Just before this debate was adjourned, Senator O'Higgins suggested that the section would empower the Minister to refrain altogether, if he wished, from bringing into operation the benefits accruing under this Bill. He wanted to know, or purported to want to know, why we on this side of the House were not objecting to the Minister being given these powers. For Senator O'Higgins' benefit, if he really wants to know, the answer can be given in a few words. The reason we are not worrying is that we have the utmost confidence in the desire of the Minister and of the Fianna Fáil Government in general to bring this legislation into operation. Every move made in recent years to improve health legislation has been opposed tooth and nail by the Party to which Senator O'Higgins belongs. Were a Fine Gael Minister for Health in charge of this legislation, we would have the utmost fear of the consequences that would flow from this Bill; but knowing that not only is the Minister himself thoroughly enthusiastic but he is backed by a Government that is enthusiastically in favour of health legislation of this nature, we have the utmost confidence that the provisions of the Bill will be brought into force by regulation at the earliest possible moment consistent with efficiency. If Senator O'Higgins thinks otherwise, he is due to be disappointed.
Health Bill, 1952—Committee (Resumed).
Arising out of Senator Yeats' speech, may I ask the Minister a question relating to the Section? Could he tell me has such a section been embodied in any other Bill? Is this creating a precedent? In the actual wording in previous Bills, has it not been mandatory and not left to the discretion of the Minister to make regulations affecting the matter? If this is creating a precedent, why should we create a precedent?
I could not give the Senator any specific instance of the same type of clause in any other Bill, but I am sure it would be found if I had time to search for it. It is not a revolutionary thing; it is on the line of other Bills of the kind.
I am inclined to think this Section is an essential part of the Bill, as the Bill is permissive. It gives to the Minister or his successor specific powers by means of regulations and if you did not provide that that was elastic it would be quite inconsistent with the scheme. This is not really a Health Bill: it is a Bill to enable the Government of the day to provide a health scheme. I think that is a mistake; I am opposed to it for that reason, but as this is the type of Bill that is going through I do not see how you could avoid having Section 22. The cost is uncertain. The capacity of the country at the moment to carry out certain services is uncertain. The Minister says so. It is, therefore, inevitable that it will not be possible to carry it all into operation and it may be found that you try certain services and find you cannot carry them out and you have to make an Order for part of the country or the whole of the country terminating them for the time being. If you have this kind of Bill you cannot avoid some kind of power such as you have in Section 22.
I put some questions to the Minister which he has not answered. I do not know whether he accepts the remarks of Senator Yeats as an adequate answer. I do not think they are. Senator Yeats said my proposition was that Section 22 would empower the Minister to refrain from bringing this Bill into effect and Senator Yeats' answer to that was that he had the utmost confidence in the Minister and in the Fianna Fáil Government. That gives me the opportunity of reminding Senator Yeats that he is only one individual and that there is a great number of individuals in this country who have not got the utmost confidence in the Minister or in the Fianna Fáil Government. However, that is only by the way. Senator Yeats' argument was that he was quite confident that the Minister and the Government fully intended implementing this Bill as soon as possible and he had the utmost confidence in them.
I took the trouble to listen to, and subsequently to read, the Minister's speech on the Second Reading of this Bill in the Dáil. Possibly Senator Yeats has overlooked it. In concluding that speech, the Minister uses this phrase, reported in the Dáil Debates for the 22nd February last, column 1914:—
"Neither do I intend to push local authorities unduly to implement the Bill."
I want to relate my remarks on this Section to the Minister's expressed intention of not pressing local authorities to implement the Bill. I wonder if Senator Yeats has given any consideration to that aspect of the matter. Does that in any way shake his confidence that the Minister and the Fianna Fáil Government intend to implement this Bill and implement it quickly? The Minister has fixed the Dáil with notice that as far as he is concerned he is not going to press local authorities to implement the Bill, that he is going to get the Bill through the Oireachtas and then going to wash his hands of it. That is the Minister's approach to this Bill as expressed in the phrase I have quoted.
Your gloss on it.
If the Senator doubts my words, he can read the Dáil Debates.
The Senator ought to read the whole sentence. Half a sentence is hardly fair.
I have read an entire sentence. There is a full stop in front of the word "Neither" and a full stop at the end of the word "Bill".
I thought there was a semi-colon. I have it here; it is all right.
There is no full stop after the Bill.
That approach of the Minister was commented on during the course of the Second Reading debate in the Dáil, and it was put to the Minister that his approach to the Bill was to get it through the Oireachtas and then wash his hands of it. He did not deny that, although he concluded the debate. I am suggesting to the Minister, to Senator Yeats, and to the House that this is a section which is put in as an escape route for the Minister, that it is an escape route which he intends using, and that he has no intention of implementing this Bill. I am not complaining about that. I think he might be very wise not to implement the Bill as it stands at the moment. I think he would be very wise to reconsider the whole matter, but my argument is that this is an escape route and an escape route which the Minister intends using.
The fact of the matter is that Section 22 of the Bill provides that the Minister may make regulations as to the manner and as to the extent to which the benefits given in Sections 14 to 21 will be implemented by health authorities. Those benefits, those services have been discussed here for the last couple of days. They are the services, in particular, noted in Sections 14, 15 and 16 of the Bill. Section 16 is that dealing with the mother and child scheme and Section 15 is that dealing with institutional and specialist services. None of those services may be available, and it is simply bluff and hypocrisy for any member of this House to try to proclaim this Bill as an instrument that is giving the people as a matter of right the services referred to in Sections 14 to 21. No one is getting those services as a matter of right and we should recognise that. They are getting the services subject to the Minister deciding that they ought to have them. Any particular class set out in sub-section (2) of Section 15 is not guaranteed either free or cheap institutional treatment or free specialist treatment. They are not guaranteed that. They cannot as a matter of law demand it and the reason they cannot demand it as a matter of right is because of Section 22 which we are discussing at the moment. What I want the Minister to do—and he is not doing it—is to acknowledge the fact publicly that Section 22 gives him the right to cancel or nullify all the benefits mentioned under Sections 14 to 21.
Senator O'Higgins has suggested that Section 22 is an escape route, especially designed by the Minister, and Senator Frank Hugh O'Donnell asks a question as to whether there was a similar section ever incorporated in any other Bill that passed through this House. I would like to bring the minds of Senators back to just one or two Bills that were passed through here that both Senator O'Donnell and now Senator and then Deputy O'Higgins supported.
There was a Housing Bill introduced in 1948 by the late Deputy Murphy, the then Minister. There was a Gaeltacht Housing Bill introduced by Deputy Blowick, then Minister for Lands. I think that Senator O'Higgins will agree with me that in both of these Bills, that later became Acts that passed through this or the other House, there was a section of this kind enshrined so that, despite the fact that these Bills made provision for the payment of grants to various classes or categories of persons for the erection or reconstruction of houses, it always depended afterwards on regulations to be made by the Minister. Would Senator O'Higgins suggest that putting such a clause into the Housing Bills of these dates was done designedly by the Minister as an escape route so that the grants which the House made provision for should not be paid?
Senator O'Higgins went further still. He suggested that this section is being put in with the intention of depriving a large section of our people of the benefits enshrined in this Bill. It is the first time, I think, it has been suggested from the other side of the House that there are any benefits to be derived from the passing of the Bill when it becomes law.
He later made reference to the statement by the Minister, in concluding the debate in the Dáil, that he did not propose to press local authorities in this matter. I have not got that statement directly before me, but I can quite appreciate that what was in the Minister's mind at the time was that, in connection with the majority of local authorities, there would be no need to press them because those people, elected as representatives on local authorities, county councils and borough councils, in general, are very anxious to give the best service possible to our people, and it is only where for political purposes some organised attempt might be made by those people who are opposing the passing of this Bill through this and the other House, to avail of whatever small representation they have on the various county councils to hold up the operation of the Bill, that there could be any question of the necessity arising for any pressure either from the Minister or any other source to give full implementation to the Bill.
First of all, with regard to Senator O'Donnell's question—this section, I believe, is to replace Section 28 of the 1947 Act, Section 20 sub-section (3) of the Public Assistance Act of 1939 and Section 90 of the Public Assistance Act of 1939, all of which are in very much the same tradition as this particular section. I do not think anybody was accused at the time of putting that section into these various Acts with the deliberate intention of holding up the Bill that was brought in in that particular instance. I think anybody would regard Senator O'Higgins' allegation as the most fantastic thing that was ever heard, and I am quite sure he has no belief whatever that there is any intention to hold up this Bill. Why should the Fianna Fáil Party waste weeks and weeks of their time in the Dáil fighting the opposition of Fine Gael——
To placate a few Independents.
Do not mind about the Independents.
You asked me a question.
Why should we issue a White Paper in 1947 stating this scheme before we even heard of these Independents, and why should we come along to implement our White Paper? This talk about pacifying Independents is all the greatest nonsense, and after all the opposition of Fine Gael to this Bill we are now accused of intending not to put it into operation at all. If the Senator thinks that, why not let the Bill go through and be done with it? There will be no trouble, if what the Senator thinks is true. That would be better instead of wasting all this time and worrying about what will happen. The Senator says we do not intend to put it into operation. Why the opposition then? Possibly the Senator is trying to stir up a little bit of trouble telling Fianna Fáil supporters that the Government is not serious. As far as our supporters are concerned, they will not take very much notice of anything Senator O'Higgins says and he is, therefore, only wasting his time.
I have the greatest respect for the official reporting staff, but I think that there should have been a semi-colon in the particular passage quoted instead of a full stop:—
"Some time must elapse before all the necessary facilities are available and all the necessary arrangements made, but there will be no deliberate holding back on my part. Neither do I intend to push local authorities unduly to implement the Bill."
I tried to make a balanced statement. I was being accused at the time of steam-rolling local authorities. We have to have regard to such accusations. I had no intention of steam-rolling local authorities. I suppose this Bill provided the first occasion on which a Minister bringing in a Bill met all the local authorities and discussed the matter with them before proceeding with the Bill. I am not saying that they agreed to every provision but, as as a result of that meeting, there were certain amendments introduced, amendments which went some part of the way to meet the views put forward by the local authorities. The charge of £2 in certain cases was put in to meet some of their proposals.
I wanted to assure the Dáil that the Bill would not be put into operation immediately. Certain regulations would have to be made. Staff would have to be provided in many cases before the Bill could be implemented. At the same time I wanted to assure the Dáil that there would be no steam-rolling of local authorities. If a local authority wanted a little more time we were prepared to agree that that would be reasonable. I think it was on the Fifth Stage of the Bill I was asked if that leniency towards local authorities would last for long; I said that it could not last for all time. I pointed out that if all the counties, except one, adopted some particular provision, the competent authority would have to insist that the county which had not adopted the particular scheme would fall into line, having been given time to come in of its own free will and having failed to do so. When one talks reasonably to the Dáil or Seanad, it is hard to be taken up by a Senator and have what one says turned back on one as if one was playing a huge joke on the people, on the county councils, on the Dáil and on all concerned. It has been said by Senator O'Higgins that when this Bill is passed I will turn to Section 22 and say: "We will not operate it at all."
As far as Section 23 is concerned, it has already been discussed sufficiently on Section 16. There is not much more that could be said on it.
In relation to this section, we have already discussed some of the sub-sections, but there are some matters in sub-sections (1) and (2) to which I wish to draw attention. We have heard a good deal of talk and boasting, and experienced a great deal of flag-waving, as it were, in connection with this question of choice with regard to doctor and institution. Here we find that the patient has a choice at two guineas per week. If the patient does not go to the institution to which he is expected to go, he may go to the institution of his choice, but he is penalised in doing so to the tune of two guineas per week. I cannot understand that. I do not know why the patient should be penalised. A patient should be entitled to go to the hospital of his choice without any penalty. In cases of serious illness patients very often have great faith in a particular institution, a particular doctor or even a particular nurse. It is very much better from the point of view of the patient's chance of recovery that he has confidence in the institution and the individuals looking after him, and from that point of view I think it is unfair to the patient to penalise him. Why all this talk about free choice when it is not a free choice? Why should a patient, if he goes to the institution to which he is directed, be paid for at the rate of £5 12s. per week while, if he goes to the institution of his choice, he is only paid for at the rate of £3 10s. per week. It seems a rather extraordinary thing but, indeed, it is really only part and parcel of the whole theme running through this Bill—control and direction. I will not say any more than that.
I do not know how the Senator can accuse us of anything wrong in this particular matter. This is the absolute essence of choice. When the Senator calls the provision made here "control" one has some idea of the mentality of the Senator. What could be more free than to tell a patient he can go to any hospital he likes? If the patient does not want a choice of hospital the local authority will pay so much; if he wants a choice, the local authority will possibly or probably take two guineas per week off for institutional treatment. Would it not be very unfair if there were two people and one goes to the institution to which the local authority sends him and the other says he would prefer to choose his own hospital if the latter was treated better because he made his own choice? I do not think anyone could defend that. If a person chooses his own hospital, he cannot expect to be treated better than the person who does not.
Why penalise him to the extent of two guineas per week?
We do not penalise him.
Is this intended only to refer to false statements with regard to means? Is it intended to cover the means test or is it intended to cover the possibility of a person saying that they had some illness when they had not?
I think it could be interpreted as making any false statement. I do not know what false statement a person would be likely to make except in regard to means.
What I mean to convey is, is it only intended to cover means? I was referring to statements made regarding illness to a doctor or someone else. In that case it would seem to be undesirable.
No.
I presume we may discuss amendments Nos. 10 to 15 together.
Agreed.
I move amendment No. 10:—
In sub-section (1), in paragraph (a) (ii), page 14, line 30; in paragraph (b), line 33; and in paragraph (c), line 38, to delete the words "vehicles or stalls."
Practically all the suggested amendments arise from a matter I discussed on Second Reading. On that occasion the discussion was cut short to enable me to tabulate these amendments for discussion on Committee. The amendments are clear enough, although an evening paper yesterday has given a wrong construction to the meaning of these amendments. That has been rectified in to-day's morning and evening papers. The meaning of these amendments is simply not to require licensing or registration of vehicles and stalls. That, ultimately, would mean food vehicles and food stalls, because that is the definition that applies in the Food and Hygiene Regulations at present in force. My desire is that that additional power should not be put into the Bill in this House or in the other House.
On the last occasion I explained that Section 38 of this Bill is a paraphrase of Section 55 of the Principal Act. It is a paraphrase and enlargement. The main enlargement is the inclusion of vehicles and stalls for licensing or registration. So far, the word "licensing" has not come in under the regulations which apply to certain food premises at present. Therefore, up to the present, the word "licensing" does not apply. Registration does apply to certain food businesses. I need not go into details of such food businesses. Registration does apply to them and anyone who is not so registered is not legally entitled to carry on the business.
I will omit the word "licensing" and refer simply to registration. If we introduce registration of every food vehicle and every food stall, we present those who have to carry out the regulations with an impossible situation. One of the most important streets in this city has been referred to already, prematurely, in the Press, in connection with this matter. It has forestalled the discussion. Does the Minister seriously contemplate officials of a local authority endeavouring to register every stallholder in Moore Street, no matter what type of food material is being sold from the stall? Does he seriously think of imposing on any local authority or their officials the task of registering every food vehicle? As defined in the existing regulations, "food vehicle" means a vehicle, vessel or aircraft which is not a food stall and in which food intended for sale for human consumption or food material is or is intended to be conveyed otherwise than in an impermeable container. So that, he would expect the local authority to register an aircraft coming into Collinstown, to register every car which brings vegetables into the city. I do not want to dilate on this matter because I could make it ridiculous. Every railway carriage would have to be registered. I would impress on the Minister and his advisers that it would be impossible to carry out the proposed legislation.
I do not want to be termed an obstructionist by delaying the House. I have made my statement as clearly as I can. In my opinion, the inclusion of vehicles and stalls as types requiring registration or licensing is ridiculous. These words were not in Section 55 of the Principal Act, which referred to "premises". Possibly, I am anticipating the Minister's reply that he wants to include these two types in case of necessity but that, of course, the regulations will not be altered to include them unless it is found necessary at some future date to do so. The inclusion of them now is some indication that there is some concrete reason for it. Personally, I cannot see any reason for their inclusion.
I want to impress on Senators that the requirements of the Food Hygiene Regulations under the 1947 Act apply to both food vehicles and food stalls. The requirements with which food vehicles and food stalls have to comply are laid down in black and white. The legislation applies to them. Why introduce a clause which requires registration or licensing of them which will entail the filling up of pages and pages, practically rooms full of documents which are absolutely unnecessary? I shall not say any more until I hear what the Minister has to say in connection with this ridiculous innovation.
I am rather surprised my friend Senator Hawkins did not jump up and give a little lesson on the bad propaganda of any form of exaggeration. Whether there should be registration or whether there should be licensing, if this Bill is passed, it will be left to the Minister. If you have provisions designed for the health of the community, for control by means of registration or licensing of shops and if there is exemption of a shop which is out on the street as a stall, the whole purpose is defeated. It would be grossly unfair. If you have provisions of this kind, both these powers must be given to the Minister. There is probably something in what Senator O'Donovan says, that it might be found necessary to register stalls, and possibly, too, vehicles, and if there was any abuse the Minister administering this would certainly have to have the powers, it seems to me.
This power has been taken, but it is not necessarily to be inferred that the power will be used to the full in case of all stalls and travelling shops. I agree with Senator Douglas that it would be entirely inconsistent if we should register shops everywhere and leave stalls out. Take meat, for example. I think that meat is one of the things we should deal with as soon as we can. We are dealing with it. Well, if we make certain regulations with regard to exposure of meat in butchers' shops and so on it would be very unfair if we would allow stall to set up outside the butcher's shop and be free from any regulation whatever. So from the pure viewpoint of consistency we have to bring in stalls as well as everything else. We would apply the meat regulations to the stalls when we applied them to the shops. A great many of these stalls are dealing with fruit and other things where perhaps regulation is not so necessary, because in fruit anyway you have some sort of covering on the fruit that is removed by the buyer before he consumes what is inside and there is certain protection in that, at any rate, against contamination or disease; but meat, I think, is a thing that will strike everybody as being an article that must be controlled if we are going to bring in food regulations at all, so I think that we would have to have this clause in the Bill.
We would naturally have to take into account the capacity of the local authority to administer any particular regulation before it is made. And if it was thought that the local authorities could not possibly cope with a particular situation, well, we would have to consider and see how that would be got over. But I think that Senator O'Donovan need not be afraid that we are immediately going to deal with all stalls selling food in the open. It will be a process which will be extended gradually to the foods that need protection most, such as meat and foods of that kind, where exposure is obviously a very dangerous thing from the point of view of health.
I am glad to hear the Minister giving the explanation, so far as it goes, because the Veterinary Medical Association, which has external association only with the Irish Medical Association, advised the Minister at the time not to allow fish, poultry, rabbits or any meat to be sold on these exposed stalls. That advice was not taken. I agree thoroughly that stalls with meat or meat products should not be exposed on a public thoroughfare. The suggestion was put forward at the time that a communal shelter or house or market should be provided co-operatively by themselves or by the local authority, where such foods would be sold under conditions where food hygiene regulations could be applied. Still, the local authorities are doing the best they can to have those meat products, when sold in stalls, sold under as hygienic conditions as possible.
I will again emphasise that there is a series of regulations at present in force to control those stalls. The registration of them even in this restricted way will not help a whole lot. It is just filling in forms, and the Minister and his officials do not seem to appreciate the amount of work that is entailed in registration of the premises that have to be registered up to the present. By a curious coincidence yesterday, the 30th September, was the final day for the registration of the registrable food businesses at present. Those that were fit for final registration had to be notified yesterday. Those that were unfit had to be notified that their registration was refused; and those that were helping to provide or to comply with the requirements had to be notified of an extension up to six months to enable them to apply. Now that entails a tremendous amount of work on officials, clerical and professional, of the local authority. They are only doing what applies to every food business, and doing it because they have to be registered, and I again suggest to the Minister that in the majority of towns or cities there will be so few of these meat stalls and fish or rabbits and poultry stalls, that it is not necessary to have all this verbiage in an enactment. The one place probably where it does apply would be the City of Dublin, because there would be so many of them, but I still think that putting this clause in requiring registration or licensing is just not necessary, that the local authority can deal with them effectively without registering them, because registering does not mean anything else only filling in their names. I still think that this addition to the legislation is not necessary.
Is the amendment being withdrawn?
Well, any amendments I have tabulated in this House I have tabulated with the purpose of trying to convince the Minister of their reasonableness and that he should adopt them. If the Minister refuses to adopt them I will withdraw them.
The amendment is being withdrawn?
That is just the one that we are discussing, the one dealing with——
Amendment No. 10 is withdrawn and amendments Nos. 11 to 15 are not moved.
Amendments Nos. 11 and 12 are different.
It was understood that amendments Nos. 10 to 15 were to go together.
I beg your pardon, I did not understand it in that light. I spoke only on the amendments relative to the vehicles and stalls. There are two amendments, Nos. 11 and 12, dealing with the deletion of the words "authorised in that behalf", so if you will allow me to discuss them I will be glad.
Amendment No. 10 is withdrawn?
Yes.
I move amendment No. 11:—
In sub-section (2), page 14, paragraph (a), line 48, to delete the words "authorised in that behalf by the health authority."
In connection with this amendment, a clause is inserted in the Bill with regard to the keeping of the register. Section 38 (2) (a) says that any register kept pursuant to the regulations by a health authority shall be deemed to be in proper custody when in the custody of an officer of the health authority authorised in that behalf by the health authority. Now I cannot see that that is actually necessary, and I cannot see subsequently any officer authorised in that behalf producing any evidence in court, as it may present difficulties to the local authority. I would suggest to the Minister that there is no necessity for requiring the local authority to authorise a specific officer to keep this register when it is in the keeping of the local authority, which has subsequently to produce evidence for the court by an officer who is authorised in that behalf. If that officer happens to be ill there would be just nobody who could produce the evidence in court, and if necessary you would have to authorise, I will not say a series of officers, but a number of officers, so that the local authority would be safeguarded. I cannot see just why it is necessary to put in that clause "authorised in that behalf."
I suggest the deletion of the words "authorised in that behalf by the health authority", as in amendment No. 11, and the deletion of the words "authorised in that behalf" as in amendment No. 12. Will the Minister accept that?
I hope the Minister will not accept these particular amendments. I think it is a matter of some importance that the registers kept under this section should not be allowed to float around the offices of any health authority or local authority and be considered as being in the proper authority no matter what official of a local authority might hold them. I think that the section, as worded, requires a health authority actually to authorise a particular officer or particular class of officer before the register is considered as being in the proper authority. That is a provision that should be retained. I hope the Minister will resist these two amendments.
It is not a class of officer that is mentioned. It is an officer.
It could be done by two or three.
I think Senator O'Higgins is right. In fact, I am advised that the county manager, being the executive officer, could authorise more than one person to keep the register. A county manager might authorise a certain person to keep the register and if that person became ill and could not appear in court he could authorise another person. It is very important that he could authorise another person. Otherwise, I am advised, a junior clerk could get hold of the register and make an entry in it—for instance some entry that would be of great importance to the person concerned and that might be of great import if brought before a court where the local authority was making a prosecution. I think Senator O'Donovan, if he agrees that it is possible to authorise more than one person, would not push the amendment. It is quite possible to authorise more than one person.
It does not read like that. However, if I cannot convince the Minister, I am satisfied to withdraw these two amendments.
Am I right in interpreting this section in this way? Under sub-section (17) the Minister may request the advice of the National Health Council on any regulation, including the regulation which deals with conditions of employment, but with the restriction in sub-paragraph (a), which reads as follows:—
"Sub-section (98) of the Principal Act is hereby amended:—
(a) by the deletion in sub-section (1) of the words ‘to give to the Minister when so required by him advice on matters affecting or incidental to the health of the people' and the substitution therefor of the words ‘to advise the Minister on such general matters affecting or incidental to the health of the people as may be referred to them by the Minister and on such other general matters (other than conditions of employment of officers and servants and the amount or payment of grants or allowances) relating to the operation of the health services as they think fit'";
Am I right in interpreting the section as meaning that the Minister will submit to the National Health Council any regulations that he makes and that they can submit to him any suggestions they like, but that they cannot submit to him a regulation involving conditions of employment? Is that so?
Not exactly. The best way to interpret the section would be that they cannot, of their own initiative, raise matters of conditions of employment. For instance, some regulation might be issued which would deal with the employment of a specialist in a certain capacity. When it is a regulation they can discuss it and make any suggestion they like. What I wanted to avoid here was that, at the end of the meeting, I would receive a resolution from them saying, for instance: "You are not paying as much as you should pay." I wanted to exclude matters that do not arise in the regulations.
It is the Minister's intention, and it is the obligation obtained in sub-section (17), that whatever regulation the Minister makes— whether or not it concerns conditions of service—will be submitted to the council and that, on these regulations, the council can make any suggestions they please, including conditions of service, but that they cannot initiate discussion on conditions of service. Am I correct in assuming that the only restriction is that they cannot initiate a discussion on conditions of employment?
That is correct.
Is there any particularly strong reason why that exclusion should exist? Has the Minister anything in mind? I do not want to pry into it if it is something more or less of departmental importance. It seems to me, however, that the council might very properly hold views which they feel should be put before the Minister but, as the section stands, they cannot do that—not as a council, in any event—unless the Minister first refers it to them.
The Consultative Council, having the name of being interested in health matters—naturally—and the name of being in touch with the Minister and giving him advice, and so forth, might be asked by any particular section of the community—for instance, nurses, midwives, doctors, mental hospital assistants—to receive a deputation because they want to discuss their conditions of employment. I think that that would be undesirable. The council might not feel that they were in a position to refuse, and it would be undesirable that they should be asked to do that sort of thing. After all, all these sections have their own ways of approaching the Minister, and have various organisations—the Irish Medical Association, the nurses' organisation, and so forth—which deal with matters of that kind.
I may say that when this was being discussed at the Consultative Council, the representatives of the Irish Medical Association were very much in favour of it. So long as matters in the regulations could be discussed, whether dealing with conditions of employment or not, they were quite satisfied that the council should not be asked to go further in discussing conditions of employment.
I am very pleased that the Minister has decided to have the council. I think it is a very important step with regard to health generally in this country. A health council means one thing and it is of great importance how that council is constituted. I should like to impress on the Minister that it is very important to have on that council people who will be of help to him in the matter. You can have a council composed of people who will not be of help and you can have a council composed of people who will be of help.
Sub-section (16) deals with the presentation of an annual report. It states:—
"The National Health Council may present each year to the Minister an annual report and the Minister shall publish the report with such comments (if any) as he thinks fit."
I should like the Minister to add to that paragraph a provision indicating how soon he will publish the report. If a report is not published within a reasonable time, it is generally useless. I do not know whether the Minister intends to publish this report with the report of the Department of Health, but the Department of Health Report is very big and involved and is often published very late. It takes a good deal of compilation, I know, but that report on some occasion has been three years old when published. Therefore, I should like an undertaking from the Minister that he will publish the report as a separate document. It concerns the health of the whole country and it should be published within a reasonable time because such a report is a safeguard for everyone. Those interested can read it and see what is happening, so that it acts as a safeguard for the people.
Finally, sub-section (17) sets out that the Minister shall request the advice of the National Health Council on any regulations he proposes to make... "except where he is satisfied that the making of the regulations is a matter of urgency and, in such case, he shall request the advice of the council on the regulations as soon as may be after they are made." In other words, the Minister is here given power to make regulations without consulting the National Health Council. I do not think that is advisable. If you have a health council, you should consult it. Perhaps the Minister knows more about it than I and he may have in mind certain cases where he may have to make a regulation very rapidly. If he will put up such cases, I shall be quite willing to agree with him, but, in principle, it is wrong to set out that the Minister shall take advice from the Health Council in one case and then say that he can make regulations and then consult the council. There may be cases where it may be necessary, but I cannot see why, even in a case of emergency, a quorum of the National Health Council could not be summoned rapidly. Many of the members will be living in the city and it would be possible to get a quorum summoned quickly. The Minister should consult or inform them as to the regulation being made, but under this he can make a regulation without doing so. We know the Minister has power to ignore the council. Let us hope that in future he will not do so.
I think that provision with regard to urgency must remain. It may be a rather minor matter, so far as advice is concerned, and still be very urgent. The most urgent situation I can think of is a situation in which an outbreak of smallpox is notified here. We would immediately make chicken pox a notifiable disease and that would have to be done in a matter of hours. There is not the smallest chance that any consultative council would have the slightest comment to make on such a decision. If a Minister has a clause like that before him, under which he is bound to submit the regulations to the Health Council, I do not think he is going to put forward the plea that it was urgent and that he could not submit them to the council. The plea of urgency would, I think, be very seldom used, but I think it is necessary. The Senator need not worry very much about it. As I said to the present Consultative Council with regard to some of these provisions, if the Minister is not keeping faith, as it were, they have their annual report and no Minister would like to be accused in that report of not keeping faith. That report must be published. He may make his comments but it still must be published, so that that annual report is a big safeguard.
With regard to publication of the annual report, the intention is to have it published as soon as possible. We issued an annual report of the Department a few days ago for 1951-52 and presumably the annual report of the Consultative Council would be for 1952-53, and, coming in at the same time, it would be incorporated. We would not have to wait for the 1952-53 annual report of the Department. If the report came in from the Consultative Council and if, after examining the position, we saw it was not likely that we would have the annual report of the Department for the next nine or ten months, we would not hold it up, but I do not like to be tied to time. If I am to be tied to time, I would say perhaps 12 months but that looks ridiculously long and if we say six months, we might find that we would exceed the six months, so that it is better left out. I think the annual report itself is the best safeguard. As I said in speaking to the present Consultative Council, if there is not good faith between the Minister and the Consultative Council, things will not work well anyway. It is better to depend on that good faith rather than to have everything put down in black and white.
Would the Minister meet Senator Cunningham by incorporating some such phrase as "as soon as possible" or "with all convenient speed"? The Modern Homes case brings to mind the phrase "with all convenient speed". I think some gesture of that sort will show that it is not intended to shelve it. Senator Cunningham mentioned a point which the Minister might think worth considering, that the report should not be incorporated in the general Department report.
Does Senator Cunningham think it should not be incorported?
It should be separate, if possible, from the general report, because the general report might hold it up. I want to stress the point that a great deal of the value of a report lies in the fact that it is published quickly.
I agree with that. I will consider the suggestion put forward by Senator O'Higgins before Report Stage.
Sub-section (3) prescribes how the consultative health committees shall be made up. Sub-section (1) sets out that the council of a county (other than Dublin or Waterford) shall by resolution appoint a consultative health committee. In other words, it is the county council appoints the health committee, the local health committee we are dealing with. Sub-section (3) then sets out that the committee shall consist of ten members including (a) not less than four members of the county council, (b) the county medical officer for the county, (c) the county surgeon of the county, or somebody representing him, and (d) two other registered medical practitioners. These people are all specified—four county councillors, one county medical officer, one county surgeon and two medical practitioners. The committee shall consist, in the first place, of not less than four members of the county council, and we must remember the opening sub-section under which the health committee will be appointed by the county council. It means, I think, that very often the county council will appoint six members, because there are two vacancies. If the sub-section prescribed four members, the county council could appoint only four members, but the sub-sections says "not less than four members," so they can appoint six members. I think that is what will happen in actual fact, in most instances. The county council will appoint six members and then you will have six members of the council with four others on that committee.
In a community of any kind, I think, you will find that there are people outside both the county council and the medical profession whom it might be very desirable to have on a committee of this kind. If you agree to delete these words "not less than", the committee would then consist of four members of the county council and these other public officials—the county medical officer, the county surgeon and two other doctors. That committee could then co-opt or elect two other members. That would provide an opportunity of bringing in people who are outside the county council and the medical profession and who might be of great help. I think that would be the better way to do it and it would not prevent their bringing in two other members of the county council, if the original committee of eight decided to do so. As the committee would be constituted under the present proposal, it would mean that there would be six council members and you might miss out somebody in the county who would be of great help to the committee—some people who have special knowledge in regard to health matters or somebody who had retired and who had plenty of time to devote to that type of work. I would suggest therefore that in sub-section (3) (a) the words "not less than" should be deleted. Of course it is important to remember that this committee has only an advisory function. That, I think, is quite clear but I should like the Minister to let us know exactly the power of a committee of that kind.
I should like to appeal to the Minister not to change the provision as set out in the section because I believe that under the proposal contained in the section you will get the best people available on this committee—that is, members who are elected by the people. I feel that the elected representatives should have at least six members on this committee because if they do not do their duty, they will have to answer to the people while the other members of the committee will have to answer to nobody. I would appeal to the Minister not to change the representation provided for members of the council on this committee. The elected representatives should be given as much power as is still left to them under the existing law and goodness knows that is little enough at the present time in this country.
I should be glad if the Minister would give us some reasons for what I regard as an extraordinary provision contained in sub-section (5). To take an extreme case, if this body meets six times in the first month of its existence, it cannot meet any more for the rest of the year unless the manager or the county council calls it together. It is quite conceivable that the committee might meet monthly for the first six months. If that should happen, it could not meet again for the rest of the year unless a meeting were called by the county manager or the county council. I do not imagine that the Minister would want monthly meetings, but it does not seem reasonable that if in the early stages of its existence the committee should hold monthly meetings, then after six months it cannot meet again during that year unless it is specifically summoned by the manager or by resolution of the county council. I cannot see why monthly meetings would not be quite reasonable.
I wish to add my voice to the views expressed by Senator Tunney. After all, the county council will be responsible for putting this Bill into operation. The county council will have to find the wherewithal to finance the measure and the county council, the elected representatives of the people, will have to stand up to whatever criticism may be levelled at the Bill after it comes into operation. I think they should be allowed to have sufficient people at their own funeral, and the Minister should not accept the suggestion made by Senator Cunningham.
There were three points raised on this section. First we had the suggestion by Senator Cunningham that we should confine the membership of this committee to four members of the county council with four medical representatives, and that they should be allowed to co-opt two others. That suggestion was opposed by two other Senators. I see no great reason for adopting Senator Cunningham's suggestion. The county council are quite free, should they wish to do so, to put on the committee any two people representing other interests, and I hope they will do so, but it is very hard to provide for all these interests, such as nursing, mental hospital attendants, pharmacists and so on. There might be other organisations such as the Red Cross, who should be represented, and I think the best procedure would be to let the county council appoint two other people, if they do not want to appoint two of their own members to complete the committee. County councils do sometimes appoint outside people on these committees.
On the vocational education committees, for example.
Sometimes you get a very good type of outside members. In all the circumstances, I think it is better to allow the proposal in the Bill to stand as it is. Senator Cunningham also wanted to know what the function of the committee would be. It will be purely advisory, of course, but, I think it will be a very useful committee in many ways. For instance, there is no such thing in a county hospital as a visiting committee although there is in the mental hospital and in the county home, I think. This committee could do the work of a visiting committee in the county hospitals if they thought it necessary. They could visit the county hospital occasionally.
With regard to meetings, it will be observed that four members of the committee can ask for a meeting. The reason it was thought necessary to have this provision about six meetings is that I was somewhat afraid that you might have a clique of four people on the committee who would like to meet, say, once a fortnight, while the other six members might not think that the business was of sufficient importance to meet so frequently. It was merely to prevent any attempt by these four members to insist on holding frequent unnecessary meetings that that provision was inserted. On the other hand, if it happened that they met every month and did good work and found after a time that the six meetings were exhausted, there is no doubt whatever that in a case like that the county manager, or if he does not agree, the county council, would authorise them to continue to hold these monthly meetings. Where the committee is doing good work, Senators need not have the slightest fear that they will be curtailed in the number of meetings which they are allowed to hold. It is merely to put a curb on mischievous members that this provision appears in the section.
I quite appreciate that, but I think the provision is a bit clumsy and that it might be advisable, if a majority feel that a meeting should be called, that they should be empowered to call a meeting. The members of the committee may have called a meeting on four occasions in the year on their own, and may have been called together twice by the county council, but once they have met on six occasions, in no circumstances for the rest of the year can they be called together without a special order from the manager or a resolution of the county council. I have every sympathy with the Minister's desire to prevent unnecessary meetings, called merely because some members of the committee may have a bee in their bonnet, but I think there could be a safeguard against that if it were provided that a meeting could be called by a majority of the committee. Remember, six meetings are provided for but none of these may have been called by the committee themselves. I imagine that the first regular ones will be called by the manager, and if they meet six times in the first six months —I think monthly meetings would be reasonable—in the latter part of the year they would be deprived of meetings. I would be satisfied if you provided that they could not call additional meetings more than three times in the year. I think this is too drastic, but I am not opposing the section.
I think Senator Douglas is much too generous. This is the most fantastic provision I have ever seen in an Act of Parliament. The reason given by the Minister is, I think, possibly even more fantastic— that he, with all the weight of his ministerial responsibility, is introducing this section in case you may have selected on to one of these committees three or four cranks who will insist on meeting more than half a dozen times in the year. I would imagine that the attitude of anyone to a person who wants to meet more than half a dozen times in the year would be to compliment him on such energy and citizenship.
Senator Cunningham and Senator McCrea have, I think, expressed what the point of view of a county council or city council would be to one of these consultative committees, that they would insist that the majority of the committee would be composed of members of the local authority and that six seats would be filled by local authority members. I really cannot see that the explanation given by the Minister for the inclusion of this sub-section can stand up. Would it not be better to leave it out and let things take their course? If the Health Bill is interfered with in any drastic way by a few mischief-makers, it is always possible for the Minister to come back with an amending section. I think this would be a fantastic precedent to create in a Bill of this sort.
I should like the Minister to say what is intended to be covered by this section. The section provides that, where a health authority is making an agreement for the provision of services with any person, it shall comply with any requirement specified by the Minister. Am I right in assuming that that is intended to refer to the context of the agreement; in other words, does the section mean that the Minister is retaining control over the agreement which is to be entered into between the health authority and the person giving the services, even on such matters as remuneration?
The local authority will be quite free to make an agreement with any hospital they wish, but they must keep within the regulations laid down. As I explained already, it is advisable—I think everybody will agree to that—that the same amount per week should be paid by each local authority to voluntary hospitals for patients. At the moment the amount is £5 12s. 6d. per week. That is the type of regulation they would have to comply with when making an agreement with a voluntary hospital. Then there will be other things. For instance, we had a discussion last night about making an allowance for the staffs in the voluntary hospitals. Some local authorities may not agree with that. They may say that they have always got their patients treated free and why should they be made to pay now. Obviously, if the Minister should make an agreement with the medical profession that staffs in voluntary hospitals should be paid, it would be up to him to see that the local authorities, in general, would carry out that agreement. There are various regulations like that that may be made from time to time which they would have to fall in with.
I appreciate that you will want some kind of uniformity. I am thinking of a case where an agreement is entered into with two members of the medical profession, one in a rural area in Connemara and another in a densely populated area. The services to be provided would not be anything equivalent as between two such areas. Will there be something like a per capita sum laid down for treatment or a lump sum? If there is to be a lump sum, it would seem that in one case the man would be paid more than he is worth and in the other case the man would probably not be getting enough.
The Senator must have the question of maternity in mind.
I was thinking of Section 16.
I think that is the only section the Senator could have in mind. I think in the case of maternity it would be a sum for each case. I do not think we should make a distinction whether it is a rural or a city area.
In the case of maternity, that would be a satisfactory way of dealing with it.
I move amendment No. 16:—
Before Section 50 to insert a new section as follows:—
The manager of a county or a county borough shall not, save on the direction of the Minister or on the advice of the Consultative Health Committee appointed under this Act,
(a) direct any medical practitioner to give medical treatment or treatment in a particular manner to any person entitled to treatment under this Act or to withhold any such treatment from such person,
(b) require any medical practitioner to make a medical report on a patient other than with the consent of the patient,
(c) require the production of the medical record of any person.
In moving this new section to the Bill, I will point out that the Labour Party have made it clear that we support the measure because of those improvements in the health services which it contains and not because it, by any means, provides the services needed by the people. Our desire is that the Bill shall not only become law but that it will also become operative. The doctors have, through their association, of which I am neither the advocate nor representative, expressed and repeated their fears that this measure will interfere with the confidential relationship between patient and doctor. The Minister has assured this House that neither himself nor the officials of his Department will disturb that relationship, and I accept his word in that respect. The Minister for Health cannot, however, as the law governing local administration now stands, guarantee in the same way that such interference by county managers or some county managers may not take place.
Closing the debate in the Seanad on the Second Reading of this Bill, the Minister correctly stated that this was not a measure on which the authority of county managers should be debated, and I have no intention now of going into the manner in which some of these officials have exercised their powers. It is pertinent for me to remark, nevertheless, that legislation has placed tremendous powers in the hands of county managers who could, unless the necessary safeguards are provided, demand the records of patients from doctor-employees of local authorities or in other ways interfere with the practice of their profession on the grounds that such doctors are members of local authority staffs and subject to the direction of the county manager.
This new section is designed to prevent legally possible abuses on a very intimate matter concerning a patient or what a doctor may do for him. As I have stated already, fears have been expressed of a danger to the doctor-patient relationship. This relationship is essentially an ethical question, and has deep roots in the Christian way of life. Misgivings that it is imperilled can readily militate against a more ready implementation of this Bill when it becomes law. The Labour Party are anxious that the services proposed should be provided promptly and, if this section is accepted by the Minister, then he will have made full legal provision to prevent an ethical abuse, removing one contentious matter from the difficult path he will have of making this in fact a fully operative service.
As to the section itself, it might be argued that it will enable any doctor to refuse to treat a patient, to give a medical certificate to a patient and to conceal records which may indicate carelessness or negligence. The section does none of these things. Doctors employed by local authorities, whether as dispensary doctors, hospital medical officers, specialists or county medical officers are all employed in a statutory manner, with statutory duties to perform competently and efficiently. The Minister has machinery for ensuring that neglect in carrying out these duties is investigated and, if necessary, punished. This section does not alter that position and neither does it alter the position where a patient can have his grievances voiced, if he so wishes, at a county council meeting, or redress for neglect pursued, in the courts of justice. The saving clauses, furthermore, in the section ensure the preservation of a machinery which may deal with a doctor's failure to cater for a patient's needs, should such arise.
The section, as stated earlier, is designed to prohibit an autocratic manager from abusing his powers to infringe on an old-established and recognised principle. It would be a serious matter if a manager could compel any doctor to disclose records or make reports on the medical condition of a patient without the knowledge and consent of the person concerned. There may be records of such attempts on the files of the Minister's Department; he will know that. If there are none such, it would be possible for the Minister to get the information from those doctors engaged in or retired from the service.
The inclusion in this section of the prohibition of the county manager directing a doctor to withhold a service is very important. We are approaching that point, if we have not reached it, where there is over-specialisation in medical science. There is a risk with intensive specialisation on the eye, the ear, the heart, the lungs, the stomach, the kidneys, the bones and so on, that the patient, a human being, is overlooked. Members of local councils are aware of the increase in their staffs since the county managers were appointed, and where so often it is impossible to find out who exactly is handling a particular matter. We are anxious, knowing the background, to make sure that this same approach is not going to mutilate the human being, that, for example, a county surgeon will not be prevented from——
Has the Senator asked the permission of the Chair to read this speech, or whose speech is he reading?
With all due respect to the Senator, I interrupt nobody. In any event, I have explained the points.
I suggest that Ministers frequently read speeches in this House.
And Senator O'Donovan never complained.
It is understood that members in the House may not read their speeches without permission.
There is nothing criminal in it.
I press the Minister to accept this amendment. Why should any county manager have authority over a doctor? A doctor is a professional man, and the doctor and the patient have their own way of life. There is a recognised principle in this country. The majority of county managers are very decent men. Why should any county manager, if he so desires, prevent a doctor from doing a certain thing and compel him to do another thing? If, for instance, there was anything wrong with Senator O'Donovan—I hope that will never be the case—why should the county manager have the right to know that? In the hope of making this Bill operative and successful, I appeal to the Minister in all earnestness not to give such power to any manager. As I said, the majority of them are decent men, but there is always the danger of there being a scoundrel.
A minute ago the Minister referred to the reason why he was preventing meetings was because there was the danger that there might be four people who would not act correctly. Now, you are giving power to one person.
Where are we giving him the power?
Are not the dispensary doctors and the doctors we appoint servants of the county manager and can he not demand the records? Is not that in the Bill?
There is not anything like that in the Bill.
The idea of this amendment is to prevent that happening. However, I will finish by appealing to the Minister to take notice of this new section and, if possible, accept it. If he does not accept it, I would ask him to bring in something between this and the Report Stage, that will protect the harmony that has existed in this country between doctor and patient—that harmony with which no layman has the right to interfere.
In seconding this amendment, I want to support all the points that have been made by Senator Tunney. I want to make it perfectly clear that we are supporting this Bill, not, of course, because it gives us everything we desire but because we appreciate that it is an improvement in the social services and the health services. For that reason we have given careful consideration to this section. We put it down with a view to making the Bill more acceptable to the people who are at present entitled to free medical treatment and the multitude of people who will come in under this new Health Bill. If this amendment were adopted, there would be nothing in this section which would enable a doctor legally to refuse certificates or whatever records are required for purely administrative purposes.
On the other hand, where certificates are required for allowances under, say, the Infectious Diseases (Maintenance Regulations) Act, T.B. priority cases under the Housing Acts, or where medical evidence is required for claimants for home assistance, then we hold that no powers should be given to a county manager to refuse the medical certificate in the cases I have mentioned where information is required for administrative purposes.
The Minister is a doctor. I know he is conversant with all aspects of rural life. He knows how difficult it is to get people to enter a hospital or a sanatorium, particularly the younger people. It is even difficult to get them to attend a clinic, a dispensary or a doctor's residence. Let me illustrate the point in this way. Let us say that Mary Murphy is paying a visit to Dr. Ryan. It may be a personal visit. Her next door neighbour sees her going to the doctor and says: "There must be something wrong with Mary Murphy. I saw her going to the doctor." Her next door neighbour confirms that by saying that she thought Mary Murphy was not looking too well. By the time it has got to the end of the townland, Mary Murphy will probably be suffering from heart disease or cancer and will be looked upon as a menace to society. That is the position, as I see it.
If the manager is given authority to demand the records of every patient who comes into hospital, and if these records are kept on the files in the county health office so that every Tom, Dick and Harry there can peruse them, you may have a whispering campaign in the county and that is certainly not going to help in the success of this Bill. I would be a great satisfaction for a patient to know that the confidence between his doctor and himself was being maintained. That is one of the reasons why we are asking the Minister to accept this amendment and have such a guarantee inserted in the Bill. I cannot see any substantial reason, and I believe Senators will agree with me, why the private and personal affairs of every man, woman and child in this State should not be kept inviolate. No one should be permitted to interfere as far as that is concerned.
There is no suggestion, as Senator Tunney has pointed out, that a doctor coming under this section should be safeguarded in, say, a case of the neglect of a patient. There is ample provision in the Bill for dealing with matters of that kind. I regret that the committees which are to be set up under the Bill are not being given statutory powers to deal with such matters, similar to those possessed by the committees administering the British health services. Our only purpose in putting down the amendment is to improve the Bill and to make it more acceptable to those who will come under it.
My objection to the amendment is that I cannot see any necessity for it. It is all right to say that a county manager must not order a doctor to give a patient any particular treatment. He never did that and never will. One might as well put in an amendment saying that the county manager must not prevent a doctor from saying his prayers. He has never done anything like that and never will.
If the Minister can assure us that the county manager will not be in a position to demand the records that we have spoken of, then we are satisfied.
The two Senators are members of local authorities and they know that, over the years, patients have been coming into the county hospitals, the county homes and the mental hospitals. I suppose a fair number of people would know about a person going into a mental hospital. Information of that kind is not abused. Everyone gets to know about it, and it cannot be helped if uncharitable people go around saying that such a person has gone into a mental hospital.
I would direct the Senator's attention to sub-section (3) of Section 5 of the Health Act of 1947, which provides:—
"Where regulations under this Act require records to be kept in relation to the health of individuals, such provision shall be made therein as the Minister thinks necessary or proper for ensuring that the parts of such records containing the names of such individuals shall be treated in a confidential manner, and shall not be published save with the consent of such individuals."
I do not think that any doctor will report on any patient without the patient's consent. It would be a very serious thing for a doctor to do. A patient, for example, goes to a dispensary. The fact that he does so means that he is accepting free treatment. The doctor will give the patient treatment at the dispensary, but he may have to send him on to the county hospital. If so, he naturally has to tell the county surgeon what he thinks is wrong. Otherwise, the county surgeon would not know whether he should admit the patient or not. If the doctor said that this was a very urgent and serious case of ulcer of the stomach which was likely to prove serious, the county surgeon would say that he would have to admit the man. On the other hand, if it was a case of hernia and was not a case of strangulated hernia, the county surgeon might say that the patient could wait for some time, and that he would admit him when there was room in the hospital. The point is that the doctor must tell the surgeon. As far as I know, that information does not go beyond the county surgeon. Records are kept in every hospital, but I think that these things are done fairly well. In all these things there is nothing as good as custom and practice.
Let us take, for example, what has been going on in this country for many years. Doctors have been examining people for national health benefits and signing certificates that patients were suffering from so-and-so. These certificates are sent up to headquarters here—24,000 of them arrive every week. The clerks working in Cathal Brugha Street must, at that rate, get to know the ailments of a couple of hundred thousand people every year. The information just goes through as a sort of routine, and the clerks are not very interested in it. They get the certificates and the cheques go out. You could not run that organisation otherwise. As I have said, practice and custom work out in that way. If you had any regulation about secrecy in that case, a conscientious doctor might say that he could not sign the certificate for a patient. The patient would then say that he could not get his national health insurance benefit. The doctor's reply would be: "That is not my affair; I cannot sign the certificate under the new regulations". I suggest to the Senator that it would be much better leave things work out as they are.
As far as this particular matter is concerned, we are adding on certain people. Over a number of years, a third of the population has been getting free services.: Now, we are adding on a certain number who will be entitled to hospital and specialist services. I do not know why any Senator should be disturbed, or why he should think, that there is going to be an undue violation of secrecy as far as those people who are being added on are concerned. I do not see why they should not flow in with the others, and why we should not allow things to work out as they have been working in the past.
I feel that if we were to accept an amendment like this it would be a sort of admission on our part that things had not been done right in the past and that we should put them right now. I must say that I have never got any complaints from any county council or anyone else in this particular issue. I think there would be a certain amount of danger if we were to accept the first part of the amendment. I sometimes have to deal with complaints. I may get a complaint from a person saying that he sent for a dispensary doctor, that he did not come until the next day and that when he came the child was dead or some other kind of complaint. The charges made are very serious sometimes, but the doctor was not to blame, because he never got the message or something else may have happened. I think we should leave things as they are.
As I have said, a third of the population, those in the public assistance classes, have been getting free services and treatment for many years now. The information that a certain number of doctors, nurses and hospitals have about some of those people has never been misused. Under this Bill, we are going to include a certain number of other people as well for hospital treatment. I do not see why we should think that there is going to be a great violation of secrecy in the future.
As far as doctors are concerned, there is no doctor, I think, as far as I know, who would take dictation from anyone as to how he would treat a patient. I do not think he could be ordered as to how he would treat a patient. I want to assure the Seanad and the public that if any doctor tells me, as long as I am Minister for Health, that anybody has attempted to interfere with him as to how he should treat his patients, I will be on the doctor's side on that.
I want to make the position perfectly clear as far as we are concerned. We are no perturbed in any way as far as the doctor, the patient or the people in Cathal Brugha Street are concerned. We are worried about giving extraordinary powers to the county manager.
I do not think there is anything in this Bill like that.
He might have power to demand certain records from a doctor if certain expenses are to be incurred in connection with a patient. If the Minister could assure us that that will not happen we are perfectly happy.
No. If a middle income group person, say, a farmer with £40 valuation, wants a simple operation for appendicitis the doctor says to him: "You need an operation; I will send you to a hospital." The farmer says: "Very good, I will go into hospital." Nobody interferes except his own doctor. The county surgeon accepts him, he undergoes the operation and is sent home. Now the county manager comes along and says: "This man perhaps could pay a couple of hundred pounds." It is not from the doctor he seeks that information. He goes to somebody else. I presume he will go to the home assistance officer because they know the people very well.
Too well for my liking.
Maybe too well, but they will be able to give information to the county manager whether they should charge or not.
The Minister has cited the case of a doctor sending a man from the country up to a surgeon. That has been the practice and, thank goodness, it has never been abused in this country. However, if a small farmer goes to the doctor and the county manager is asked about the bill, the latter, a lay person, comes into the picture and knows what is wrong with the man.
No, not necessarily.
If you give that assurance we will accept it. What we are afraid of is that the manager will be given too much power.
No, he will not.
The Minister for Health will not have much power to deal with him because I understand that the manager is the servant of the Minister for Local Government.
No, he is not the servant of the Minister for Local Government. He comes under the Minister for Local Government and under my Department for other legislation.
We hold the fear that the manager and his clerks will know what is wrong with the farmer. We would like the situation to continue as it has been going on in the past which reflects great credit on the doctors. I still would ask the Minister very earnestly between now and the Report Stage, if he is not prepared to accept this new section, to devise some means whereby some clerk in a county council office will not know what is wrong with certain patients.
If the county surgeon insists on his right that cannot happen. He will accept a patient, operate on him and send him home. As far as the county manager is concerned all he will ever be told is that such and such a person was here from 6th June to 7th July.
I can take it that the Seanad can consider the Minister's remarks as a definite assurance that so far as regulations can be made by him under Section 22 dealing with the manner of provision of institutional and specialist treatment are concerned, they are not going to infringe the principles which are suggested in this amendment. I think the Minister is right in saying that under the Bill as it stands there is nothing there specifically giving authority to the county manager or anyone else to inquire into records or to dictate to the doctor as to the manner of treatment. But it does seem to me that by a sidedoor method this power could come into the Bill by reason of the fact that this Bill is dependent entirely on ministerial regulations. I accept from the present Minister his assurances that any regulations made by him will not be such as to give these powers to the county manager or to the local authority as a whole. We are not legislating just for the term of office of the present Minister. It may be that this will crop up in seven, ten or 15 years' time when another Minister with a different outlook is in office. I gather Senator Tunney's appeal to the Minister is to see if something could be devised to ensure that the undertaking given by the Minister now in regard to these regulations will have the force of law in some way.
As long as the professional people—and Senator O'Higgins and Senator Cunningham will, I am quite sure, agree with me that they are jealous about their rights and privileges—the county surgeon and the county physician insist on their rights nothing can go wrong. Unless you have a weak county surgeon combined with a scoundrel of a county manager nothing can go wrong.
I agree entirely with the Minister's presentation of the facts of the case, but surely the amendment actually gives power to the Minister and gives power to the consultative health committee which, according to the Minister, nobody has now.
Yes.
I think the amendment makes the position of the doctor very much worse. It suggests that the Minister now will have power to compel a doctor to reveal all kinds of secrets and records about his patient which the Minister has not got at the moment. This question of what we call professional secrecy is not a matter that benefits the doctor in any way. It is for the protection of the patient. It prevents anybody else knowing what was wrong with the patient. It does not affect the doctor.
Except legally, I think it does.
Legally, perhaps. I agree with what the Minister has said and I am satisfied that the doctors have these rights to withhold information from the county manager or from anybody else.
I will accept that if the Minister will give me an assurance that the patient has the same rights in this regard. He has no organisation.
The patient has the rights.
Under Section 51, sub-section (2): "The Minister may by Order vary the division of the functional area of a health authority into dispensary districts and may by such Order provide for such transfers of officers as he considers necessary or expedient." In other words, he may change the dispensary district and, so far as I read from this, change the dispensary doctor from one part of the country to another. It may mean that he will only change from one part of a county to another, but I think it possibly gives him power to change from one part of the country to another. However, that does not matter very materially. What does matter is that a doctor may be told at any time that his residence and his whole area in which he worked is going to be changed and he is going to be moved from, say, North Donegal to South Donegal or, for all I know, he may be moved from Donegal to Cork. I think that is a hardship on the doctor. It may affect his family and it may affect his own life. He and his wife have made their friends. He may like the school his children are attending; they may be getting on well there.
Some Senators may say there are other Government officials, like civil servants, who are also changing in that way. However, they are not sent from one remote district to another but go from one big town to another where things like education make no difference. If the doctor is sent from one remote town to another, it causes great hardship. There is another difference between a civil servant and a doctor. A doctor living in a certain area of the country has made friends and people get to like him. He knows a great deal about them and has built up a certain amount of private practice and goodwill. As soon as he is changed he loses that completely— someone else takes his place—and he is at great financial loss for some time for that reason.
We have had some examples of forcible removal and forcible appointments and do not want to have trouble of that kind again. It is really not necessary that a doctor should be moved around in this way and I would appeal to the Minister to alter the wording by adding, say, "with the doctor's consent." The Minister might suggest to the doctor that he should be moved and the doctor may agree. That is done very often in other appointments.
Furthermore, the doctor has no one to whom he can appeal. The Minister will bear me out that there is no appeal provided. The Minister's word is law. He can direct a dispensary doctor to change from one part of the country to another. It is very unfair and will cause great hardship on doctors if it is passed. It will be made use of in certain cases and can give rise to trouble. A doctor may be moved against his will from one place to another. He has no appeal and must do as he is told. He is tied hand and foot, as if he resigns from the dispensary service he loses his pension rights, seniority and so on. Therefore, he cannot resign, he is absolutely tied and the Minister and the Department would know that and would know that they can move him around. It is very unfair and frightfully unjust to have a person in the position where he must go. He might be given the option to go but I do not think he should be compelled. I would appeal to the Minister to reconsider the section.
I agree fully with Senator Cunningham, if the section can be interpreted as Senator Cunningham says, namely, that the Minister can transfer a dispensary doctor from one part of the country to another. When I read it, that was not the meaning I took. I understood it would give the Minister power to alter dispensary areas, possibly to make two where there is one now——
That is right.
——and that the doctor would be retained in the same geographical area. I would not see the same objection if that is so, as would exist if it has the interpretation Senator Cunningham says.
Some years ago when Dr. Ward had a National Health Bill before this House, I remember making some little contribution on the question of dispensary doctors and their operating districts. I hold the same view very strongly to-day. When our present districts were allocated, we had not the means of transport and communication we have now. Districts which then would be very large and difficult to operate would not be so difficult to-day. The suggestion I put forward then was that in a large part of our country we could amalgamate a number of dispensary districts and the person relieved of duty as a dispensary doctor could be better employed looking after the school medical inspection or in some other specialised medical occupation. I am sure he would be just as content and would be doing much more useful work, than operating in a district in which there is very little to do. It is extraordinary how the whole picture can change overnight. When you meet dispensary doctors down the country who are making a case to the county council or the health authority, their case is that there is no private practice, that a dispensary doctor has to live on his remuneration as a dispensary doctor. Now we have the suggestion read into this by Senator Cunningham that the purpose of this amendment is to give the Minister power to transfer a dispensary doctor from one area to another, and that the doctor is going to lose the very valuable asset he had of private practice and social life.
It would vary in different areas.
This case is not made at all when there is an application before the local authority, to be presented to the Minister, for increased remuneration. It is quite the opposite case then, but that is beside the point.
I would urge the Minister to retain the powers given in this section for that particular purpose, as our dispensary districts are outworn and do not conform to modern times. There should be some co-ordination or cooperation between the Department of Health and the Department of Posts and Telegraphs to provide a telephone service to a greater extent for calling a doctor or a nurse in the remote parts of the country. That would improve the medical service very much and, at the same time, would not deprive any dispensary doctor of his livelihood.
I approve of this section, subject to adding something on the Report Stage. It says that the Minister can by Order vary the division of the functional area. I suggest the Minister should add: "After consultation with the county council." Most local authorities have been looking for years for this power. Dispensary doctors in most counties want some readjustment of their areas so the time is appropriate for us to show some signs of democracy. The Minister could add: "After consultation with the county council" or "After consultation with the doctor". That would be an improvement.
As one who referred to that matter on the Second Reading, I cannot see that there is anything intended to bring undue hardship on any officer—I am convinced there is a necessity for an alteration of the present districts. If that necessitated the shifting of a doctor, it could not mean very much. He would still be within striking distance of his previous district. He is working for a certain health authority and he could be shifted only from one functional area of that authority—usually a county—to another functional area of the same authority. In most cases it could only be to another part of the county and it would be very rarely that would happen. I would not see anything happening as Senator Cunningham suggests, where a doctor could be taken out of a remote place in Kerry and, to make his purgatory still harder, shifted to Mayo or Donegal. He could be shifted only within the area of the health authority by which he is employed.
In fairness to doctors, it would often be better for doctors, when they come into a health district, to be employed just by the health authority, with no fixture in any area. It would often be better for the doctor if he could be removed. We know that in the past the same thing could be done and he could be changed around. He may just come into the service in the county and then be shifted from Clonakilty to Mallow and in a month's time be sent to Castletownbere. There is nothing by way of hardship to doctors there and if necessity demands it it is only right that there should be this provision. In fairness to local authorities I have seen in the past where they have given the benefit of the doubt to doctors who wanted to go into places they thought would be suitable. I do not think it is intended to create any hardship and I believe that it is quite fair.
I would like to say that what I had in mind in this section was the revision of dispensary districts. In some of the newly built-up areas in Dublin where there is a shifting population, I am sure Senators will agree, there is necessity for the new dispensary districts which have been set up. It might have happened—although I do not thing it has in any particular case—that a man might be operating in a particular area and partly outside it and that he would be given some of these new areas to cover and would say: "That is not my area." It is to cover that kind of case that there is this provision in the section. I know a town in my home county that is being divided into two areas. There is no trouble there about a man accepting half, but he could legally say: "I am not going to accept half." It was to get over cases of that kind that this provision was put there. I admit that Senator Cunningham has a point and the provision could be used harshly and I would like to look into it again and see what could be done.
Section 11, for instance, deals with a very similar case where an institution is closed and a man may be allocated to another institution by the local authority If the man feels aggrieved— the very same case was put to me in the Dáil—because he might be in a town where there was a good secondary day school for his children and might be moved to a place where the school facilities were not good, what are we going to do about it? The Dáil agreed that he could appeal to the Minister. Here, of course, it is the Minister who is doing it, and unless we change it and let the local authority do it and then let him have an appeal to the Minister as an arbitrator or put in some such condition as, say, "a reasonable or short distance," or something like that, I do not know what else can be done.
I would suggest, "without undue hardship."
Or "in consultation with the local authority."
This is an excellent section. Is it possible to prohibit the importation of filling material unless the importer has a warranty from the seller, such as happens at present about pulp? Would not that simplify the whole thing? There is a very elaborate provision about the importation, and is it possible to prohibit the importation unless there is a warranty from the seller? Would the Minister consider that?
Importers are registered, and having been registered and licensed, I think they are quite entitled to import then.
Yes, I see.
I think we have something to say about this section. This is a very important section, and it really has nothing to do with the new Health Bill. It is one of these general sections about health and again about control. This is a section meant to bring about and arrange about the control of certain substances including what we call radio-active substances, and also, it seeks to control irradiating apparatus.
Now radio-active substances are substances which give out constantly various types of rays which are used for several purposes in science, in various laboratories, and they are also used in the universities by research workers and also extensively in the treatment of disease. Most of these substances are quite new and I suppose that is the reason for this new legislation to control their use. These substances are dangerous; if they are handled by people who do not understand them they may cause injury to the person who may come too close to them if they are not properly managed or handled. So that there is something to be said for controlling their use and storage and distribution. There is a certain amount of these things in this country and, as I said, they are used in laboratories and in hospitals. They are not produced here really, or only to a very slight degree, but they are imported from abroad under the control system which is laid down by the country from which they are imported and the transportation is quite safe because they are properly guarded and up to the present they are handled only by people who understand them. There has been legislation in these countries abroad about these substances and I have no objection whatsoever to the Minister introducing in this Bill a clause to control them. They are substances which should properly be controlled but I think they should be controlled by a properly constituted body and not by the Department of Health because I do not think the Department is qualified to do it. I think you require a body something like the Medical Research Council. I have been told and I hope it is true that the Minister intends to hand over control of these things to the Medical Research Council and with that I am quite in agreement. I also wish to emphasise that I agree that these substances should for the present at any rate be controlled until we have more experience and know more about them. On the other hand I suppose nobody will attempt to use them except people who know about them. They are used at present by certain doctors in Dublin and by scientists, but nobody else has access to them and it is right that they should be controlled.
Now we come to irradiating apparatus. That is a much more serious matter from our point of view because irradiating appartus includes such appliances as X-rays, and short-wave therapy which is used in the treatment of certain inflammatory diseases, of rheumatism and very extensively in surgery, and which is used, I suppose, in every hospital in Dublin at the present time and in many doctors' consulting rooms. We have things like infra-red lamps used by nurses in the treatment of aches and pains and rheumatism and by masseurs and masseuses and people of that kind for special treatment. We also have Finsen light and ultra violet light used in the treatment of skin diseases and many other diseases. We have the ordinary sun lamp used as a tonic and often recommended because of its beneficial rays as treatment for children especially in winter time and which you will find in many people's homes. Patients are sometimes recommended to use these rays and parents are often advised to give these rays to their children, especially during the winter, since they are particularly beneficial in this climate. Naturally people find it cheaper and more convenient to buy these lamps instead of bringing the children to some institution every day. These lamps are not very expensive. The people are shown how to use them and there is no danger. Indeed, they are less dangerous than an open electric fire.
Powers are being sought under this Bill to control all these things which have been used so extensively here for years past. Now if a doctor wants to have an X-ray machine in his consulting room he must procure a licence. If a nurse requires any of these special lamps or lights that I have mentioned she must have a licence. Why? The Minister will tell us, of course, that there will be no difficulty about getting a licence; all one need do is apply. But this provision gives the Minister a certain control. We have never had any reports of damage or injury from the use of these machines. Yet, the Minister is now seeking to get control of them. He will, in future, know who possesses them. I think the provision gives the Minister certain undesirable powers. He will be in a position to refuse a licence. Some people may think I am exaggerating but let me repeat again, and this is important, that I know a hospital in this city where there was a treatment machine which became worn out. The Department of Health has refused to give a grant to the hospital to buy a new machine.
Now in all hospitals one gets cases of cancer. In some cases the disease is not diagnosed until after the operation has been performed and microscopic examination has taken place. Patients may have to be treated by machine following operation and, if there is no machine in the particular hospital, the patient will have to be transferred to another hospital. Very often the relatives ask that the patient should not be told from what he or she is suffering when it is a case of cancer. If the treatment machine is not available in the particular hospital in which the patient happens to be the patient will have to be transferred to a cancer hospital. He may be sent to St. Luke's, in Rathgar. He will immediately know the disease from which he is suffering. Furthermore, the doctors who operated will lose control and touch with the patient. The principle is entirely wrong. The people responsible for the operation are also responsible for the subsequent treatment in consultation of the colleague who carries out that treatment. At the moment the patient remains with his own doctor. That is desirable. It is customary. That may not be customary in the future if this Bill passes into law.
A new hospital is being planned in Dublin at the moment and the people who are planning it were told not to make any arrangements about X-ray treatment for patients. Here we have a direction from the Department of Health as to what may or may not be done.
I commend the Minister for introducing this measure for the control of radio-active isotopes because they are dangerous substances but I see no reason why the other apparatus I have mentioned should be controlled. The control does not exist in other countries. These machines have been in use for more than 30 years in hospitals, in doctors' consulting rooms, in private houses. Why does the Minister seek control now? I hope the Minister will tell me I am wrong in suggesting that it is merely to get more power and control but that is the fear I have because of certain things that have happened.
Is there any use in telling the Senator that he is wrong, since he will only get up and say the same thing over again. How often has he told the poor simple Senators the way in which I am interfering with the voluntary hospitals? Yet, that is just not true.
Do not take it personally. I am referring to the Minister.
It is just not true. I will not say any more about it. I do not care how often Senator Cunningham repeats it. It is not true. It is Irish Medical Association propaganda and it should stop.
It is not Irish Medical Association propaganda.
The Minister will not interefere. He is paying the voluntary hospitals' expenses. He will do anything the voluntary hospitals ask him. This is just Irish Medical Association propaganda and there is no foundation whatsoever for it.
The Department of Health has been considering for a long time some legislation in relation to radio-active substances. I must say when I read the literature on these substances I found it absolutely frightening. If someone gets hold of radio-active substances for the purposes of experimentation, or anything else, it is impossible to get rid of them. They cannot be burned, since the ashes left are themselves radio-active. They cannot be put into water, because the water becomes radio-active. It is a frightening substance and someone must control it. For health purposes, it is the Minister for Health who should control it.
As Professor Cunningham has pointed out, doctors use certain irradiating apparatus; so do hospitals and nurses. I have no intention of interfering with these. I can well imagine that had I not included this provision the Irish Medical Association would have come to me asking me to control the use of these irradiating apparatuses because unauthorised people were using them.
We have never done that, not once in the last 30 years.
I suppose that was because the association did not think of it, but you did more foolish things than that in the past.
We instruct both nurses and masseuses in the use of the apparatus.
I am not referring to those. I am speaking of unauthorised people who are neither nurses nor doctors nor anything else. It will be a good thing if we can stop such people using these things. There is no reason why nurses should not use infra-red or sunlight treatment, but there are unauthorised people using apparatus and it is important that they should be stopped.
It seems to me that when I include a provision in the Bill the Irish Medical Association thinks up all the arguments against it. I must say they have thought up very good arguments in this particular instance. Had I not included the provision I am sure they would have thought up excellent arguments as to why I should put it in. That is the position in which I find myself all the time. They oppose anything I try to do and, if I do not do something, they ask why I have not done it. To a great extent I suppose that is what is responsible for the delay we had in passing this Bill in the Dáil, and for some of the time we have spent in discussing the Bill here.
It is not being unreasonably delayed here.
I admit that. I have already arranged to consult the Medical Research Council in connection with all these matters. I do not know anything about them. I would not know one end of an X-Ray from the other. I would not know which side to stand on. But, I want to get advice and I intend to get advice from the Medical Research Council on all this business. As far as I am concerned I am quite prepared to exempt certain things only for the fact that unauthorised persons are using them. For that reason it may be well to say that doctors can use this and nobody else or that dentists can use this or that hospitals can use it, as the case may be. To that extent, I think the regulation might be useful. If Senator Cunningham would look at it in that way, he might see some good in this section. If the Medical Research Council, which is composed, I think, entirely of doctors, say to me: "Leave certain things out of your regulations altogether," I will do that.
The Minister would not consider putting in sub-section (2) "the Minister may after consultation with the Medical Research Council" so as to put the Medical Research Council into the Bill, considering that the Department, as he says, and it is of course quite credible, has no specialist knowledge of this particular thing, which is peculiarly specialised? If the Minister is in fact going to make regulations, not only after consultation but on the advice of the Medical Research Council, would not it be advisable to put that into the Bill?
I see one objection to that, that there may be no Medical Research Council there, perhaps, in three or four years time and then the Minister could do nothing.
The Minister is again accusing me of attacking him personally, which I do not do.
I am taking it as the Minister, not personally.
I refer to a Minister for Health in this county. I mentioned this question of a certain hospital which was refused permission or were told that, if they bought this apparatus which they wanted to renew one that had worn out, they would not be allowed money for it on the deficit. That is what I was told about it. I do not know whether that occurred during the present Minister's occupancy of the position or not. I do not know who was the Minister at the time. That happened. I would like the Minister to deny here that that did happen.
I could not deny it.
Then why accuse me of putting forward this as a matter of propaganda? It is not propaganda. It is a matter of fact. The old apparatus is still lying in the hospital in the room where it was used and no patient has been treated there for a couple of years because they had not go a new one. Is it not a fact that a certain hospital could not get permission for a treatment machine from the Department of Health?
I would like to see that too. I am not accepting that as true.
The Minister accuses me of being grossly inaccurate and of putting forward propaganda. I am not. I am merely pointing out that that is what has been happening; that is the tendency and the more power that is given to the Minister or the Department under him, the worse it is. In that way they control everything; they can direct things. That is the theme of this whole Bill: control, dictatorship, direction. That runs right through the Bill the whole way. The Minister, whoever he may be, will be master of the whole medical profession and of all the people who are ill. They will do what they are told and so will the doctors. That is dictatorship of a kind you have not in any other country as far as medicine is concerned. I would like to ask the Minister, finally, is there any precedent for this control of an irradiating apparatus?
There is.
In other words, is there any other country that he can tell me where all these things that are being specified are under the control of the Department of Health?
Yes, in our neighbouring country, England, Scotland and Wales.
In England, no.
Yes.
Radio-active isotopes alone were handed over and the Minister refused to have anything to do with them and he gave them to the Medical Research Council in England, but X-rays and other things are not controlled.
They control irradiating apparatus, just as is proposed in this section. The Senator mentioned certain specific instances where we turned down, let us say, an X-ray apparatus. I would like to see the facts of that case. I think that if I put the facts before this Seanad or a jury of this Seanad they would say that the Minister had a point, and may be some of them would say that the Minister was quite right.
I got a proposition the other day. A certain hospital—I forget which—has eight operating theatres. There is very full apparatus for giving anæsthetics which costs about £120. They had seven of these. They wanted the eighth. It was put to me by the Department, why should they want the eight. Are there ever eight operations going on at the same time? I said: "Maybe so, but you had better not bring me down again on the voluntary hospitals". I thought it was ridiculous to give the eighth, that at least they could use the ordinary apparatus for giving an anæsthetic and not put the country to the expense of another £120, but I had to sanction it because, otherwise, Senator Cunningham would be quoting here to-night that I turned down an apparatus for giving an anæsthetic costing £120. That is the sort of thing that is being put up every day of the week. There was a very costly apparatus asked for by a hospital. I do not remember the name of it but I do remember that it would be used only very occasionally, perhaps three or four times in the year, by any hospital, but it would be very important for those three or four times. A neighbouring hospital had it. We asked them could they not send three or four patients a year over to this hospital and they said: "No, they would not". We had to pay out of the hospitals' fund for that. These are the sort of things that are put to us and these are the sort of things we have to agree to. If we did not, Senator Cunningham would say that the control is going on. They are most ridiculous things.
A new hospital is going to be built. The proposition was put to me that not only did the operating surgeon want a shower bath, but that every surgeon wanted his own shower bath. That is the sort of thing that is being put up. Of course, we did not allow it. Senator Cunningham does not quote that because he knows that the Seanad would laugh at him if he accused me of controlling the voluntary hospitals in that respect.
There are the sort of propositions that are being put up. That is the sort of money that would have to be spent if you had not some Minister or somebody else to control the ridiculous propositions put up by the staffs of the voluntary hospitals. They are never refused anything reasonable. In fact, they get a lot of things that are unreasonable. Why? If you like, because I have not the moral courage to be accused by Senator Cunningham or the like of him of being unkind to the voluntary hospitals. He has cowed me, I admit, by this talk. Senator Cunningham and men like him, with this talk, have cowed me into agreeing to things that I should not agree to.
That is a marvellous line for the Minister. The Minister is excelling himself.
I should not agree if I were only fair to this country, but they are getting away with things of that kind. Even so, you come along and quote some hospital that is going up where we said: "Do not put in costly apparatus." I do not remember any such thing. I would like to see the circumstances and to know what they are in this particular case. In some other place there was some other apparatus worn out which was not renewed. I do not remember that either, but I do remember, as I quoted, some of the ridiculous things I did agree to in order to try to prevent this propaganda going on that the Department of Health and the Minister for Health were up against the voluntary hospitals. If I had known that Senator Cunningham would come here, and if I had known that he would quote these cases, I suppose they would have got their X-ray and all these other things.
Perhaps they will get them before the Report Stage.
Mr. P. O'Reilly
The section gives power to the Minister to control materials for the destruction of rats and mice. I wonder why rats and mice were specifically mentioned? The Minister should delete "rats and mice" and substitute the word "vermin." Alternatively, he should add the word "rabbits." I read in the newspapers recently that a doctor or a scientist in France brought out some substance for use in the destruction of rabbits. Possibly that may mean the destruction of the rabbit population in France. Since rabbits in particular, perhaps, can or might become a very serious matter, and are becoming a very serious matter in this country, and since they are classified by most people as vermin, I think the Minister should at the Report Stage eliminate, "rats and mice," and substitute, "vermin," as an alternative.
I think the Minister should stick to his rats and mice.
I read about the particular virus referred to, and I do not know if it is dangerous to human beings. That being so, I do not think it could be dealt with under the Health Bill. However, I will have it examined before the Report Stage.
On Section 62, I want to ask the Minister for some explanation on this section. So far as I can read it, it provides facilities, for example, to teach, but the university is not getting control over those appointments. I would like to know from the Minister if that is so.
I did not get the point. Would you repeat it?
This section provides facilities to teach medicine but no medical school has control over the appointments of those who will teach.
That is not exactly right.
I would like an explanation of that.
Take a college. First of all the college will, in the legal wording, say: "We are interested in such and such a hospital for clinical teaching." If the Minister thinks that that is right, he makes an Order that the hospital comes under this section. The local authority then must provide facilities for clinical teaching. At that stage, of course, you only go so far as saying that the surgeons, the physicans, or the gynaecologists in the hospital actually will do the clinical teaching. That is as much as some colleges at least require at the moment —that the teaching be done by the staff there. But they may go further. If a vacancy occurs, for instance, for a surgeon, the college may then say: "We are interested in this appointment." If the Minister agrees that they have a case for being interested in the appointment he brings a certain regulation into force, and if he does the Local Appointments Commission in choosing their board will take three —or at least I should say half, let us say three—from the governing body of the college concerned, and appoint three themselves, and the Minister appoints the chairman.
There was a long-standing tussle between local authority hospitals and colleges in certain cases. The local authority hospitals were making their appointments, as they were bound to by law, under the Local Appointments Commissioners, and the colleges argued that they were practically compelled to appoint those men professors when they were appointed, like pathology, bacteriology, surgery, medicine and so on—that they had no option. They felt that it was very unfair to them, that is to the teaching college. Well, I could not see how it could be got over, because we could not very well have the thing reversed—that the university would first make the appointment and the local authority would have to take whatever person it was, because he might not be the most suitable person for them, and after all the local authorities' first consideration must be the health of the people, not whether there is a good professor of surgery or medicine. The health of the people is their first consideration, so they have to insist that they would have the appointment made with that point of view in mind. Both sides met, and it was they suggested—it was not I suggested—I can tell you that— that they would agree to have the board composed of half and half with a neutral chairman, and eventually they agreed that the best person to appoint the neutral chairman was the Minister for Health.
That is how the section arrives here; and the operation of the section—I would just repeat it before I sit down —is that, first of all, if a college medical school claims to have an interest in a hospital for clinical teaching the Minister may make an Order, and then the local authority must provide facilities for clinical teaching with the staff that is there. If a vacancy occurs in that hospital, then the college may claim to have an interest in the appointment, and if it is agreed that they have an interest then the machinery laid down here would be brought into operation for the appointment.
I thank the Minister. I really wanted to draw attention to that, and must stress that it is a matter of great importance, especially at the present day. I meant merely to warn—when I use the word "warn" I do not mean threaten, but to warn in a friendly sense—that if any establishment or hospital is being given facilities for teaching, or teaching is being established in a hospital, clinical teaching for students attending there, some medical school in Dublin—as you know we have three medical schools—should have a big say in the appointment of the people who are going to give the teaching, or that a medical school should at least approve of the appointment of those who are going to give that teaching. That, nowadays, has become essential, and, therefore, it would be a great mistake if facilities were given at any hospital where people in that hospital who would give this teaching were not approved of by some medical school in the city.
I move amendment No. 17:—
Before sub-section (3) to insert the following new sub-sections:—
(3) Where a health authority provide a course of instruction under this section, they may, at their discretion, permit registered medical practitioners who are not medical officers to attend at such course.
(4) The Minister shall notify the Medical Registration Council of courses of instruction approved under this section.
The amendment, I think, is fairly clear. I think it is perhaps somewhat, if you like, on the lines of Senator Cunningham's warning on the teaching and that the teaching authority should have some say on those appointments. It has been put in that where a local authority provides a course for its own officers in any particular subject they shall at least notify the Medical Registration Council, which, of course, is the supreme authority so far as medical teaching is concerned in this country.
In that way they keep at least in touch with that authority. Now at the Consultative Council meeting we held recently I was pressed very strongly to bring this amendment in by the medical members, and provided this amendment was brought in they also thought that a second amendment should be brought in, that is, that where these courses are provided by a local authority for local authority officers there was no reason why other practitioners in the area, if they liked to avail of the courses, should not join if they wanted to; so these two amendments, therefore, are included in this.
Why the Medical Registration Council instead of one of the teaching bodies? It is not a teaching body.
They are all appointed there by the teaching bodies.
It is the only one that does combine them all. That is fair enough. Quite right.
Yes.
There are certain things here that are somewhat worrying and give rise to a good deal of doubt. I think that originally in this section there was some intention to establish a post-graduate medical school. That has been dropped because I think the Minister very wisely has come to realise the inadvisability of that. The State does not take on the teaching of a learned profession. That lies within the province of a university or a special school appointed for that reason. The State should have no say in it, and anybody who would attempt to interfere with that, take over control of it or upset it in any way from the State point of view or a Department of State would, I think, be crazy.
The thing would get nowhere, and it would not be recognised by anybody. The teaching there would not be recognised by any other country. That is a very serious matter. Why does the Minister want to do all this about post-graduate teaching? Remember that the hospitals that are best equipped to do this are the clinical hospitals. You have the men there who are most experienced in that line of work, and they are the hospitals that should do it. Do not think for a moment that I have any interest in this. I have taken part in post-graduate courses in Dublin: our various medical schools run them fairly regularly. We have one that is run by a combination of hospitals in Dublin. We have one in St. Vincent's Hospital for people studying for the M.D. degree, which goes on the whole year. Doctors come from all over the world for their training in the clinical hospitals. Why does the Minister interfere and start something like this? Do not think that I have any special or what has been called here "vested" interest. I have taken part in a number of courses in Dublin. We do not get any salary for it: we do not get paid. It means very hard work. These men expect the most up-to-date things to be taught to them. We do the work voluntarily. The only charge is a nominal fee to cover expenses.
I hope the House appreciates that I have no financial interest of any kind in the matter. I am only interested in seeing that the doctors who come up from the country to do these courses will get the very best teaching. Where will you find it? It was intended to start a post-graduate medical school in St. Kevin's Hospital, Dublin. You may have the most brilliant staff there: I do not say that you have not. However, you have men in other hospitals who are well known as specialists in their own line and who are teaching and have been teaching for years and who have experience in how to teach. Many of them are on the staffs of universities and other medical schools in the city. Which would you prefer should give this post-graduate teaching? Remember that we in this House are deciding it now. The Minister may say that he has no intention of establishing a post-graduate medical school. Let me, however, read sub-section (2) of Section 63 which states:—
"A health authority, with the approval of the Minister, may do all things necessary to provide from time to time courses of instruction for medical officers (including medical officers of other authorities)."
In other words, he can do anything he likes. He can start a post-graduate medical school to-morrow if he wishes. I think that that was in the original Bill or in a Bill a year or two before that. I want the House to give this every consideration because it is very important. Which do you think is the place where these men would get the better courses? Is it in St. Kevin's Hospital or in some of the clinical or other of the hospitals? It is for the members of this House to decide that. I think it is very dangerous for any Department of State to interfere with education in the learned professions. This provision may have been inserted in the Bill without giving it due consideration. Remember that State medical teaching does not exist elsewhere and it will not be accepted. You may give post-graduate courses, but I do not think you will get the best value if you do it in that way.
I have not very much to say. We thought it was necessary to have these courses in certain cases for local authority officers in particular. It might happen that the best person to give the course would be a man attached to a local authority hospital. Senators must bear in mind that the staffs in these local authority hospitals are now growing in experience. They were recruited on very good competitive lines. The best man was selected and got the job in each case. No influence of any kind was used on their behalf. We have got an extremely good staff in these county hospitals. They now have experience, and they may prove to be the best men to give courses in certain subjects that would be necessary for local authority officers. I do not see why I should make any apology for providing for that. The power is not there at the moment. I was informed that, legally, a local authority could not provide its hospital for clinical teaching of any kind, either post-graduate or undergraduate. This clause is necessary to enable local authorities to have their hospitals used for that purpose.
It was never my intention to have a post-graduate school, as Senator Cunningham says. I had no intention of having any diploma or any degree of any kind conferred as a result of a course of this kind. The only thing that was ever thought of—as far as I am concerned—was courses in various things. I do not see why anybody should object. Knowledge is a great thing, wherever it comes from, if it is good. If we can get a certain amount of knowledge from the local authority hospitals which might not be got as well from any other source, I think we should take power to see that that knowledge is got. That is the object of the section.
Has the Minister anything to say about the wording of sub-section (2) of this section, which reads:—
"Any offence which is to be prosecuted consequent on an inspection carried out in pursuance of this section by an authorised officer may be prosecuted by the health authority."
It strikes me that you prosecute a person in respect of an offence. You do not prosecute the offence. Would the Minister look into that point? It is just a matter of wording.
Yes, I see. I will look into that.
When is it proposed to take the next stage?
I suggest Wednesday week next, the 14th instant.
Will we get the remaining stages on the 14th?
We will see that later.
The Minister is not doing very badly, for all his air of injured innocence.
Thanks very much.