Seanad Éireann debate -
Thursday, 1 Oct 1953

Vol. 42 No. 13

Health Bill, 1952—Committee (Resumed).

Question again proposed: "That Section 16 stand part of the Bill."

Minister for Health (Dr. Ryan)

I was asked about certain figures with regard to the number of beds available for maternity cases. I gave some figures in the Dáil when this matter was under discussion. I have not checked up on it, but I think there might be a few additional beds since then. At that time the number available for maternity cases in hospitals was 1,112. On the basis of each bed accommodating 25 women in the year, which is about a fortnight roughly per person, these beds will accommodate 44 per cent. of the maternity cases in the country. In addition to that there were 640 private maternity home beds and they would accommodate 24 per cent., making a total of 68 per cent., a figure which, as I said yesterday, compares very favourably with the number of beds available in Great Britain or the Scandinavian countries which are supposed to be very well hospitalised.

In addition to that, we have authorised in the Department of Health the building of certain new hospitals and the addition of beds to county hospitals which will provide an additional 550 beds. It will, of course, take a few years to get these completed. Some of them will be ready to come into use before the end of the year and some next year. I think the last of these 550 beds will be probably those in the Coombe Hospital which, I expect, will be ready in about four years' time. When these are provided there will be accommodation for 89 per cent. of the maternity cases in the country, so that only 11 per cent., therefore, will have to remain at home. These beds, I think, will be more than sufficient to meet any demand there may be for hospital accommodation for maternity cases.

Other interesting figures which I looked up last night are with regard to the number of cases which have been dealt with by the three maternity hospitals in Dublin. On their own figures as supplied for the Hospital Year Book, in 1951 the Rotunda Hospital dealt with 4,000 cases in the hospital and with 2,000 cases on the district outside; that is, domiciliary treatment. The National Maternity Hospital, Holles Street, dealt with 4,150 indoor and 400 outdoor. With regard to the Coombe Hospital, I have not got the figures for the same year, but in 1952, 2,250 cases were accommodated in the hospital and 750 on the district.

It will be observed from these figures that in the case of the Rotunda, which deals principally with the north city, one out of every three was dealt with on the district in their own homes. In the case of Holles Street, one case out of 11 was dealt with on the district, and in regard to the Coombe, practically one in two—17 to 22. A small number, about one in two, was dealt with off the district and the remainder in the hospital itself. It is not easy to explain in the case of the Rotunda and the Coombe why such a big proportion should be dealt with in a domiciliary way and such a small proportion dealt with in Holles Street, because if you take it from what you might call the social point of view of the fitness of the house for delivery at home, you would imagine that Holles Street would be better situated than the other two hospitals. Both the Coombe and the Rotunda Hospitals are situated in the middle of the slum area of the city. Holles Street is a bit outside the slum area and is, therefore, in a district where the houses are better on the average than the houses in the vicinity of either the Rotunda or the Coombe. However, it is sometimes very hard to explain these things, but that is the position.

There were a few other points raised last night. Senator Cunningham told us that in France they give a lump sum of £30 to a woman in confinement. Of course, there is no use comparing France with this country because if we had the same fertility rate here as they have in France we could afford to give £30. Fortunately or unfortunately, perhaps, our fertility rate is different. Therefore, we could not deal with the matter on those lines.

There is one point to which, perhaps, we have not adverted in this discussion as to whether there will be more and more cases applying for hospital accommodation rather than have the maternity take place at home. Undoubtedly, there is a tendency that way. The reasons given by certain Senators were the domestic difficulties with regard to domestic help, and so on. As some Senator very aptly put it, a woman with two or three children who would, perhaps, find it impossible to get domestic help could not have her baby at home but she might succeed in getting her baby placed with her mother or her mother-in-law. That is a tendency and the Bill will not interfere with that. The tendency may continue to grow. The Bill has nothing to do with that. So far as the Bill is concerned it would pay the woman and her husband as well if she had the baby at home as if she had it in hospital. We are not interfering with that tendency in any way. Indeed, I should like, if possible, to alter that tendency and make it more attractive to have domiciliary treatment as far as possible.

I think that the best way to do that is to try and induce the doctor concerned to keep the woman at home rather than send her to hospital. The best way to do that is to pay the doctors better if they look after the baby at home. That might have some effect. That will be the scheme as far as it goes.

I am afraid that giving a grant, as was advocated, I think, by Senator Cunningham, to a woman in the case of maternity is not going to cover the case as we want to cover it from the health point of view. It is all very well to give a grant to the woman who is a truly provident woman and her husband. They will probably spend that money on her maternity and on clothes for the children and so on, but I think that Senators will agree that if you give a grant to certain young married people who are expecting a baby the money may be spent before the baby comes at all and then we may have to do something about the maternity. I think it is better that we should provide that the woman will be looked after in the case of maternity. As far as the grant is concerned, that is different. There is a grant of £4 for women in the lower income group.

Mr. Baxter

When do you give that —after the arrival of the baby?

Dr. Ryan

It will be given at that time, either the day before or the day after. I do not know. It will be given around that time. It is designed to help the woman to buy clothes for the baby, but whether she will spend it in that manner I do not know, but she will get that £4 into her hands. It was put to me by certain people who advised me in regard to that scheme that if she has her baby at home and if she gets the £4, in all probability it will be spent on entertaining her friends when they call to see her. We cannot help that. If it is spent in that way 75 per cent. of it will come into the revenue.

Some Senator also said—as a matter of fact, I think it was Senator O'Higgins—that this particular section could not be operated for three or four years. I must say that I cannot see that. Let us say that the appointed day is the 1st April—I do not know whether we will be ready for that; regulations will have to be framed— and that we have the regulations ready for Section 16 to bring the maternity scheme into operation and that we make the Order before the 1st April. In such an event the local authorities will be in a position to operate the scheme if they so wish. I do not see what is to prevent local authorities from operating the scheme from that particular date.

They will have to get the doctors to agree to work the scheme. That may be done centrally. If the I.M.A., apart from their non-co-operative attitude, are prepared to talk to me about what terms should be offered to medical men in this particular scheme when the Bill becomes law, then we might be able to make a national agreement with doctors who will participate in this scheme. There should be no great difficulty then in having the local authorities operate it.

Senator O'Higgins also said he noted that there was not a choice of doctor. He took the very extreme example of a dispensary doctor in a remote district. Admittedly, a choice of doctor is difficult in that case but it is not impossible. These districts do not cover the great majority of the population. The great majority of the population is situated either in towns or at any rate in places within ten or 12 miles of a town or village, and there will be a choice of doctor for the great majority, even for those women in the remote districts. They may have a sister, a mother or a mother-in-law living in a town and they may be quite free to take up residence in the house of the sister, mother or mother-in-law for the period of their confinement. They will have a choice of doctor in that way.

That also covers, I think, the answer to the query that was put by, I think, Senator O'Reilly when he mentioned a person living in a town which is situated between three different counties. All that the section says is that the doctor must have an agreement with the local authority. If Senators think over it, it is obvious, I think, that the local authority concerned must have an agreement with the doctor, but there is nothing to prevent them having an agreement with doctors outside their own county. Let us take an extreme case. Take the case of a woman living in the County Kerry and that her mother, let us say, lives in the County Kildare. If she likes she may go back to her mother, have her baby at her home and she can make an agreement with her doctor there. All that the doctor there has to do is to write to the secretary of the Kerry County Council and to say: "I want to be put on your panel."

Professor Cunningham

Supposing her mother also lives in the County Kerry as she may?

Dr. Ryan

Then, of course, there is difficulty. They all live in the County Kerry. I am answering a question about a woman who goes outside her own county. The point that Senator O'Reilly made was that we should change the words "the local authority" to "a local authority." I think we will have to keep to the words "the local authority." I was taking, for example, a case in the County Kerry. In that case, Kerry will pay the bill and there is nothing to prevent it paying the bill. If the doctor in the County Kildare, or in any other county, formally writes to the secretary of the Kerry County Council and says: "I want to be put on your panel," that is the end of it. Having got an acknowledgment to his letter, he treats this lady who has come up from Kerry to live with her mother and when everything is over he sends in his bill and gets paid.

I do not think any difficulty will arise about a doctor living outside a county. Of course, there is no doubt but that many women will be inclined to come to Dublin for their confinements. If they do, they can go to a doctor in Dublin. All he has to do is to write to the county concerned and say: "I want to be put on your panel." When he does that, he is all right as far as getting his remuneration is concerned.

The question was also asked: "Who is going to decide who will go to hospital?" The first thing that happens is that the woman who is about to be confined selects a doctor off the panel. She goes to him and tells him that she is expecting a baby and asks him to look after her. He says he will do that. He is then in sole charge. If he says to her that she can have her baby at home, well that is the end of it. But if she says that she would prefer to go to hospital—I suppose we may not have doctors with the moral courage to resist—but if we have a doctor who will resist and say: "You must stay at home," then she must stay at home if she wants to come under the scheme. If, on the other hand, he says: "Yes, I am going to send her to hospital," it is he who decides.

No one but the doctor decides whether she goes to hospital or not. Suppose he decides that she is to go to hospital, he knows probably, and, if not, he gets in touch with the local authority, what hospitals are on the list for this county and he selects a hospital for his patient. If a bed can be found in that hospital, then that is decided, as far as that is concerned. If, however, there is no bed available in that hospital, then the woman must go to some other hospital. That is all.

I think that what I have said covers the queries that have been raised on this particular section. I think myself that there is a rather unwarranted anxiety about the possibility of working this section. I do not think there is any difficulty whatever if the I.M.A. would be helpful, if they would co-operate and negotiate for a settlement with regard to what they should be paid. If they do not, then I suppose all we can do is to put in advertisements for doctors who are prepared to work under this particular scheme. But, once having got doctors to work the scheme and having them on the panel of the local authority, women will get to know who these doctors are. Then, I think, the scheme will work fairly smoothly. I want Senators to keep in mind that it is the doctor, and nobody else but the doctor, who takes on a woman who is in sole charge, and of saying whether she will have her baby at home or whether she will go to hospital. If he says that the woman must go to hospital that is the end of it.

Mr. Baxter

Suppose there is no bed, who is in control then?

Dr. Ryan

If there is no bed there will be a bed found, I hope. We have been working in this country now for a long time. Work has been going on here as long as the Senator and I can remember.

Mr. Baxter

And before our time, too.

Dr. Ryan

The country has gone on during all that time and if people wanted a bed badly they got it. We are going to provide more beds. The Senator should not be raising what are, if you like, unreal difficulties. I cannot see how any Senator can argue that there will be more beds required as a result of this Bill than there are at the moment. Apart from this Bill, it must be admitted, I think, that there is the tendency to-day for people to want to go to hospital. A lot of women want to go to hospital now who did not want to go there before. I think I could argue, as far as this Bill is concerned, that it is going to ease that position a bit because at least we can now say to a woman: "If you stay at home we will pay the doctor; we will pay the nurse and we will pay your chemist's bill; we will pay all that for you if you stay at home." That certainly should be some inducement to a woman to stay at home if she can manage it at all.

Professor Cunningham

The Minister has made a great number of promises in regard to maternity hospitals. He has, in fact, promised more beds. We have been listening to these promises for at least 20 years, but apart from the National Maternity Hospital nothing has been done. I, unfortunately, was not here in time to hear the figures which the Minister gave in regard to maternity beds in this country. Somebody else will deal with them. I very much doubt their accuracy. If the Minister was so anxious to provide maternity beds for patients why has he been so slow, or why have the Departments under the various Governments that we have had in this country, been so slow in providing the beds? Plans for maternity hospitals were drawn up years ago. The Coombe Maternity Hospital was promised a new hospital long before the last war. So far nothing has been done. They are still working on plans. New plans had to be made because the old ones had to be scrapped. New sites had to be found. All that has been going on. Why has not the maternity hospital in Galway been built? They started on that, but all they have is a small unit. They have not a proper maternity hospital there. Why did they stop building the maternity hospital in Limerick some months ago? That is held up. We have had all these promises.

The Minister said that the beds in the local authority hospitals for maternity cases amount to 1,112. I should like him to specify where they are. I have been in charge of a maternity hospital in this town and time and again I am rung up from the country to say that they had no beds down there for their maternity patients. So far as those parts of the country are concerned, are those beds in the county homes or are they in the county hospitals? Where are they?

I do not wish to detain the House by recalling some of the things which have been happening with regard to maternity patients in the country, of patients being sent from the county home to the county hospital and from the county hospital back to the county home and then back to the doctor to take the patient—the patient having been in an ambulance for hours. As regards nursing homes, the figure of 640 beds has been given. Why should patients go to a nursing home if they can get treatment free in a hospital? The total of 1,152 beds has been given. The figure is absurd. The Minister is very native and has a great facility for turning an argument or a figure in his own favour. He spoke of the Dublin maternity hospitals and the number of cases they deal with and why it is that one hospital will deal with a higher percentage of cases than another hospital. The Dublin maternity hospitals are in three districts. The Rotunda deals with most of the north side. You find by far the biggest number of the working class people living on the north side of the river and the Rotunda serves that district. The Minister said that one in three of these patients stays at home. A lot of these patients have always stayed at home. Some of them will in future but the tendency has been there to go into hospital. I know that perfectly well because I visit the Rotunda several times a year. I go there to conduct examinations and I see patients lying on trolleys in the corridors waiting for somebody to vacate a bed. The Rotunda has been concerned for years in trying to select patients as between those who should go in and those who could stay at home. If all the patients who wanted to go in did so there would be something like 5,000 and not 4,000.

The position in regard to the Rotunda Hospital would be much worse were it not for the fact that we have the National Maternity Hospital on the other side of the city. The National Maternity Hospital has about the same number of beds as the Rotunda and the district which it serves is entirely different from that served by the Rotunda. There are not so many working class people there although there were years ago. When I was much younger I worked in that hospital as an assistant. I knew the district very well down by the docks, the tenements, and so on. There were all kinds of houses and a very large number of people lived there. You may remember between 1930 and 1938 or so a lot of these places were pulled down and the people were evacuated mostly out to Crumlin and the population of that district has dropped.

If the Minister had inquired as to where the patients in the National Maternity Hospital come from he would find that a very high percentage of them come from the north side of the city because they know they cannot get into the Rotunda. If he is anxious to get the figures I am sure we could give them. We have a very small district of people living around us. We have only something over 400 deliveries in the district in the year but a very big number in the hospital because they come from all over the place, from the county and from the country.

The Minister has tried to make the point that the Rotunda encourage the patients to stay at home and that the National Maternity Hospital take all they can in and do not encourage them to stay on the district. If we had 50 more beds in the National Maternity Hospital we would still have a certain number on the district. The Coombe Hospital is in exactly the same position. They are in a big area where there are poor patients. They cannot take in any more than they do and they have a very high percentage of patients living around the district who cannot get into the hospital. These are plain facts and anybody who wishes to inquire further into them can do so.

According to the Minister, this Bill encourages patients to stay at home, because the patient's doctor will be paid, the patient's nurse and chemist's bill will be paid and the patient will be given £4 to spend. However, in regard to the patient who comes into the maternity hospital, her doctor is paid, her nursing and chemist bills are paid. It is all free and she is also given £4 to spend, whereas the patient who remains at home has to be looked after. The nurse does not stay all day; someone has to cook for her and look after her children; she has to provide linen, light, heat and everything else that is necessary. Which patient is worse off? All that is provided free in hospital, but the patient in her own home has much more expenditure and the encouragement she is getting is £4 into her hand.

The Minister referred to the point I made in regard to patients in France getting a grant of £30. The French people were anxious to increase the birth rate and they therefore gave this inducement. Surely the Minister does not think that handing 30,000 frances into a patient's hand to spend as she likes is the method that was adopted. Nobody would be crazy enough to suggest that. The patient is given this money in the form of grants. Her doctor's fee is guaranteed to a certain figure; the hospital and nursing fees are also guaranteed to a certain degree and she gets a certain allowance to spend. The Minister condemns this method of giving money to spend, although he himself proposes to give them £4. I think the patient should get some money to spend as she thinks fit, but if you gave a sum of £30 to a patient for confinement you would not hand it as cash into her hand. It was never suggested that you should. Under the insurance scheme you do not.

Then the Minister went on to introduce something which I think is dreadful. He suggested paying a doctor more if the patient could be encouraged to stay in her own home. That is a dreadful thing to do. It would mean that the doctor would be anxious for the patient to stay at home because he would get more money. That inducement might balance his better judgment in regard to sending that patient to hospital if he thought she should be sent. That is a very wrong attitude. Why should a doctor be paid more to encourage a patient to stay at home? It is imposing a strain on the doctor which is unfair.

The suggestion was also made by the Minister that if the members of the Medical Association are prepared to go down and talk to him he will settle all this business up and everything will be grand. We have talked with the Minister several times and what it amounts to is this. We approach the Minister with a few little points on which we do not agree. Having consulted the Minister, if we agree with him he will then tell us what he is going to pay the doctors. It is there in the Bill. He has the power. The Minister is the dictator. He can tell us and that is what you call consultation with the Minister. If we agree with him he will tell us how kind he is going to be to us.

Mr. Hawkins

I did not wish to intervene in the discussion on this particular section except that reference has been made by Senator Cunningham to the Galway Maternity Hospital. I would like, as one of the representatives coming from Galway, to make it quite clear to the members of the Seanad that as far as the Galway County Council and Galway health authority are concerned they have been in the past and are at the present one of the foremost health authorities in the country in making provision for both maternity services and sanatoria and every other medical provision that can possibly be made in the county. There was what the majority of us will refer to as undue delay in going ahead with the erection of the Galway Regional Hospital, and I have no hesitation in stating here or elsewhere that that delay was in the main due to no other section of the community than to the medical profession. I attended meetings of the Galway Board of Health, as it was at the time; an architect was appointed, plans were drawn up——

Professor Cunningham

When?

Mr. Hawkins

Plans were submitted to the board of health and on every occasion that such plans were submitted there was one or other of the medical profession who attend the Galway Central Hospital, as it was then and is now, who queried or questioned or suggested that certain alterations should be made in regard to the particular section they themselves were in charge of. As a result, there were innumerable alterations and each alteration—as every member of this House who is on a local authority knows—took up considerable time. If there was delay in having the work put under way in Galway, it can be laid only on the people concerned. There is a new maternity hospital erected in Galway. Not alone has it been in operation for quite a considerable time, even prior to the war, but the regional hospital which has cost over £1,000,000 is completed and about to be opened one of these days; apart altogether from the fact that a regional sanatorium has been erected there inside the last few years at a cost of another £1,000,000.

I do not think it is right for any Senator—and particularly a Senator occupying the position of Senator Cunningham—to get up in this House or elsewhere and accuse, as has been the case, a local authority that has lived up to its responsibility so well as Galway health authority or county council has in the past.

Professor Cunningham

My accusation was not against the local authority. I asked the question why the Galway maternity hospital has not been built.

Mr. Hawkins

It has been built.

Professor Cunningham

Completely?

Mr. Hawkins

Yes.

Professor Cunningham

That is news to me.

Mr. Hawkins

All the Senator's information it not as up-to-date as he expected it would be or should be. I have a feeling, having listened to the discussion on the various sections of this Bill both to-day and yesterday, that much of what has been said would bear better fruit if it were put forward by the spokesmen of the medical profession in consultation with the Minister and that more good would have come from it than can be expected to come from many of the statements that must be taken as representative of the medical profession here in the last few days.

Senator Cunningham queried the Minister's figure in relation to the number of women who were treated in maternity hospitals in Dublin, but there is one question in connection with this matter on which I would like to have a figure from him. Apart altogether from the number of persons treated in hospitals and treated by the staffs of hospitals in their homes, the most important figure to have is that of the number of women who were turned away because of lack of hospital accommodation, who should have had accommodation in the hospital, rather than be compelled to have their babies at home. Can Senator Cunningham justifiably give one concrete case where a woman presented herself for admission to either of the maternity hospitals in the city or in any part of the country, and where the doctor in charge of the maternity hospital was quite satisfied that that was a case that should receive hospital treatment——

Professor Cunningham

I never said that.

Mr. Hawkins

This is the question I am putting—with that knowledge, from his experience and from his skill in his profession, being satisfied that this case should have hospital treatment and because he had not that accommodation at his command, that person was turned away and allowed to have her baby at home with consequences that, as Senator Cunningham has pointed out in many of his statements here, might result in the death of that person? If that has been the case, has it not taken Senator Cunningham and those associated with him quite a long time to go to the Minister or to the Department or to the public in general and point out this state of affairs, that nothing has been done in this country for the last 20 years in providing maternity hospitals and hospitals of that kind? This attack has been held back and this vital knowledge has been kept from the people. I have no doubt that if a man in Senator Cunningham's position in his profession made known the position to the people, money would not be the obstacle in providing the accommodation. It has all been held back.

I look rather scantily at the various papers published in this country from time to time and I have not seen the medical profession or any individual of it making known these facts to the people, saying that something should be done to provide the hospitals— until this Bill is introduced. Then we have a suggestion made at various times in this House and elsewhere that this Bill is not worth the paper it is written on, until such time as the accommodation Senator Cunningham proposes is provided. The worse case that any person could make is an exaggerated case, as he is not going to get such support he might get for a reasoned case. That is what Senator Cunningham has set out to do in his approach to this Bill.

Senator Cunningham took the Minister to task for suggesting that the provisions of the Bill will help to encourage those women who can stay at home to do so and that the provision made in it will also influence the doctor to encourage people to stay, as the doctor's bill, the chemist's bill and the nurse's bill will be paid. We do not live in the clouds. Most of us live amongst the working-class people of the country and know their conditions and what influences them to avail of facilities that are provided. I know from the greater part of the people that I meet in my particular locality, those of them who do go to a maternity hospital go there because of the free service which they would not get at home. Quite the majority of the women I know would prefer to stay at home if they were assured they would get the free service and would not afterwards be presented with a nurse's bill, a doctor's bill and various other bills that might arise out of the particular case. Senator Cunningham, having less confidence in his colleagues than we ordinary people have, suggests that because the doctor is going to receive some slight increase in remuneration from attending such a case, he will encourage them to stay at home for no other reason, not to relieve congestion and not because the home conditions would be better for the woman concerned. Senator Cunningham has definitely stated that the fact that the doctor is going to receive more for attending a woman in her own home is going to influence him because of that extra remuneration to advise her to stay at home. I do not believe any man in this country would do it despite what Senator Cunningham suggests.

Mr. Baxter

It is a very difficult matter, obviously, for a layman to enter into a discussion on this question as the Senator who just sat down has demonstrated. I am quite satisfied the House would agree with me that he has made no contribution whatever towards clarifying the difficulties which confront us.

Dr. Ryan

Who made no contribution?

Mr. Baxter

Senator Hawkins.

Mr. Hawkins

Well, we will wait for it now.

Mr. Baxter

If I make a contribution it will not be my first intervention and I will at least try to be as reasonable and as intelligent about this as it is possible for me to be. I think that, irrespective of the side of the House on which one sits, we must all agree that Senator Cunningham has made a tremendous contribution to this discussion, and, further, has made the type of contribution that ought to be welcomed in this house, because he has spoken about something which he knows and which is part of his being. He is talking about the work of his profession in the way we know a master who understands his work talks. He is putting the benefit of his enlightened experience before the House. I think it is a magnificent thing to have a man as busy as Senator Cunningham is known to be in his profession prepared to come into the Oireachtas and give us the value of his experience. It would be better for the Oireachtas if there were more people like him and the Oireachtas would be a better place if there were more like him in it, but they will not be encouraged to come in here by the kind of approach that Senator Hawkins made to the suggestions that were put to the House. I am rather surprised at Senator Hawkins. On the whole, one can find little fault with him, but I do not know what has taken him to-day.

An Cathaoirleach

Perhaps the Senator would now discuss Section 16?

Mr. Baxter

Yes, Sir. It is very difficult to discuss it in the light of the speech made by Senator Hawkins. The Minister will recall that I put a query to him and he has not yet answered it.

Dr. Ryan

What is it? I will answer it if I can.

Mr. Baxter

I am going to try to get an answer to it before I leave the House. We go back to the beginning. When is this part of the Bill going to come into operation? The Minister has indicated that he hopes to be able to make a start on it on the 1st April, he said. I have tried to elicit from the Minister what is to be the position of a local health authority if he commands that they will provide certain facilities and it is beyond their capacity to do so. If patients suffer in consequence, if either serious injury or death results because this service cannot be provided for the people whom the Minister declares are to have it, does an action lie against the authority as a consequence? I am not a lawyer but I would like to know the position. Senator Cunningham indicated he has fears as to where the doctor would stand in this regard. I must confess that the Minister was unconvincing so far as I was concerned. There was an air of unreality in the case which he made, when I thought of conditions and what they are like as I know them to be myself in the area which is to be the Cavan health area in the future—and the Minister earlier admitted that Cavan seemed to be a rather different problem or a peculiar problem inasmuch as there were demands for hospital treatment there beyond the capacity of the hospitals. That position is there and is going to be there after the 1st April. It is all very fine for Senator Hawkins to stand up and proclaim to the country the magnificent achievements of the Galway County Council and the Galway health authority. Where did they get the money? Did these millions come from the rates of Galway or from the sweepstakes? If you got them the other way you got something that we have not got and of which many other counties are just as badly in need and unable to secure.

If you have a maternity hospital near completion in Galway which costs £1,000,000 and which was started during the régime of the inter-Party Government, where did the money come from? If there was another type of hospital built earlier in Galway where did the money come from? Fourteen years ago Cavan health authority purchased a site to build a hospital and not one stone has been put upon a stone yet and when some time ago we asked the Minister to receive a deputation from Cavan County Council he did not absolutely turn us down—he rarely does that; he is always ready to listen and on the whole he is always ready to receive people and not ungraciously either— but he indicated to Cavan County Council that there did not seem to be any hope of anything being done until after the five-year period or the seven-year period and that they would be wasting their time. Yesterday he admitted that there was a peculiar problem in Cavan. I put it to the Minister—where are we going to find beds for maternity cases in our circumstances at present and what are to be the consequences in a county like mine? I am quite certain that if other Senators told of local conditions in their counties they could tell the same story because we are not the least progressive in Cavan in regard to the reconstruction of our hospitals since the early days of this State. I cannot see how we can meet the demands of the Minister in this and I am concerned and perturbed about it.

I would like to have this further information from the Minister. If he says we are going to start on the 1st April, when is he going to make his Order? When is he going to indicate that he is going to start on the 1st April, because there will be financial commitments and as all members of local authorities know quite well it is not on the 1st April you levy your rates. The estimates are prepared on the 1st January and it is at the February meeting that you strike the levy. The Minister would have to have his mind made up by December as to when he is going to bring this part of the Act into operation.

I feel that much of this is still in the air and we are not going to be able to bring it down to earth, because we have not the space to cater for the people who should be catered for. I am not going to go into the case and the many points made by Senator Cunningham, but I see in my own part of the country the problem that is there. You have one type of problem in my county. On the other hand, I do not want to go too wide of the particular branch of the medical science under discussion, but at the last meeting of our county council we had an intimation that in the sanatorium in Cavan we are now going to have to treat patients from, I think, Westmeath and Longford, where they have no sanatorium to be treated at home.

That is the problem all over the country, and when you have that position, much of the thing is in the air and however desirable it may be to do so when you try to bring it down to earth there is no place you can rest your cot.

Professor Hayes

The debate on this section provides a good example of the point I was trying to make yesterday. When this Bill passes into law it will effect nothing. Nothing will happen until the Minister makes an Order putting the Bill into operation. He may make an Order putting some part of the Bill into operation. He may make an Order putting the Bill into operation in certain areas. But even then nothing will happen until the Minister makes regulations. The great difficulty in discussing this Bill is that it depends absolutely and entirely on the kind of regulations the Minister will make and the Minister has given no indication at any stage of what kind of regulation he will make. Therefore, it is not possible for anybody, without knowing what the regulations will be, to discuss adequately what will happen.

Senator Cunningham, who is intimately experienced in the matters with which this section deals, can give a certain idea of what may happen but even he, despite his knowledge and his experience, cannot adequately discuss this matter without knowing what the regulations will be. The section is based entirely, as indeed is the whole Bill, upon the ground that the Minister will get the requisite powers—remember, the Bill is permissive—and that, having got those powers, he will then make regulations. He is prepared to consult all kinds of people. He is prepared to meet all kinds of people; he is prepared to be nice and gracious and sympathetic and pleasant, but he is not prepared to tell us anything and the main reason why he is not so prepared is because he himself does not know. Nobody knows what the effects of the Bill will be and the Minister does not know what he will put into the regulations.

I do not like intervening in a discussion between two medical men but this section, together with certain other sections, does offer an inducement to women to go into hospital rather than remain at home. That appears to be quite clear. The Minister says the reverse is true but, having said the reverse is true, he then says he could give a further inducement. What shocks me in the Minister's speech is the extraordinarily low standard he attributes to everybody, both doctors and expectant mothers. Surely it is not true to say that if doctors get a higher fee for attending patients in their own homes they will keep more and more women at home. That seems to me an astounding statement.

Secondly, he pointed out that if expectant mothers got the grants they would spend the money foolishly on entertainment instead of keeping them for the purpose for which they were given. I cannot visualise any section of our people setting themselves such a low standard or acting so foolishly as that.

We may as well get on with the section because, until we see the regulations, we have really no idea what will happen. It is quite clear that there is not a sufficient number of maternity beds. It is quite clear that this section, together with other sections of the Bill, tends towards more and more hospitalisation as distinct from treatment in the home. Under sub-section (4) a doctor practising maternity will have most of his practice taken from his unless he makes an agreement with the local authority and becomes to that extent the servant of the local authority.

All through this Bill the fundamental aim is the nationalisation of medicine. Doctors will work under regulations made by local authorities and those local authorities will in turn be responsible to the Minister. The intention is to make doctors employees through the medium of agreements with local bodies. I think that is a bad thing.

Dr. Ryan

I want to say a word about Cavan County Council. I said yesterday that I knew there were sometimes 100 patients waiting in Cavan. Nevertheless, there is a fairly good hospital there. There is a fairly good hospital in Wexford. Wexford has no county hospital such as Cavan has. Surely Senators ought to have some consideration for the Minister for Health. He cannot build all the hospitals simultaneously. He has to spread the programme over 20 years.

Mr. Baxter

That is agreed.

Dr. Ryan

Therefore, some will be done straightway and some will have to be left until later on. A Minister for Health—it was not I who did it— picked out the areas where the hospital services were fairly good and decided they could afford to wait. I was in Manorhamilton and I found the hospital there in an appalling position. A new hospital will be opened in Manorhamilton in the next few weeks. There are hospitals under construction in Longford, Carlow and Dundalk, but Senator Cunningham would give the impression we are doing nothing. We are spending over £5,000,000 this year on hospitals.

Professor Cunningham

I was speaking about maternity.

Dr. Ryan

If the British were spending £200,000,000 I am sure Senator Cunningham would tell us what they were spending on hospitals, because he admires the British.

Professor Hayes

The Minister must have a very weak case when he begins to wave the flag.

Dr. Ryan

Did we not hear all about the British yesterday?

Professor Hayes

This is all so much nonsense.

Dr. Ryan

Senator Cunningham is a member of the Fine Gael Party. He is always telling us what people are doing in other countries and accusing us of doing nothing here.

Professor Hayes

If it were not for the Fine Gael Party nothing would be done here. Everything done here is based on what the Fine Gael Party did in the past.

Dr. Ryan

Cows in the distance have long horns. Fine Gael never built a hospital.

Professor Hayes

They built this State.

Dr. Ryan

They took over the workhouses and when we came in in 1932 those institutions were in exactly the same condition as they were in when they were taken over ten years previously.

Mr. Baxter

Could the Minister not meet the case without losing his temper?

Dr. Ryan

Senator Cunningham says there has been no progress in hospital building for 20 years past.

Professor Cunningham

I was speaking about maternity hospitals.

Dr. Ryan

Senator Cunningham said there was no progress. I have a statement here showing what has been done in relation to maternity hospitals in every county. Senator Cunningham was a member of the Joint Committee and the recommendation of that Committee was to add 100 beds to each of the three Dublin hospitals, 50 private and 50 public. Mark you, 50 private. That would give a total of 300 beds. He now says that if we add 550 beds we are adding too many because we are adding them all over the country and not just in Dublin. Senator Cunningham has the Dublin hospital mentality. He does not see why we should have 550 beds all over the country. If we accepted the recommendation of the Joint Committee, of which he was a member, and added 50 private and 50 public beds to each of the three Dublin hospitals, that would be a grand thing.

I said we would pay doctors at an increased figure for treating people in their own homes and that that would be an inducement to both doctors and patients to accept treatment in their own homes. I am accused immediately of imputing low motives to doctors by Senator Cunningham and Senator Hayes. I also said that if the maternity grant was given beforehand some of the women might spend it foolishly. I do not believe that every doctor would be influenced by what he would be paid. Neither do I believe that every woman would spend the grant foolishly, but it might happen in some cases. Will any Senator, even a Senator with his eye to propaganda in the way Senator Hayes has his, tell me that no woman would spend that money foolishly? We know very well that some of them might. Having spent the money, we would have to do something about it.

Mr. Baxter

What point is the Minister trying to make?

Dr. Ryan

Senator Hayes accused me of imputing low motives to women because they might spend the money foolishly.

Mr. Baxter

That is if the grant is given before the birth actually takes place.

Dr. Ryan

Supposing we did——

Mr. Baxter

Whoever would suppose that would be a stupid person.

Dr. Ryan

What can we do with the stupid person? We must deliver the baby even though the mother has been stupid.

Mr. Baxter

But the stupid person would be the person who would give the grant before the baby arrived.

Dr. Ryan

Because I said it would be stupid to do so, Senator Cunningham and Senator Hayes accused me of low motives.

Mr. Baxter

Not at all. You said they might spend it if you gave it to them.

Dr. Ryan

Of course they might spend it.

Mr. Baxter

It is on that you built your case.

Mr. O'Donnell

If people get money to spend surely the Minister is not going to lay down the way they should spend it.

Dr. Ryan

No, but I say that she gets money because she is going to have a baby and the idea is that she would look after herself when she got it. I say that if she gets this money she may call a party of her friends and say that she is going to have a baby and spend the money first and then we have to look after the baby.

Mr. O'Donnell

Is not that the usual thing?

Dr. Ryan

Because I said that, I am accused of low motives by the propagandists in the Fine Gael Party.

About the Irish Medical Association, Senator Cunningham says they will not meet me because, he says, if they do meet me and if they agree with me, I will say: "Good men; it is all right now," and, if they do meet me and I say "No," I am a dictator. Let us reverse the position. If I meet them and agree with them, they will be the dictators. That is what he wants, that they should be the dictators as to what should be done where they are very intimately concerned with regard to payment, and so on. I think the doctors are a good body of men, just as good as the carpenters or the plumbers or anybody else.

Professor Cunningham

Thank you.

Dr. Ryan

They are just as good. We would not certainly call the carpenters together and say: "I am not a dictator. Whatever you say, we will give you." They say: "We want 14/- an hour," and I say: "That is all right, you can have it." That is what Senator Cunningham wants for the doctors. I am not a dictator if I agree with whatever you say.

Professor Cunningham

Rubbish.

Dr. Ryan

If I do not agree I am a dictator and, because I will not guarantee to agree beforehand, they will not meet me, they will not co-operate.

Professor Cunningham

I said nothing of the kind.

Dr. Ryan

But they said they will not co-operate.

Mr. Baxter

I do not think the Minister is fair to himself in that.

Dr. Ryan

They said publicly at their annual meeting that they would not co-operate in this Bill and Senator Cunningham says that, if I did agree, everything was well and good.

Professor Cunningham

I did not say they would not meet you.

Dr. Ryan

They said it. I thought Senator Cunningham said they would not meet me. That is a change. I welcome that change. Senator Baxter wants to know what will the local authority do if they are committed to do a thing and cannot do it. Senator Baxter is always looking for difficulties.

Mr. Baxter

It is important to look far ahead.

Dr. Ryan

If Senator Baxter had been a Member of Parliament 75 years ago when a Bill was brought in to compel the local authorities to bury people he would have asked what would happen if there was a heavy frost. He is always looking for difficulties.

Mr. Baxter

The Minister is merely evading answering my question by that sort of comment.

Dr. Ryan

There is no use in Senator Baxter putting questions like that. If he were in my place, he would say that nothing can be done.

Mr. Baxter

Has the Minister ever heard of an action for negligence by a patient in hospital?

Dr. Ryan

He would say to the people: "I cannot do anything because it may happen that in some particular case a person would go to the local authority and the local authority would say that they had no bed for the patient and the patient would take an injunction against them and get heavy damages." It is a ridiculous question. He knows he is looking for ridiculous questions which do not deserve to be answered.

Mr. Baxter

The Minister cannot answer, just as he cannot answer any other question.

Dr. Ryan

I cannot answer. If there were an epidemic and if 5,000 people in County Cavan got sick on the same night and came to the local authority, perhaps they would have an action against the local authority. I do not know. How can I answer that question? What can we do about it? Are we going to wait, to say that we cannot go ahead and must drop this Bill?

Mr. Baxter

Are not you creating that legal situation?

Dr. Ryan

Then we must drop the Bill because we cannot do anything about it? Senator Baxter is searching for difficult questions and because I cannot answer he says I am trying to evade.

Mr. Baxter

I think you ought not to apply it. That is my difficulty.

Dr. Ryan

We ought not to apply the Bill at all!

Mr. Baxter

In areas where its application is beyond the physical capacity of the hospitalisation facilities.

Dr. Ryan

And where we have hospitalisation as good as any other country?

Mr. Baxter

We have not the space.

Dr. Ryan

County Cavan, of course, need not adopt this Bill for some time, if they like.

Mr. Baxter

If you say that, it is different.

Dr. Ryan

They can make arrangements with other hospitals at the moment. In County Cavan, if a person comes whom they cannot accommodate in the county hospital, they can ring up some hospital in Dublin and send the patient there. Why could not they continue to do that under the Bill? Why makes difficulties, as if it were impossible to do that? When the Bill is passed they can continue the same thing as they do now.

Mr. Baxter

They cannot.

Dr. Ryan

I do not see why they should not. My objection to some of the Senators who have spoken is that they are raising difficulties that nobody could possibly deal with because they are ridiculous difficulties. They are raising difficulties giving instances of cases that may even happen at the moment and that have to be dealt with. When the Bill is passed, cannot they deal with them in the same way?

Mr. Baxter

There is no legal obligation on us to provide services for all these persons at the moment. You are doubling the number of people.

Dr. Ryan

We are adding certain people.

Mr. Baxter

In my county there will be double the number.

Dr. Ryan

I would like Senator Baxter to deal with this—suppose there is a person in the middle income group who is very ill and who will die to-night unless he can get into a hospital and suppose I do not pass the Bill, how does he propose that that man should be dealt with? Does he think it is all right if the county manager could say: "There is no legal obligation on us. You can go and die." If the Bill is passed there is a legal obligation. Does Senator Baxter think he should die?

Mr. Baxter

I do not think anything of the kind, as the Minister knows.

Dr. Ryan

That is the sort of question the Senator is putting.

Mr. Baxter

It is not. Perhaps the Minister will give me a chance to put it to him again.

Dr. Ryan

Very well, I will.

Professor Cunningham

I am sorry to intervene again, but there are just one or two points that I want to refer to. One is of considerable importance and has not been previously ventilated. The Minister raised it and I think I should have permission to refer to it. Before I do so I should like to refer very briefly to something that Senator Hawkins said, that was, why was it that the maternity hospitals did not make it known before now that they were so short of beds? It has appeared in the daily Press— not very frequently—we do not like to publicise these things; it does not help anybody. If the Senator would read any report of any of the three Dublin maternity hospitals he will find it in every annual report going back goodness knows how many years. He will find it mentioned in every annual report by the master of the hospital. These reports are published very punctually every year. I am sure there is no reason why Senator Hawkins should read one but that condition of affairs is well known to the Department of Health for a number of years as the Minister will bear me out.

The Minister referred to the fact that I sat on the committee which recommended to the Department of Health that the Dublin maternity hospitals should be increased in size to the limit of 100 beds each. The new Coombe Maternity Hospital, just about to be built, will contain 250 beds. The present Rotunda and National Maternity Hospitals each contain about 150 beds. In counting the number of confinements in Dublin, the number of patients being refused admission, the number who will require admission in future with the growth of the city, we decided that we would require for these patients an additional 50 beds in the Rotunda and 50 in the National Maternity Hospital. Let the Coombe go on with its plan to build its hospital for 250.

When the Department of Health was planning with the Coombe Hospital to build this new hospital they specified that a certain number of beds in the Coombe Hospital should be private beds. The Minister, I am sure, will not contradict that. They specified that a certain number should be private beds. With that, I am in thorough agreement. People know that for any surgical condition of a maternity case—I mentioned it yesterday—they are safer in a properly equipped hospital. No nursing home, unless it is very big and deals with a big number of cases, can ever be as well equipped as a hospital. Therefore, it has been the custom in various countries. You will find it if you wish to go to Denmark for example—you can fly there without touching England. You will find it in Switzerland, where they have very up-to-date hospitals and in not very old hospitals on the Continent and in every hospital in America. That is as it should be and as the Minister and his Department have recommended for the new Coombe Hospital, capable of dealing with any patient irrespective of her class or her ability to pay. The wealthy man's wife is just as much entitled to the best service as the poor man's wife. The poor man's wife gets the best service at present, especially in maternity cases when she goes into hospital. The well-to-do man's wife has to go to a nursing home and the hospital is better equipped to deal with an emergency than a nursing home. If you have a nursing home, as recommended for the Coombe Hospital, attached to the hospital, you have all the services of the hospital like X-rays, laboratory, blood transfusions and all those things very readily available, and that is as it should be. We have fallen very much behind in that way.

There are only a few hospitals in the city like the Mater, Jervis Street, and Vincent's, which have nursing homes attached to the hospital. We find that very helpful in dealing with the most difficult cases. So it should be with maternity or with any hospital of any kind such as a mental hospital which can deal with all classes of patients. Why should we stick to the old-fashioned idea that maternity hospitals as such are only for the poor? The Minister mentioned that, and it was our recommendation in the Coombe Hospital, to have a certain number of private beds—I have forgotten the exact number—but we recommend that for the benefit of patients paying rates and taxes there should be these private beds. Other hospitals also should have some private beds and I stand by that.

Question put and agreed to.

SECTION 17.

Question proposed: "That Section 17 stand part of the Bill."

Professor Cunningham

Now Section 17 has to deal with infants. This Section 17 includes all infants, as you will see if you read it carefully, and it is going to give rise to a certain amount of difficulty again. For example, sometimes these infants, infants born in a maternity hospital or in the patient's home or in a private hospital under this Act, may if ill require special treatment or specialist treatment very often. An infant specialist may have to be called. You may find an infant specialist who has signed an agreement. Some of these infants are rather difficult and peculiar cases. As you can readily understand, some of them require surgical operation or very specialised medical treatment. Now we find in every city and in every country that these operations are highly specialised ones and you will find very few men who are prepared to undertake to do them.

There are certain operations which I have in mind which will turn up in one maternity hospital three or four or perhaps five times a year and you may have the same number in another.

You will find there is probably only one surgeon, or at most two, that you can pick upon who has had experience and is capable of dealing with it. If this surgeon has not signed an agreement, is independent, and likes to keep his independence and freedom, and has not signed this agreement to work under the Department of Health, can he be called to treat that infant? If he has not signed an agreement, remember that you would not have a great choice of doctor here, and should he be called, will he be paid for treating that infant if there is nobody else who has signed an agreement available? That is a point I want to raise which I would like the Minister to answer, please.

As the Bill stands at present, the parent, in this case, of the infant has a choice of doctors. If the infant is in one hospital and it is ill and its people select a doctor from another hospital and want him to come in there to treat or operate on or specially attend that infant, can they do so? This is a very special point because if, say, an outside doctor can be called in to treat patients in a public hospital in the city it can give rise to a great deal of trouble and confusion. As a rule all these patients in a hospital are treated by men on the staffs. They have complete staffs in the maternity hospitals and they call in consultants where necessary. If they are going to have people called in from one maternity hospital to another, this is going to be very upsetting to the staff. If the patient has the choice and demands that a doctor be taken from another hospital that is very difficult, and I want to know how the question of choice is to be applied in cases like that.

Again if a patient is in a nursing home and if she has to pay the £2 and if her infant gets ill in that nursing home and the doctor wants an infant specialist to come in, and the patient now claims that she is being treated under this Bill and that, therefore, she is entitled to free treatment from the specialist called in, although she can well afford to pay for the treatment of the infant, can he refuse to go? She is, remember, a patient who is entitled to this treatment and she wants this doctor to come in to treat her under the Bill. She is in a nursing home under a doctor. Can a doctor who has not signed an agreement refuse to treat that patient because she is paying in the nursing home?

Dr. Ryan

I am not sure if I have got the questions exactly, but the Senator will correct me if I have not got them correctly. I think the first question is that if an infant is suffering from disease which requires very specialised treatment and if the mother is a paying patient being treated in hospital, can she employ a specialist not on the panel? Is that the first question?

Professor Cunningham

No, the first question was if the infant requires very special treatment in the way of operation and the man capable of doing it is not on the panel.

Dr. Ryan

Yes, that is right.

Professor Cunningham

It was how he can be remunerated?

Dr. Ryan

Well, that is a question that I think can be got over. I am not going to say exactly at this stage how we are going to remunerate specialists of that type, but obviously they must be brought into the scheme somehow or other. The local authority at the moment has power, so far as I understand, to employ specialists, to send their people to specialists if it is necessary, and I think that by an extension of that power the difficulty that is mentioned by the Senator may be got over. At any rate, I think you may take it that the aim is to get the best possible treatment whatever it may be. It would be, therefore, necessary to employ eminent specialists if necessary in any particular cases. Number two, I think, is where the patient chooses her own hospital, can she ask for a specialist not attached to that hospital? I would say "no", because the position there is that under Section 25 a patient can choose her own hospital, but she chooses that hospital, of course, naturally under agreement with the hospital concerned, and if the hospital concerned says: "You came to us to be looked after by our doctors," that is the end of it and she cannot go further than that. So really it is a matter for the hospital. That is what it amount to. The local authority take no further responsibility for the person who chooses her own hospital. They say: "We pay a certain amount, but that is all the responsibility we have." It is a matter, therefore, for the person concerned and the hospital to make whatever agreement they like themselves. At the moment, if a person goes to any particular hospital, he or she has to abide by whatever rules apply there. If that hospital says: "You cannot take in any outside specialist here," that is the end of it.

Mr. Douglas

I should like to ask the Minister a question in regard to sub-section (2) of this section. This is a question which has been put to me and which I should like to hear the Minister answer. A parent can choose a doctor from those who have made an agreement—that is, from the doctors on the list. That much is quite clear. Suppose that the doctor who has been chosen by the parent is uneasy in regard to this abnormal case and wants a consultation immediately, can he do so?

Dr. Ryan

Yes.

Mr. Douglas

Even though that consultant might not be, for the time being, on the list?

Dr. Ryan

I should like to make it clear that I do not like to say "Yes" unconditionally there. What happens at the moment is that the local authority have specialists on their panel. In other words, they have an agreement with certain specialists. I am not sure of the position in regard to gynaecology but, as regards ophthalmology and some other specialised branches of medicine, certain specialists agree to come and look after any case that may be referred to them. That will continue. In fact, it may be extended to other specialists besides, for instance, ophthalmologists. Radiology, orthopaedics and some other branches of medicine have been dealt with so far. These specialists have been appointed by various counties. In a few places, they have appointed a whole-time gynaecologist. It has been the practice of councils to appoint specialists who are there for consultation with the ordinary practioner.

Mr. Douglas

Frankly, I am looking at this more or less from the point of view of my own experience. I am trying to deal with this as a problem and, therefore, let us forget about this scheme for a moment. The child is very ill and the doctor who has been called in by the parent is not happy and wants a consultation. If the parent can pay and the doctor says that he is going to call in a certain specialist, the parent agrees to pay. I want to translate that into the terms of free service under this Bill. I want to know, in the case of a child who is very ill, if the doctor can—as I think he should be able to do—call in the best advice available, and, assuming that the parents cannot pay for it afterwards, there should be some way by which the doctor can receive reasonable payment.

Dr. Ryan

That is the intention, certainly.

Question put and agreed to.

SECTION 18.

Question proposed: "That Section 18 stand part of the Bill".

Professor Cunningham

This section is very short and it reads as follows:—

"A health authority shall, in accordance with regulations, make available, without charge, at clinics, health centres or similar institutions, medical, surgical and nursing services for children under the age of six years."

Does that include all children?

Dr. Ryan

Yes, all children.

Professor Cunningham

Irrespective of whether their parents come under the Act and irrespective of whether the infant was born under the Act?

Dr. Ryan

I think I should put it this way. The service will be available for all children as far as advice goes. Whatever small treatment that might take place in the clinic would be free, but any subsequent treatment outside the clinic would come under Sections 14 and 15.

Professor Cunningham

I realise that this is a small point, but how is surgical treatment to be given in the clinic? I suppose it means minor surgical treatment.

A very important point arises here in connection with children's hospitals. Remember that children's hospitals, wherever they are—we have a couple of them in Dublin—run what we call "out-patients' departments" or "clinics," where the parents bring the children to be examined by the doctors and where treatment is prescribed for them. That takes place in what used to be known as the dispensaries of these hospitals: we now call them out-patient departments or clinics. A clinic is a place where you examine patients, investigate as far as you can, and then decide what is to be done. These are run every day in all the children's hospitals. Will the Minister explain to us the position under this Bill of these hospitals and these out-patients' departments that are run by these hospitals, because it is not quite clear? I think they are not mentioned in the Bill and they are the departments that are doing most of the work in this city. I should like to hear how they will be affected.

Dr. Ryan

Is the Senator referring to maternity hospitals only?

Professor Cunningham

I am referring specifically to children's hospitals such as Temple Street, Harcourt Street and the new hospital at Crumlin. We have infant clinics in the maternity hospitals, too.

Dr. Ryan

With regard to infant clinics in the maternity hospitals, some consultation has taken place between Dublin Corporation and the maternity hospitals. A temporary arrangement has been made that the maternity hospitals would do the work for Dublin Corporation. If that arrangement works smoothly, it means that the problem for Dublin Corporation under this Bill is solved.

Professor Cunningham

That is working.

Dr. Ryan

Let us take, next, the children's hospitals. There are two children's hospitals in this city and soon there will be a third. They are voluntary hospitals. They will be treated much the same, as far as any arrangement is made, as the ordinary general hospitals. I have already pointed out, in reply to a question by Senator Baxter, that if, for instance, County Cavan had not room in the county hospital for a case or that if the medical men there thought it a case that could not very well be treated in the county hospital, then, in all probability, it would be sent to a Dublin hospital where there would be room or where some specialist treatment could be given. The county would make an arrangement with the children's hospital or the general hospital, as the case might be, and send the patient along. That will continue under this Bill except that a wider range of patients will be sent than have been sent in the past. Otherwise, things will run much the same.

Dublin has only one what you might call local authority hospital and that is St. Kevin's. It is not nearly large enough for its requirements. Therefore, Dublin has to send most of its cases to the hospitals in the city. Dublin has a different type of arrangement with the voluntary hospitals—an arrangement which I am not sure can continue. At any rate, it is there at the moment. Instead of paying the capitation rate which is paid by county councils for their patients in voluntary hospitals, Dublin Corporation give a lump sum to the voluntary hospitals and expect the voluntary hospitals, in return, to take any patients that may be sent by the doctors. In that way, Dublin Corporation get over their obligation to those in the lower income group who, at the moment, are public assistance patients. When this Bill comes into operation, Dublin Corporation, like the county councils, will have to look after those in the middle income group in regard to hospitalisation. I suppose they will make a somewhat similar agreement with the hospitals. I suppose, too, that the hospitals will expect to get more from the corporation—but that is a matter for them—and that they will then send their patients along.

I think the Senator mentioned out-patient departments. A good deal of consideration has been given to the out-patient departments and it was proposed at one stage—I must say I thought it was a very good proposition, but naturally I do not know as much about these subjects as Senator Cunningham and men like him who are working in Dublin hospitals—that the patients should be screened before reaching them; in other words, that patients should reach them only as sent by the dispensary doctor and that people should not come direct to these hospitals. In that way, the Dublin general hospitals in their out-patient departments would get the more difficult, the more specialised cases which could be dealt with more efficiently by the hospitals than by the dispensary doctor and which would, secondly, be more useful material for teaching than would be available in the ordinary cases which come along there. I do not know what progress has been made in that regard, but so far as I am concerned if the Dublin hospitals were still of the opinion that that should be done, they would certainly have my support.

Professor Cunningham

I was interested to know what assistance the hospitals would get from the Department in connection with the work they are doing.

Dr. Ryan

I said yesterday that we were paying deficits to hospitals. The deficit, in the first instance, is based on a number of beds occupied per week. In the end, the deficit is paid under some other heading, but that is how we start. Again, in that respect, it has been put to me on more than one occasion that we should also make some allowance for the number of patients treated outdoor. We are considering that and I suppose that, in all fairness, we should do something of the kind, because there may be a voluntary hospital with 100 beds and treating on the average 50 patients per day in the out-patient department and another hospital with 200 beds but treating only ten patients per day in the out-patient department. In one case, the hospital is dealt with on the basis of 100 beds and, in the other, of 200 beds, and that is obviously unfair, because the hospital with 100 beds and treating a large number in the out-patient department have to supply dressings, medicines, heating, as well as time—of course, time is not charged for at the moment—and it is obviously unfair that that should not be allowed for. It is a matter which is being considered at the moment. If it should come that a payment would be made per bed per week to the voluntary hospitals, some consideration at that stage should also be given to the out-patient departments.

Question put and agreed to.

SECTION 19.

Question proposed: "That Section 19 stand part of the Bill."

Mr. Douglas

I am not very clear as to what "treatment service" in sub-section (3) means. The sub-section reads:—

"Where a health authority are not satisfied that an adequate health examination and treatment service is available for pupils attending a school in their functional area which provides elementary education and is not a national school...."

The normal position in most private schools is that the school authorities know that the parents are in a position to provide and pay for medical services and if a child becomes ill, the doctor is sent for. The child is sent home and the parents are able to, and in fact do, provide a doctor. On the face of the sub-section, if I understand it correctly—I may not so understand it—it seems as though practically every private school will come under the section because they have not got in the school itself a treatment service. Each individual parent provides the treatment service and therefore it would look as though the health authority was expected to provide for a health examination and treatment service—whatever that means; I take it that it means some kind of medical treatment—in every private school. I do not think that is intended, but I do not know exactly what is intended, and I should be glad if the Minister would clarify the situation and say what exactly is intended in relation to the private school for small children whose parents are able to pay.

Mr. S.T. Ruane

There is a phrase occurring with monotonous regularity in the Bill: "A health authority shall, in accordance with regulations, make available, without charge ..." The peculiar aspect of this is that the local authority will have quite an amount to do with the operation of the Bill. Local authorities will have to collect the wherewithal, or part of the wherewithal, to make the Bill operate, if it ever operates, but members of local bodies have got no indication whatever as to the weight of this obligation on local finances. We had some talk here yesterday on this question of something for nothing, and many of us have experience of the abuses which a something for nothing service may lead to. Personally, I know of such a situation in relation to the administration of the scholarship scheme. A local authority provided an ex gratia grant for the children of poor parents who had won scholarships and whose parents could not afford to provide the necessary equipment for the secondary school. Several people for whom the concession was never intended applied for that grant and so manipulated “pull” on the local authority that they got it and a stage was reached at which the Government had to cut out the concession completely, with the result that poor parties suffered. I visualise something similar happening under this Bill.

So far as regulations are concerned, a local authority may refuse to carry out the regulations of the Minister. That may lead to a dissolution of the local body which will, in turn, lead to chaos. Local authorities at present are very much concerned about the size of local bills and the Party line-up, so far as expenditure is concerned, in different local bodies is not what it used to be. For that reason, I should like to say that we are really legislating on lines of which the people who will have to pay know nothing of what the financial commitments may be. They have not been taken into the confidence of the Government. Round figures have been given—it may cost so much in the £—but the people generally have not got the remotest idea of what the administration of the Bill, when it becomes law, will cost.

Mr. Baxter

Sub-section (3) opens with a phrase: "Where a health authority are not satisfied..." How is that to be determined? Is it the county medical officer who will determine it? What sort of investigation is to be carried out before it is determined that a service is not adequate, that the examination and treatment service available for children attending a school is not adequate? This function of the health authority is one which the health authority will be very chary and hesitant in undertaking. The school may be a convent school under the jurisdiction of a health authority, a school where there is a kindergarten to which children whose parents are able to provide a health service for the children themselves are sent.

I think that any health authority will be very hesitant before deciding that their officers should walk into a school without saying even as much as "by your leave." If anything like this is to be done, I would suggest to the Minister that he might amend the sub-section by inserting a clause to provide that this treatment would be made available after consultation with the educational authorities of that school. Quite frankly, if I were a member of a health authority in my county and we had to consider the case of the school to which I have referred, where the children attending are receiving education which would be on the level of that received by children in the national school, the first thing I would suggest before any officer of ours put his foot inside the door would be that he should go and consult with the authorities of that school. I suggest that a provision of that sort might be inserted in that sub-section because failing that, difficulties will have to be faced and they will not be pleasant difficulties. I think there is still sufficient respect for educational institutions throughout the country to make members of local authorities rather hesitant about entering these institutions without any discussion beforehand—going in, as it were, armed with the big stick of the health authority and the Minister. I think we should be very careful as to the way in which we use our legislation in this regard.

Professor Cunningham

I do not think the Department will have very much trouble in these private schools. I am quite in agreement that it is desirable that school children should be inspected but when you come to the private school where you have children whose parents are capable of looking after them, and generally do look after them well, I think that this question of forcing inspection on them in any way is very undesirable. I am thoroughly in agreement with Senator Baxter on that point. I think this whole paragraph is undesirable and that it should be deleted entirely. These people as a rule look after the children very well but even so I do not see any objection whatsoever in suggesting to the school, as has been done elsewhere, that they might have a medical man attached who would go in periodically and inspect the children. That might be done but I do not think that they should be compelled or that there should be any dictation to the school from the Department of Health. I think that would be very undesirable. The Medical Association wrote to the Minister on this point and they asked him certain questions about it. They asked, for example, as to how the authorities would know that the obligation imposed on the school was being fulfilled. The sub-section says:—

"Where a health authority are not satisfied that an adequate health examination and treatment service is available for the pupils attending a school in a functional area, etc."

We wrote and asked them how they proposed to be satisfied and what procedure they would take in order to be satisfied. The reply we got was that it will be for the authorities of a school other than a national school and not for the teachers or parents—in other words, the authorities must satisfy the health authority in relation to the adequacy of any health examination and treatment or service provided in the school. It is very definite that they must satisfy the Department that there is adequate examination and treatment.

In reply to the second point they stated:—

"It is expected that the authorities of the school and the health authorities will be able to come to a conclusion on these matters without questionnaires or inspectorial visits to the school."

That, to me, does not make sense. I cannot understand how the Department of Health is going to be satisfied that the health examination in these schools is adequate and satisfactory without even inquiring about it. Not only do they not intend to inquire about it but they do not even inspect. How then are they going to be satisfied? The thing is rather contradictory and I should like the Minister to clear it up. I would appeal to him instead of dictating to these schools and threatening them with the mailed fist that he should encourage the schools. I think in that way he will get plenty of co-operation and that he will find that there will be no difficulty in dealing with these private schools.

Dr. Ryan

First of all, if we want to be logical we should be satisfied that the health of children attending these private schools is being looked after as well as the health of children attending national schools. It would be anomalous if we were to provide by law that regulations should be made to have children attending national schools examined and leave these other children without any attention whatever. Various suggestions were made to me when drafting this Bill. First of all, I took in even secondary schools and vocational schools as well as national schools, but when I came to consider the matter later, after various objections had been made, I thought the logical thing was to get some sort of uniformity for children whatever type of schools they might be attending. I thought it better then to leave out secondary and vocational schools, but to have an examination carried out some time in all primary schools. That is why these private schools are included.

Mr. Douglas

That is in regard to the examination. It was about the treatment service I asked.

Dr. Ryan

I shall deal with that matter in a moment. Then there is the question of who determines. As the letter to the Irish Medical Association says, we did not want to lay down hard and fast rules about serving notice because in most cases the county medical officer of health will hear probably whether or not the children are being looked after from the point of view of health. If he is satisfied that they are being looked after, well and good. If he is not satisfied he will probably ring up the headmaster or approach him in an informal way and state that he would like to have an assurance that things would be put right. I am sure that after this second step, things will be put right but if things are not put right, he may have to serve a notice to have the examination carried out. I am just stating that to illustrate the way in which an effort will be made to have things put right informally before resorting to more formal steps. That is why we did not lay down that notice should be served by such a date and all that sort of procedure.

The point is that if the local authority on the advice of the county medical officer of health says that they intend to carry out an examination then the manager must be informed under Section 32 sub-section (5) which says:—

"Without prejudice to the foregoing sub-sections of this section, a health authority shall consult the school manager of a school before determining the day or days on which and the time at which a health examination of children in the schools will be held and shall, so far as may be practicable, comply with the wishes of the school manager."

I do not think, therefore, that the school manager could have any great complaint, because, as I say, he will probably be approached, first of all, informally and asked to put things right. If he does not, then an examination must be carried out and he will be consulted with regard to the date on which the examination will be held. It says here, as Senator Douglas has pointed out, not only examination but treatment. The treatment covered here is only a very small matter. It is only treatment which might be necessary on the spot. We were advised that if we did not put in "treatment" a doctor going to a national school to carry out an examination if he found, let us say, that a child had just cut his finger and treated the child he might be in for trouble because he treated the child without permission. "Treatment" is put in to cover that sort of minor treatment on the spot. Any further treatment is dealt with in further sections.

Mr. Douglas

Must not the school prove that they have somebody who will give this treatment? That is in the section.

Dr. Ryan

I know that. In most schools, as Senators know, they have a matron or a nurse who looks after minor injuries. Of course a doctor can be called in if necessary. No health authority surely will insist that a doctor must be called in every day or must be there at all times. It will be sufficient if there is a doctor who can be called upon if any further treatment is necessary. Suppose a doctor, as a result of an examination in a national school or a private school, finds that there is some defect which would mean bad teeth, bad ears or bad eyes or a malformation which would require orthopaedic treatment in the case of a national school pupil the treatment for any defect will be free. It does not matter what family the national school pupil belongs to, the treatment for defects will be free, but nothing else will be free. If, on the other hand, a doctor when examining pupils in a national school suspected, let us say, that a pupil had congenital heart disease—I think that would not be regarded as a defect— he would say to the pupil in that case: "You had better get that treated." Whether that treatment would be free or not would depend on what group the child belonged to.

Senators should understand that defects discovered in a national school examination will be treated free no matter what group the child belongs to. As to other ailments, where the doctor concerned would say: "You had better see the doctor," whether the treatment will be free will depend on what group the child belongs to. In the case of children attending a private school, if there is anything wrong with pupils the medical examiner will say: "You had better see the doctor," and these pupils would fall into their own particular group, whatever it might be, as regards payment. That is how the question of payment will be determined.

Mr. Douglas

That seems to be reasonable except for the provision of treatment service. I think most small private schools would be well advised to provide for examination. I agree with the Minister that that is as desirable in a private school as in a public school. But to provide treatment service in the case of a small sized school or kindergarten school would create some difficulties. If it only means getting a bandage, that is a treatment service in the ordinary meaning of the words, but if there are serious defects which will have to be treated they should be treated by the doctor at the expense of the parents, not of the school.

Dr. Ryan

There is something in what the Senator says. My anxiety was to put them exactly on a par with the national school pupils. Perhaps it is unfair to insist on it here. I think however it would be interpreted as having a small first-aid set on the premises. In case we might have any medical officer of health who is a crank, I will consider taking it out on Report Stage.

Mr. Douglas

I think you would get co-operation for the rest of it if you took that out.

Mr. Baxter

Might I point out that sub-section (1) of Section 32 says: "A health authority intending to arrange for a health examination of children at a school, under this Act, may give to the school manager of the school notice in writing of such intention..."? The words there are "may give"; there is no obligation. I think that whatever way you may deal with a national school these schools are in a slightly different category and that you ought to take account of that. If the Minister is reconsidering the drafting of it he should consider the possibility of inserting in it some such words as I have suggested so that this would be done after consultation.

Dr. Ryan

Sub-section (5) of Section 32 says that they shall consult the manager and so on and try to meet his convenience if they possibly can. I should like to explain that we start off by saying "they may" because, as Senators know, the medical officer of health is going round the county, say County Cavan, and he knows all the parish priests and managers and if he meets one he may say: "I will be round next week". If the manager says: "Come around next week" there will be no trouble. We do not say "shall", because in that case he would have to send a formal notice, but if the manager insists on it he shall do that or if the manager does not agree.

Mr. O'Higgins

It would be more proper to discuss that when we come to Section 32. It seems to me, however, that the beginning of sub-section (5) is somewhat ambiguous. The question would arise as to whether sub-section (1) or sub-section (5) of Section 32 would be the prevailing section and thereby a collision would occur.

An Leas-Chathaoirleach

We had better deal with that when we come to Section 32.

Mr. Baxter

That is why I think that when dealing with schools other than national schools you would require some different words. I think you would get more co-operation by the insertion of the words "after consultation".

An Leas-Chathaoirleach

The Minister stated that he would give that consideration before the Report Stage.

Mr. Baxter

That is with regard to treatment, but this is a different point. The Minister says that he supposes what would happen is that the county medical officer of health would ring up or meet the manager but there might be some who would not have knowledge, as the Minister has, of the different methods of approach of county M.O.H.'s It would be unfortunate if you had a county M.O.H. who did not approach this in the right way and I feel strongly that there should be an obligation that this should be done after consultation. I ask the Minister to look into that because people do not want the big stick held over them.

Question put and agreed to.

SECTION 20.

Government amendment No. 6:—

In page 6, line 39, to delete "dental and ophthalmic" and substitute "dental, ophthalmic and aural".

Dr. Ryan

This is consequential.

Amendment put and agreed to.

Question proposed: "That Section 20, as amended, stand part of the Bill."

Professor Hayes

As a matter of drafting, Section 20 says that the charge for an appliance which has been broken or destroyed through neglect shall be as approved of or as directed by the Minister. Is that particular or general? Surely it is not intended that the Minister shall make an Order for every specific case, but it seems to be worded like that.

Dr. Ryan

That would be a general Order.

Professor Hayes

Is that clear from the wording?

Dr. Ryan

Is it to the amendment the Senator refers?

Professor Hayes

The section—the last words in Section 20.

Dr. Ryan

Let me give an instance. At the moment the people in the lower income group are entitled to free spectacles. If a lady is paying for spectacles for a child she will be able to train the child, even though it may be small, to mind them. The child may break a couple of sets, but he will be trained eventually.

Professor Hayes

I agree entirely with what the Minister wants to do.

Dr. Ryan

The parent may not bother about training the child and the intention is that we will charge 2/6 or 5/- for spectacles in the future.

Mr. Baxter

That is one up for us.

Dr. Ryan

The intention is to have the parents train the child.

Professor Hayes

The intention of the section then is that the Minister will make a general recommendation.

Dr. Ryan

Yes.

Question put and agreed to.

SECTION 21.

Government amendment No. 7:—

In page 9, line 4, to delete "dental and ophthalmic" and substitute "dental, ophthalmic and aural".

Dr. Ryan

This is consequential.

Professor Hayes

Is there any idea as to the cost of this particular part of the Bill now?

Dr. Ryan

No. I would not like to hazard a guess. I think the dental section of this Bill is going to be comparatively costly. Compared with the other things in the Bill, I believe it is one of the biggest items.

Amendment put and agreed to.

Section, as amended, put and agreed to.

SECTION 22.

Question proposed: "That Section 22 stand part of the Bill".

Professor Fearon

Suppose the Minister is dissatisfied with the responsible local authorities. Some of the things in this Bill may be so large that they will not understand what they have let themselves in for. I take it the Minister asks them to strike a rate to enable them to provide the services he requires. Suppose they decline to strike that rate and make difficulties. Are the finances going to be made difficult? What happens if the local authority does not come up to scratch?

Mr. Baxter

I just want the Minister to reiterate what he said earlier with regard to these regulations. These regulations are going to be sent to the local health authorities before they are implemented. By the local health authorities I do not mean the executive officers. I mean the members of the local authority, whoever these may be. I am not going to dwell upon this point at length as I have said enough about it already. I merely want to add now that I am quite satisfied the Minister appreciates that in all the local authorities there are people who are interested in the improvement of the health services. The way for him to achieve his end is to secure the co-operation of these people by passing on to them information and knowledge as to what he wants to do. I suggest that he ought take steps to see that regulations that are being made by him under this Bill and which relate to the responsibilities of the health authority are put into the hands of every member of every local authority.

Mr. O'Higgins

In my view, Section 22 is one of the most important sections in the Bill quite apart from the fact that it brings up the general question of this whole scheme depending practically entirely on ministerial regulations about which the Dáil knew nothing when they passed this Bill and about which the Seanad knows nothing at the moment. I think it is quite clear from the characters of the section that the fate of this Bill in so far as it is going to be implemented or not depends entirely on Section 22. Section 22 seems to me to provide that no matter what has gone earlier, no matter what benefits are referred to in Sections 14 to 21, they are not going to be provided unless the Minister makes regulations under this section and if they are to be provided they are only going to be provided to the extent that the Minister will direct in the regulations which he will make under Section 22.

I want to put it plainly to the Minister. What is the meaning of this particular section? Has it any meaning? Does the Minister and do those supporting him intend that the services provided in Sections 14 to 21 are to be given? If it is intended that those benefits are to be given, why is it necessary now in Section 22 to provide that the Minister may make regulations applicable to every health authority, every health authority of a particular class or a particular health authority not only as to the manner but also as to the extent to which they may make available the services already provided in this Bill?

That seems to me to have been included as a possible way out—an escape—for the Minister or anyone succeeding him from implementing the services already provided in Sections 14 to 21. I do not necessarily say at this stage that it is a bad thing for the Minister to have left himself a line of retreat, but I want to know is that the intention of this section? If it is not the intention of the section, why is the section included? Surely the section must mean that we are now limiting the extent of the services provided in the various sections from Section 14 to Section 21. Not only are we limiting them, but we are providing, if we enact Section 22, for the possibility that those services, first of all, may not be provided at all unless the Minister directs that they shall be provided. Secondly, if they are to be provided, the people need not expect that they are going to be provided in the full measure about which so much boosting and boasting has been done, but that they will only be provided in the manner and to the extent that the Minister decides by the regulations he may make under this section. None of us knows at the moment what these regulations will be.

Professor Cunningham

I should like to draw the attention of the Seanad to the wording of this section. It says:—

"The Minister may make regulations applicable to every health authority, every health authority of a particular class or a particular health authority as to the manner in which and the extent to which they are to make available the services specified in Sections 14 to 21 of this Act...."

In other words, the Minister can dictate to any health authority. He can tell them the manner in which and the extent to which they are to make available the services specified. He can tell them exactly how they are to run their hospitals and the extent to which they are to run them. He can, if he wishes, according to this Bill, nullify all the advantages already in the Bill. He can wipe the whole thing out if he wishes. The powers are there for him to do so. A Minister for Health can do that under this Bill. The Bill gives him complete dictatorial powers in his control of the local authorities.

I have mentioned before that I do not think that that is a desirable thing in our national life and I do not think it is desirable at all where health is concerned. It is very dangerous and objectionable. The Minister has more or less accused me several times of attacking him. I know the Minister's intention in that clause. At the same time, any Minister, given the powers set out there, can do exactly as he likes. He can cancel this whole business if he wishes. Perhaps I was unwise to mention anything about it.

Dr. Ryan

There are two points which occur to me which, perhaps, I might plead as making the section necessary in this form. I mentioned already that the Dublin Corporation had made an arrangement with the Dublin maternity hospitals with regard to infant treatment, examination and so on. If I were to publish regulations dealing with infant treatment, I probably would have to make different regulations for the other counties from those for the City of Dublin. I should say that it will be necessary to make regulations applying to particular authorities or to one particular authority. We must have the power, I think, to make one regulation for one authority and another regulation for another authority. The instance I have given shows that that will be necessary.

As regards limited extent, I was asked about dental treatment. I said that dental treatment was going to be a very big item. Apart from being a very big item as regards cost, it is going to require a good deal of organisation. Most counties at the moment have one or two dental surgeons employed. They will want many more. I do not know whether the counties will be inclined to employ more dental surgeons or, alternatively, contract with existing dental surgeons to do some work for them. Personally, I would prefer the latter. After all, if dental surgeons set up in practice in certain towns, they look forward to a fair remuneration from it to enable them to live, and so it would be unfair to take it from them. I think it would be better for the local authorities to contract with these people to carry out certain duties for them on a sessional basis.

I have said sufficient, I think, about all the various possibilities as to how dental treatment can be carried out. It is possible that some counties will say that they are going to employ dental surgeons whole-time. If so, you will have certain regulations applying to them. Other counties will say that they are going to employ dental surgeons on a sessional basis. We will need to have other regulations applying to them. Suppose we come to the conclusion that it is not possible to deal with the whole dental business at the moment, and maybe will not be possible for two or three years, we should at least try to keep teeth as good as they are. In other words, we might prescribe conservative treatment and not do anything about dentures at the moment. To the limited extent, therefore, of giving conservative treatment, we might make regulations and say: "No dentures until we are ready that..."

There are various possibilities. I think that if Senators would look at this from the point of view of the person who is very anxious to put the Bill into operation as soon as possible, with full regard, of course, to ordinary efficiency, they would come to the conclusion that there will have to be a great deal of latitude in the regulations, first of all, possibly by applying them to certain local authorities and not to others; and, secondly, in giving limited service in some cases where the full service cannot be given. On the whole, I think the section is necessary.

Mr. O'Higgins

I would like the Minister to be honest with the House. Is it not a fact that this section puts into the Minister's hands the power to nullify every benefit given under the Bill, and that Section 22 empowers the Minister to cancel everything that has gone before it? Is it not a fact that Section 22 leaves it entirely to the Minister, or to anyone who may succeed him, to decide whether this Bill is going to be implemented or not, and that, without any limitation as to time and without giving any remedy in law to a person who may be in receipt of benefits under the Bill, the Minister, or anyone who succeeds him, may cancel those benefits without giving notice to the recipients or to anybody else?

As far as I can see, every word that I have spoken with regard to the importance and effect of this section is true. It is a matter of some surprise to me that Senators, sitting on the same side of the House as the Minister, who were inclined to applaud every time the words "Health Bill" were mentioned, have never referred to this section. As far as I can see, everything that has gone before is all "cod", having regard to this section. Undoubtedly, it gives the Minister a stranglehold on the Bill. It gives him authority to cut off benefits, to discriminate against a particular health authority as well as the right to pick and choose as between the various sections and categories set out in sub-section (2) of Section 15.

The Bill does not, as a matter of right, give either a mother and child scheme or any other health scheme to any section of the people. There is no right under the Bill to give these unless the Minister should decide to make regulations defining the manner in which, and the extent to which, a health authority may provide these services. I am not quite clear as to whether a health authority can provide these services should the Minister decide not to make any regulations, but I am quite clear, because it is set out in black and white in Section 22, that whether or not a health authority is giving these benefits, the Minister may put a stop to them.

There is no mother and child scheme unless the Minister decides that a particular class are going to get it under regulations made under Section 22. There is no school examination or treatment if the Minister decides, for any reason that may cross his mind, to limit or to cut out the operation of Section 19. There is no mother and child scheme under Section 16 if the Minister decides to limit the effect of it. I want to get it honestly from the Minister whether or not he intends to use the powers in Section 22. Is it not a fact that, under Section 22, he has the power to cancel the operation of every benefit in the sections from 14 to 21?

Mr. Yeats

I move to report progress.

Progress reported; Committee to sit again.