment about a fresh outlook in another and allied connection.

In April, 1946, when the Ministry of Local Government was being reorganised and three Ministers were being provided for instead of one, when, presumably, a new outlook was being brought to bear on this matter of public health, I brought up a motion asking for what I call, for want of a better name, a White Paper. I could not at the moment be very precise, but I think the House understood what my purpose was. I am not ashamed to admit that I was influenced by the practice which has been growing up in Great Britain since the war. Let nobody taunt me because I went to Britain for an example. The House may remember that, when the Minister for Industry and Commerce desired to justify his somewhat totalitarian Statistics Bill, he said that it was on the lines of a measure which was being enacted at Westminster. Let us not quote everything done at Westminster as right, but let us examine what is done there, and, where it is applicable to our circumstances, profit by their experience. On that occasion, the Taoiseach dealt very fairly with my proposal. He thought I was asking for something which I did not understand, but he said: "I have already told you that the Senator's demand is being met and that a White Paper will be circulated. How long it will be circulated before the Bill, I cannot say at the moment." I do not know whether or not this is the Bill referred to. After all, it deals with a very limited portion of our health services. I shall be surprised if the Minister does not say that further legislation will be required for necessary improvements in those services. I hope later to outline a proper approach to a well-organised and adequate health service.

A year has passed and there is no White Paper. That adds to the uneasiness as regards what goes on in the dark. We do not get our reports until they are three years overdue. We are promised a White Paper and a year goes by without getting it. Is the Department understaffed or what is wrong? I am not sure that there are not too many people there writing to one another. A very experienced public person said to me once: "It is not more staff you want; it is less staff; the less the staff, within reason, the quicker the work will be done." There is a great deal in that. The Executive Council should be somewhat ashamed that the production of those reports takes three years.

Business suspended at 6 p.m. and resumed at 7 p.m.

When the House adjourned I was dealing with this promised White Paper—promised more than a year ago—the appearance of which, I suggest, is necessary to a proper approach to the whole of this question of public health. I relate that general statement to the title of the Bill. The title of the Bill is: "An Act to make further and better provision...." I stress the word "better". In order to make better provision it is essential to have an educated and understanding public. That very idea underlies the whole future stability of the democratic system. Unless our public is educated and unless an increasing number of people takes an interest in public affairs and are encouraged to take an interest in public affairs the survival of democracy is very uncertain. How can the Government help? I would suggest that this White Paper—"technique," if you would like to call it—is essential to an understanding of public affairs. How can you expect the ordinary, intelligent citizen to understand anything on the big question of better health merely by a measure of this kind? Important as it may be, it is largely consolidatory in the sense that it is an enabling Bill, carrying very little detail of what is proposed and only a portion of the whole of the public health policy.

My idea of a White Paper is that we should be given an outline of the future health reform—and Heaven knows reform is needed—and that that Paper, although it is white and on paper, should give an outline of what the Government suggests should be the new public health policy. The Government would not necessarily be committed to any of the particular proposals. This should be on the lines of the Health Services White Paper in England and should give a general outline of future proposals—what I might call a general staff, a "thinking" Department idea. Those proposals should come before both Houses of Parliament in the form of a resolution, where there could be a general debate which would necessarily cover the whole ground of public health. That document should obtain such publicity that the professions would meet and discuss it, that there would be interested persons who would open a correspondence about it in the Press, and that there would be general and widespread interest. After that, and after the public presumably had absorbed something regarding the future policy, then and then only, in the light of public discussion should the Government bring in their considered proposals for legislation. Instead of that, we are told nothing, we cannot get the relevant reports on which to form an opinion, and out of the dark these piece-meal Bills are brought forth.

On the question of better health, let us examine the subject in relation to what I suggest are the important priorities, since it is only in that way that you get an indication of the purpose and of the finance of any proper health service. Anyone knows that the first thing that should be done is to enlarge and make real the whole of the dispensary system. In the City of Dublin, the voluntary hospitals are dealing with many simple ailments which should first pass through the dispensary. These hospitals should not be called upon to deal with many of these ailments which are now taking up their time. Why must they do so? One cannot do anything else, as you cannot send people away and say: "Go to the dispensary, you are not a case for us," as the dispensary system is entirely inadequate. I suggest that the same thing applies to the boroughs and, to a lesser degree, to the rural districts. As a priority, the first thing we need and that should be outlined in the health proposals, is a vastly improved and expanded dispensary service as the basis of any true health development.

I certainly agree with the policy of the extension of the home nursing service, but we should get some indication of what that involves—how many extra nurses will be involved, what their cost will be and what their conditions of service will be. With regard to the conditions of service, I may interject an example to show how these things dawdle on and drag on. I know a certain hospital with which I am associated and, when we wanted to establish a nurses' pension scheme, we were told to hold up, as the Government had it in hand. They still have it in hand and when we are going to see it I do not know.

This question of educating the public has received support from important sources. I have here a paper by Edward Stephenson, Chief Medical Adviser to the Department of Local Government and Public Health, Dublin, and reprinted fromThe Journal of State Medicine, volume 38, No. 10. This is the passage to which I would call the Minister's attention:

"The progress of preventive medicine depends in a great measure on the enlightenment and education of the people and it was realised by the central authority that, before any material advance could be made in health reform, the public should be educated on the needs of the country."

What has been done to educate the public? It is surely not suggested that these piecemeal Bills, dealing with only a section of the problem, and a minor section, are educating the public. A White Paper of the right kind would have been educative but that has been withheld from us for a year. I would ask the Minister to give the public information, in order to get the public's co-operation and to meet the point made by Senator Fearon. Coercion will get you nowhere. You want an enlightened, sympathetic and understanding public and that you will not get unless you have the whole matter brought into the open and debated in a big way. We have Parliament. We have a Press. We have a people. They are entitled to a picture of the proposals that underlie a better health service.

This Bill has been debated from all aspects, both here and in the Dáil, and I do not think that very much remains for me to say in regard to it but there is one point that I would like to put to the Minister. Is there any provision in this Bill for the employment of chiropodists? Any of us who has experience of country life knows the extent to which people are suffering from corns. People cannot enjoy life or good health as long as they cannot walk about with comfort. I have seen some of my agricultural workers crippled. Walking is the greatest penance to them. The provision of a chiropodist would be as essential as any other provision made in the Bill and the cost would not be great. If necessary I will put down an amendment but I would prefer that the Minister would do so. There is a big number of chiropodists in Dublin but there are none in the country. I would suggest that those who would be eligible for free treatment under this Bill could, if they desired, be attended by a chiropodist in the dispensaries. One chiropodist could do the work in any particular county and I think one visit once every quarter or once every month in every district would be sufficient. If the Minister would consider that matter he would be doing a great service to the people of the country who are suffering great pain. I see some Senators smiling but I regard it as a very important matter.

They are sympathetic smiles.

It has been said that Dublin women are the most beautiful in the world but there are very few of them who know how to walk. I think we can attribute that to the corns with which they may be afflicted. If there is no such provision already in the Bill, would the Minister accept an amendment or would he draft an amendment to provide for the employment of chiropodists in the rural areas?

Senator Sir John Keane gave me the impression that he thought that I had asked the Seanad to meet and to give this Bill rapidly; in other words, that the Seanad should not take, as he said, the customary period between the Second and the Committee Stages. I have no objection whatever, if the Seanad is agreeable, to taking the Committee Stage in two or three weeks' time and the Report Stage a week after that. That would suit me all right. But what I did not like to hear the Senator suggest was that the Seanad might adjourn consideration of the Bill until after the summer holidays.

One of the big points that was raised by a number of Senators is the point in the Bill that the local authorities are to carry out practically all the provisions of this Bill but that the Minister makes regulations telling them what to do, how to do it, and so on. That has to be considered, not in the strict or narrow sense in which it is put into the Bill. I think Senators will realise that one must have power to go a good deal further than you mean to go because you may have to go that far in certain cases. What is really going to happen? The local authorities have always carried out the health regulations and there is no reason why they should not do so in future. We mean, when this White Paper, which I will talk about later, comes along, to discuss the question of organising a local authority other than the county council. That local authority will carry out the health services but the Minister must make the regulations, first of all, to enable them to do certain things and, secondly, to try to have some sort of co-ordination between the counties for the country as a whole.

In fact, the world is going further than that. We have signed a world health convention under which we undertake to co-operate with the other countries of the world to take common action in certain cases. Surely, common action must be taken between all the counties and all the cities for many things and, therefore, there is a necessity for a central authority. That necessity, I think, would be admitted by every Senator. Take one thing that was mentioned—vaccination against smallpox. There would be no use in allowing each county to adopt that or not to adopt it as they thought fit because, unless every county adopted it, it would be no use. The same thing would apply to some extent to many of the other things that have to be done. In any case, it is hardly necessary to argue the point that a central authority is necessary. The local authority also is necessary. The only difference of opinion probably is as to how far the local authority should get powers and how far the Minister would withhold or would keep to himself functions that might apply to the country as a whole.

Take mother and child welfare, for instance. We want to encourage every county to do it. We want to encourage every city to do it. Certain regulations will be drawn up by the Minister, after consultation, of course, with the medical men and others who may be able to advise on it. These regulations will be issued eventually and they will be regarded for a long time to come as what you might call a model set of regulations. They will be given to each local authority and within these regulations they will be asked to act. They cannot go outside these regulations because they have no power to go outside them. We do not think that they can come up to the regulations in all cases for many years. They will do their best, we hope, and will, we hope, in every case come up to the model or ideal scheme of mother and child welfare that we have in mind and that everybody would have in mind if he were in my place.

There is another thing. Do not think that the Minister or his Department will be dictators, as some Senators appeared to believe. The Seanad may take it that some regulations will be suggested by the local authority. The local authority, probably, will say that in their particular county they would like to have power to do so and so over and above the power they had already and, unless the Minister sees some very strong reason why they should not get it, he will say: "Very good; we will make the regulation that will enable you to do that." In that case a regulation may be made for one county or a number of counties. It may be made, say, for county boroughs and not for the rest of the country, as the case may be.

The point has been made as to whether it is fair to legislators that they should be asked to pass a large enabling Bill like this and not know what the details are that will go into the regulations afterwards. It would be a very difficult thing to put all these regulations, with all the details, into a Bill. It must be remembered that the regulations may vary as between, say, the rural and urban parts of the country, that they may vary between some county councils and others, or that a different set of regulations may vary, to some extent, as between one county and another. These regulations will be very long and detailed, dealing with the time, say, that a school inspection should be held. They will also, in time, I hope, deal with the forms that must be filled. In that connection, I would like to say that a central authority is necessary in order to get uniformity in the type of inspection that is done and in the type of questions that are put so that when dealing with the matter in a statistical way we will be able to deal with it intelligently. It will enable us to classify the number of children that are suffering from a particular disease, to see, for example, whether there is any geographical significance in that particular disease, and whether there is any significance with regard to class or means, and so enable us to get at an understanding of the cause of that particular disease. Of course, it is necessary to get an understanding of the cause before one can treat disease of any kind. Therefore, it is only labouring the point to say that a central authority is as necessary as a local authority. We can only hope that the local authorities will take on as much responsibility as possible. At the same time, there will be co-ordination maintained by the central authority between all the local authorities in matters where co-ordination is necessary.

Senator Douglas raised a point on Section 55 with regard to the giving of licences to shops. The Senator said that under the section we could provide to license every grocer in the country. That is true. There is the power there, and it is a necessary power, but I do not think, however, that it is a power that will apply at least for a very long time. I cannot see it extending to all grocers. Probably every Senator would agree that, as soon as we have the machinery, personnel and so on, we should try to insist on a better standard of cleanliness with regard to meat and the sale of meat. That would mean, of course, that we would have to register every person who sold meat and, therefore, every shop where meat was sold would have to be licensed. There may be other articles of food that it will apply to, but it is not going to apply for a long time. It is not going to apply to the small huckster shop or to the small grocer who is not dealing in foods of that kind. I do not think that we need worry very much about that section, even although it gives wide powers. These wide powers cannot be used because we have not got the organisation or the personnel to enable us to carry out a very big inspection of all grocers at the moment.

Senator Douglas made another point with which I agree. He said he thought that compulsion should be applied only to prevent a person from injuring others. I think that is exactly how I would define my attitude, too. I think I said on the Second Reading that if we were only dealing with, say, deficiency diseases which school inspection will bring out—goitre, rickets, or some other deficiency diseases—that we probably would not have to insist on compulsory inspection because if the parent has a child that is suffering from rickets or goitre—these are not contagious diseases—it is only the child that will suffer, and if it is the parent's concern solely, then, I think, there is no case for compulsory inspection. We insist on compulsory inspection in cases where a child may be a source of infection to others. It may be tuberculosis or the more infectious diseases, such as scarlatina or diphtheria, and these may be hidden away unless we have this inspection. Infestation would be another instance. That is why it may be necessary, on occasion, to use these compulsory powers. I have said already that, as far as I am concerned, I do not intend to see this power used unless it becomes absolutely necessary.

Senator Douglas asked what was the position with regard to conscientious objectors. I think I made it clear on the Second Reading that nobody can be compelled to accept treatment. Senators may take that as the first point, that nobody can be compelled to accept treatment. There is a certain amount of compulsion, in certain circumstances, in the matter of inspection. There is also compulsion for immunisation against disease. In that particular case, when we say to the district medical officers that they should immunise, say, every child against diphtheria, a conscientious objector will get the prescribed form if he asks for it. If he signs the form his child will not be immunised. The form is then put in. That will cover the case of Christian Scientists who were mentioned by Senator Douglas. There is, however, the overriding provision that in the case of an epidemic it then becomes absolutely compulsory to do immunisation, and the conscientious objector will have to put up with that. But in the ordinary school procedure, of getting school children vaccinated against smallpox or immunised against diphtheria, the conscientious objection will hold.

There is a distinction between an order and a regulation. I believe that the regulation is the general sort of thing that is made for a number of authorities. An order is anad hoc thing that is done. Perhaps it would be hard to define the difference between the two, but, generally speaking, that is the practice that is followed. One is called a regulation and the other an order. With regard to Senator O'Donovan's question, I find that if any Bill gives a Minister power to make regulations that, under the Interpretation of Enactments Act, it also carries the power to amend or revoke.

Some Senators spoke about the cost. I am sorry that Senator Madden in his speech disregarded my announcement in the beginning. I suppose that when a Senator goes to a lot of trouble to prepare a speech there is a temptation to make that speech. However, I did say in the beginning that there will be no extra cost on the local authorities. It will work in this way. Whatever a local authority is expending this year on health services will be ascertained and agreed upon between my Department and the local authority. Then we will say to the local authority: "You will raise the same amount for health services and we will make up the difference until our contribution is as high as yours, until we reach the fifty-fifty stage. Then from that on we will go on the fifty-fifty scale." Under that arrangement, so far as I can foresee the development of these health services, it is not likely that any health authority will have to provide anything for health services for about six or seven years. It will remain as it is for these six or seven years and there is no use in looking beyond that. As Senator Fearon pointed out, even if these health services do cost a lot— they will cost somebody, either the taxpayer or the ratepayer, quite a lot— the country will gain in good health, and even from the financial point of view we should be satisfied with the results.

Senator Fearon asked if we could make a certain charge in certain circumstances for treatment. I do not know if that could be done by regulation. Possibly it could; it is a matter I should like to look up. Senator Fearon also spoke of trying to avoid compulsory examination. Of course, I should like to avoid that. He suggested that, first of all, we should reserve the compulsory powers unless they are absolutely necessary. I agree with that. Secondly, he suggested that we might punish the persons in an indirect way by withholding some benefit to which they would otherwise be entitled. I am afraid that that would amount to the same thing, because what we have here is that if a person does not present the child for examination he is fined. When he is fined, the matter is disposed of. The other would be a more continuous sort of fine. He suggested that we might allow the parent to be present at the examination. Probably that could be done. He also suggested stopping the compulsory powers at 12 years of age. All these things can be considered. There was also the point of dealing with the medical men concerned, that is, compensating them for their increased labours, etc. Naturally, that will have to be done. The Senator wound up by visualising the time when, as Samuel Butler said, a person would be put in jail for being sick because he should not be sick. I wonder if the Senator, when he is speculating on things like that, will say what we are to do with the big hospitals when there are no longer any sick people.

Senator Baxter said the country was rather disturbed over the increase in tuberculosis. The Senator is wrong in that. We all agree, of course, that there is far too much tuberculosis in this country. The mortality from tuberculosis, however, had reached the lowest figure on record in 1938. Then it went up from 1938 to 1942. It has been coming down since. In 1946 it was almost down to the 1938 figure; very close to it. The rate has been coming down very satisfactorily in the last few years, which is a consolation, I am sure, to everybody. There is quite a lot to be done yet; quite a lot of room for improvement.

I know that Senators usually make the point, which is a good one, that we should try to remove the cause of disease where we can by means of good housing, good food, etc. But do not let Senators get it into their heads that disease in this country is altogether due to lack of food, because, so far as I know, if it were the fact that our health record here is low on account of the amount of food we get, the health record of other countries should be very much worse, but it is not. We must remember there are other causes and we should keep these in mind. There is no use in trying to explain food in terms of calories or vitamins; you cannot do it on those lines, because if our people, say, a hundred years ago, had known about calories and vitamins, they would have starved to death on potatoes; but because they did not know about them, they lived well on potatoes. We probably do not get enough milk, but half the world gets no milk at all. All these very difficult problems present themselves—how we need so much milk here and other countries have no milk; how well we live on potatoes here and cannot make out where the calories come from. This subject of food is one which cannot be dealt with very lightly.

Rheumatism was mentioned by some Senator. That is a matter to which we mean to give attention. When we get our regional hospitals going, we mean to have specialists attached to these hospitals, one of whom will be for rheumatism. We hope to have eye specialists, nose and throat specialists, rheumatism specialists, orthopædic specialists, etc. We hope to have a specialist attached to each regional hospital and that either the specialist or his assistant will visit each county periodically. It will depend on the particular malady whether he should visit once a month or twice a month or once a quarter. That is the type of organisation that will be set up when the regional hospitals are established.

There are other things, such as the common cold, which gives a lot of trouble and which nobody has ever gone into very deeply. They are paying a lot of attention to that in England now, and we hope we will gain from their experience. Senator Counihan's reference to corns was by no means a joke. Nothing can cause a person so much discomfort as corns. There is no reason why we should not deal with that. I think any health authority could employ a chiropodist. I hope the Senator will see the young ladies of Dublin walking somewhat better when that is done.

A question was raised with regard to the grading of dispensaries and whether there should be a salary proportionate to the number of persons in an area. That is a matter that is being considered. I think I announced that we have a public health survey going on and as a result of that we should be able to have our dispensaries reconstituted, if necessary, so as to make it possible for either one man to take charge of a dispensary area, including the mother and child welfare service, or make the area a bit bigger and give him an assistant. In big dispensary districts in Dublin it may be necessary to have three or four medical officers. At any rate, when we do the survey, we will get over whatever difficulties there may be in that respect.

The question of Mayo was raised. I dealt very fully with that matter on another occasion and I do not want to go into it now, because it is not a matter of general interest to Senators. I suggest that if the Senator who raised it reads the speech I made in the Dáil on the Health Estimate, he will find that, for the benefit of Mayo Deputies, I went very fully into the whole question and told the Dáil what my views were. Senator Hawkins referred to compensation and quoted a legal decision in a case which occurred in Cork. Unfortunately, our Health Bill was fairly well advanced when that case came to my notice. We did put in an amendment to cover cases which might occur in any institution under a health authority, but we have not been able to cover the case of a public assistance authority. In time, all institutions will come under the health authority, but some time will elapse before that takes place, and the question to be considered now is whether it is worth while to bring in a Bill on the same lines to deal with patients in public assistance institutions. We will see if that may be necessary.

Senator O'Donovan raised a point about food inspection and suggested that we had cast rather a slur on the veterinary profession because we did not give them due notice of the Bill. We did not intentionally cast a slur on any profession, but there was no reason why the veterinary profession should come into this Bill. The section he refers to, Section 22 of the 1925 Act, which was repealed, was re-enacted in 1941. That is why it is repealed now— it should have been done then—in order to make good the omission at that time. The point, therefore, is covered, but, as I mentioned to the Senator and his organisation, the veterinary profession will be reorganised, I hope, in the near future, and it is possible that a Bill may be brought before the Oireachtas dealing with the profession, the duties they will be expected to perform and the local authority, Minister, and so on, under whom they will perform these duties and I ask the Senator to wait until that legislation comes before the Oirechtas.

Senator Ó Siochfhradha raised a point about the training of young medical men. The point was also raised by Senator Fearon. That is a position which we must try to remedy. We have discussions with the medical schools and we hope to be able to remedy the omission with regard to the training of young medical men and enable some of them to be trained here rather than have to go away for training as they have to do at present.

What I particularly referred to was that part of their training which pertains to experience in hospitals.

We have all that in mind, training in hospitals and so on, and we hope to be able to do something in that regard. The Senator also raised the question of the private practitioner and how he would fare under this Bill. I have discussed that on a few occasions with the men concerned and I have tried to persuade them that they will do better under the Bill than they do at the moment. They do not altogether agree with me, but I think they will do better, because, if there is to be inspection of children twice a year, I am quite sure that quite a number of parents will get a certificate from their own family doctor who is a private practitioner and he will naturally charge them for it. They will get work which they never got before, writing certificates, setting out that children are in good health. As against that, they will lose a certain amount because mothers and children will avail of the free service, but one should balance the other and they should not come off too badly.

Senator Concannon and Senator Sir John Keane stressed the matter of the education of the public in health matters. That is a matter of which we are very conscious and we mention in the Bill that we want power with regard to it. The intention is to use the newspapers and the radio—to make talks on matters of health and advice to the ordinary person on how to avoid disease or treat certain things, a fairly general feature on the radio—and I hope we may be able to effect some good in that direction.

Senator Sir John Keane referred to the annual report. The Local Government Department has a very difficult problem to handle. The medical officer in each county issues his annual report fairly promptly—soon after the year is up—and these reports can be got by any Senator—I am not sure that they are available in the Library, but I am sure they can be got. These reports then come to the Local Government Department. The Department has some trouble in writing for further information because they must give tables, classifications of diseases and so on and it takes a long time to get these figures clarified and into line and to get the tables produced. Then, of course, printing at the moment is very slow. The Department of Local Government is not comparable with an ordinary business firm because the Department has got these tables to produce and the only comparison which I can see is with the Department of Finance, which issues its reports very much quicker than the Bank of Ireland.

Senator Sir John Keane wants White Papers and I absolutely agree. The White Paper system is a very good system, because, when a Minister issues a White Paper, it purports to be his view of how things should be done and it invites criticism from all concerned. That criticism can be considered, and, if sound, the suggestions can be incorporated in the legislation. I promised that the White Paper being prepared when I took over the Department would be issued as soon as possible. I think I have now satisfied myself that the official issue can be brought to the Government for consideration. The Government, of course, must agree because there are certain financial provisions in it. It will then be published. The printing will take some time, but it will be published, I hope, some time during the summer.

In the other Department of which I have control there will be a White Paper issued also before the end of the year which will give Senators an idea of the future of social welfare and, I am afraid, it will give them a shock, too, when they see what it will cost.

Question agreed to.

Committee Stage fixed for Wednesday, 16th July.