Health Authorities Bill, 1959—Second Stage.

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

This Bill is a rather complicated measure and I do not know whether, at this hour of the night, the Seanad would like me to expatiate at length upon it because I have already spoken at length in the Dáil and, presumably, most of the members of the House have read what has already been said there.

That is so. We would be satisfied if the Minister would agree to use the Committee Stage to explain the various points that arise.

The main purpose of the Bill is to establish special health authorities in Cork, Dublin, Limerick and Waterford. I may say that objective was very forcibly in mind in the year 1952, when a letter was issued by the then Minister for Health to the local authorities concerned in these areas. Since that period, there has been a great deal of debate, discussion and correspondence, between the Minister and these authorities. I think I can say that seldom has there been a measure to which so much consideration has been given before it it was introduced into the Oireachtas.

The secondary objective of the Bill is to assimilate the existing organisations for the treatment of mental illness to the general health services. The Minister for Health is, naturally, interested in securing the unification of these authorities in order to produce coordination of the various functions in a way which will enable them to render better and more convenient services to the public for whom they are intended. He is also naturally anxious to secure, where he can, economies in the administration of the services.

An extraordinary situation exists, I may say. The city of Dublin is perhaps a leading case in point. Here in the city and county of Dublin, almost 25 per cent. of the total population of the State resides, and, of the 706,000 people who constitute that fraction of the population, practically 36,000 persons may be assumed to live within the city of Dublin and the borough of Dún Laoghaire, their immediate suburbs and districts contiguous to them. In other words, one can say 95 per cent. of the population of the city and county of Dublin is essentially a single population unit. I think that fact is almost a coercive argument for unifying the administration of the health services in that area.

In actual fact, in respect of these 700,000 souls, there are no less than seven authorities concerned with the operation of the health services, some providing similar services for the people in their own administrative areas, some providing separate services of all kinds, but all tending to overlap in one way or another, causing a great deal of confusion and inconvenience. To some extent, that position may be said to be obtaining also in the case of Cork, but not by any means in so marked a degree. In Limerick and Waterford, we have two areas consisting of the county and county borough, two administrative units where there is not so great a degree of overlapping, but there is this fact that the population of both those areas is very much smaller, for instance, than it is in the case of some of the administrative counties.

In the case of Limerick, the total population of Limerick city and county in 1946 was 138,000. In the case of Waterford, it was 74,000. Yet both these local administrative units are carrying a whole paraphernalia of health services as independent entities.

The whole proposal, briefly, is to provide for the city and county of Dublin, the city and county of Cork, the city and county of Limerick and the city and county of Waterford, one health authority in each case which will administer all the services, and we hope, administer them very economically—in such a way that the services will be more readily available to the people and that some economies in their administration will be secured.

It will be understood, particularly in the case of Dublin, that in many instances where a person is seeking to secure general hospital services, he may first have to go to the Dublin Corporation in order to prove that he is entitled to avail himself of these general hospital services and, when he has proved his entitlement to the services, as soon as the question arises as to whether or not he is to be charged for these services, he has then to turn to the Dublin Board of Assistance. Therefore, in respect of that simple matter of securing admission to hospital, we have two independent authorities with their two separate offices and two separate staffs dealing with the one individual. That is one of the things which we hope will be eliminated by this Bill.

There is one other matter to which I should perhaps refer, that is, the question of the staffs of the existing health authorities. Naturally, they have not been unconcerned as to what might happen to them in the change. Apart from the question of remuneration, which will not be affected, there is the fear of impaired prospects of promotion, the fear of being transferred to another centre or the fear that their status may in some way be depressed.

All these are questions primarily for the persons who will be the managers of the new authorities. The issues, however, were particularly raised in the Dublin area and I arranged for the matter to be discussed between my Department and the City Manager. The City Manager, I understand, has been in conference with representatives of the staffs concerned on the Dublin Corporation, with particular reference to the loss of promotion prospects. As the discussions are still in progress, I do not wish to say anything more at present, but I assure the House, as I have assured the Dáil, that my attitude and the attitude of the City Manager towards the staff who will be transferred will be sympathetic. I am sure the same can be said for the managers of the authorities in the other areas affected by the legislation.

I should hope that the Seanad will be content with that brief explanation of the Bill and, as Senator Hayes suggested, on the Committee Stage, I shall be prepared to deal at greater length with the various points of detail.

As an inhabitant of one of the areas the Bill will affect, I welcome the Bill, with, I confess, a note of desperation in my voice. The note of desperation comes from the fact that I am a member of the local council which is trying to make the existing health legislation operate. Whatever hopes this Bill brings, they must be more than pious hopes. We must make the new Act work or, if we do not, we shall have to get rid of it and of whatever is there already.

On the premise that the services the Bill will provide could not possibly be worse than what are there, we must give the Bill a trial but if it does not work, we should tear up the whole thing. The explanatory memorandum says there has been inefficiency and confusion under the present system. That is a complete description of the way the Act has worked. It is a very painful confusion of bad planning and, as a result, I think the various councils have been run very close to bankruptcy. The ratepayers are not much better off. On the whole, the people who are sick, I think, are not much better off than they were.

I do not subscribe to the notion that all the services deteriorated but certainly some groups of people seeking help have not been able to get the help they would have got before the Health Act came along. I said last night that the cost of health services in Cork increased in ten years from £175,000 to £530,000. It is a fantastic and frightening growth. It tends to injure and destroy the fabric of local government because all other local government purposes have been snowed under as a result. If there is any prospect of remedying the matter through this Bill, then I want this Bill.

The Minister is aware of the position in Cork city. It is the fault of the inhabitants of that old city that, for years, they have been thinking of extending the city boundary but only the City Council have done anything. The Minister is aware, too, that there has been overlapping in the areas controlled by the South Cork Board of Assistance. We hope he will rationalise the situation. It is a most dreadful jig-saw. If the new authority can sort it out, I am all for the new authority.

The statistical population of the city of Cork, as it is at present geographically described, is 80,000 but the real population is somewhere about 120,000. The suburbs on the periphery of the city contain the difference. These are well-off citizens. They make very few claims on health or social services. They are ideal inhabitants for the authority in whose area they live.

I want to make this plea to the Minister. In the interim period, whilst the extension is being carried out, there are obvious difficulties for Cork city because, in the city proper as we now have it, too few carry too many of those who demand such services. The city is an ill-contrived place because of this spilling-over of the authority of the county. Until that is made right, there are certain—the Minister knows what I mean—delicate problems on which we might have trouble with our colleagues on the county council. The Minister understands the position. I want to express my gratitude for his help.

It is not completely inappropriate to express the hope that the great regional hospital project in Cork has finally been shelved. I have spent four years trying to achieve this result, with the assistance, indeed, of a notable member of the Government Party. However, £60,000 has been spent on the project. This is one example of the kind of planning done under the previous health services. That money has been spent on planning and on ground purchase. We should forget the scheme. We should throw it into the River Lee and let it go to the tide. Let us sell the site but let us not go ahead with that scheme because I believe we cannot afford it. It is as simple as that. I and, I am sure, the Minister, in our private affairs, would not dream of spending money if we could not afford it unless it were absolutely essential for our existence. This regional hospital is not essential. If anything, Cork is an over-hospitalised area. We should employ that simple yardstick to all such proposals —I want to stress "all"—until we can afford them.

I have been regarded as speaking in this House in the rôle of a very constant pilgrim to the Wailing Wall. We are in trouble in this country because I think we are living beyond our means and spending too much. Organisations can protect themselves but the large unvocal section of our people are unorganised. The load of taxation is crushing them. We have this health service. I hope this Bill will make it work more efficiently. If it does that, I hope, at a lower cost than the cost of the present service, I welcome the Bill.

If one accepts the present organisation of the health services as the ideal, then I think that probably this Bill is to be welcomed. There has been a great deal of confusion in the minds of the people as to the organisation of the health services, particularly in Dublin and Dublin county. In so far as this Bill helps to rationalise what is, to my mind, a very defective system, it is to be welcomed. If a few years ago somebody had got up in this House and said that the services in Dublin, Cork, Waterford and Galway were inefficient and led to confusion on the part of the public, I wonder whether such a statement would not be branded as extravagant.

I have no great hope, I must confess, even when this measure of rationalisation of the health services in the different counties to which it is to apply takes place, that the individual, when he is sick in bed in hospital and when he is in the outpatients' department, will get a particular advantage. I have known cases of people who were sent as public health patients by dispensary doctors into hospitals in the city of Dublin. I know one case of a person who met with an accident about one o'clock in the afternoon involving a fracture of the collar-bone. On going in for an X-ray, that person was greeted with a complaint that he should have been in earlier because the X-ray department shut down at 5 o'clock, as if the person could influence the time at which accidents take place.

It struck me very forcibly that some extra money could be provided to make the place where people in the out-patients' department have to sit, oftentimes for long hours, more comfortable, more presentable and less draughty. That would do a great deal to improve the lot of the individual who wants to avail of the public health services in this city. If this Bill were designed to achieve a reorganisation in these important details for the persons who want to avail themselves of the public health services satisfactorily, I would give the Bill unqualified approval.

I oftentimes wonder whether those charged with the administration of the health services—I confine my experience to Dublin simply—would go about and see what the unfortunate people who are in a state of ill-health or are not feeling well have to put up with from the point of view of interminable delays, lack of information as to what they should do and uncertainty as to their rights at the various hospitals they have to attend. I hope that with the establishment of a single authority in Dublin and, perhaps, in the other places, Cork, Waterford and Limerick, there will be one central authority who will have the whole duty, burden and responsibility which they cannot shelve on to any other authority of seeing to these very important details that so much affect the dignity very often of the unfortunate people who are in need of treatment.

I would hope that, when this is got out of the Minister's way, he will be able to organise things in such a way that the personal element that enters into the administration of the health services will be taken care of to a much greater extent. If the people operating these health services only observed a modicum of ordinary courtesy you would not have some of the bitter complaints and recrimination one hears from poor people at the present time who know they are poor and feel that there is no other service available to them.

I had hoped to have the opportunity of raising a number of matters at this stage in relation to certain sections of the Bill but I forbear from doing so on account of the attitude the Minister adopted in not delaying the House unduly because of the time of night, but since the Minister referred to the question of staff, that is one of the matters I am concerned about as a member elected on the Labour Panel. I feel bound to comment upon the matter at this stage.

The Minister said that the staff in the various authorities are very concerned about their future position. I must say that reading the Bill I felt it was extremely unsatisfactory in relation to the provisions being made for staff who are to be affected by this piece of legislation. I should have thought that there would be a clear declaration contained in the sections dealing with the transfer of staff that the staff to be transferred to the new authority would not suffer any worsening of conditions of service. I should have thought that the Minister could go somewhat further, that where people do, in fact, suffer a worsening in their prospects of promotion, which is bound to happen in a service which is amalgamated, some kind of compensation similar to that which is found in other statutes under which people are affected in regard to employment would have been made available to them in this measure.

That is important for this reason: If we transfer staff from one body to another and they are badly affected as far as their future is concerned by the change, you will not have the contented staff administering the health services you should have. Above all, I think in relation to health services, you must have a staff who are working at maximum efficiency and who have no reasonable grounds for dissatisfaction and grievance.

The Minister indicated that this is a matter which has already been raised by the staff themselves but he says it would be primarily a matter for the new authorities. That is immediately where I part company with the Minister because the position of existing staff in these different statutory bodies is being affected—and very probably adversely affected, in some instances— by an enactment of the Oireachtas. If the position of the people is being adversely affected by an enactment of the Oireachtas, I think the Oireachtas has a duty, as it has undertaken in other cases, to offset the adverse effects created by its own legislation.

I would urge the Minister to consider the possibility, even at this stage—and I believe he has gone a great distance in satisfying demands in the Dáil—of providing some statutory basis for the provision of compensation to people who will be adversely affected in their future prospects by this legislation.

The Minister said that the attitude of the county managers, the heads of health authorities, and his own attitude, will be sympathetic. While I have no doubt that the Minister, being the good natured man he recently declared himself to be, will be sympathetic, very often, a Minister's resources do not go as far as his sympathy and in these circumstances the sympathy is not worth a great deal. Either the Minister should ask the Oireachtas to invest him with authority or, alternatively, he should invest the new authorities which are to be created under this Bill with resources from which to meet the justifiable claims of people who will be adversely affected in their future prospects by this piece of legislation.

I abhor the thought of having people operating this legislation who would be prejudiced from the start because of the adverse affect the legislation would have on their future prospects. They will be operating a service which requires the maximum of goodwill and efficiency. There are other matters on which I should like to speak on this stage but perhaps they can be dealt with on Committee Stage.

I welcome this Bill because it brings the authorities in the different areas together and in so doing produces an average cost for the Health Act, as far as impact on the rates is concerned. In my view, this is a good thing but there are grave anomalies and grave disparities in the burden which is placed on the ratepayers by the Health Act by virtue of the fact that some areas are poor areas and other areas quite rich. For instance, take two areas which are not being dealt with in this Bill as concrete examples. In Louth, where I am a member of the county council, a penny in the £ brings in about £1,000. There are two large urban populations and this, of course, results in a very heavy impact on the ratepayers.

The Senator has gone very far away from the terms of the Bill.

I have not.

With respect, the Senator has gone away from the terms of the Bill. This Bill relates to certain authorities which are named.

Very briefly, then, I shall say that, in my opinion, in the seven authorities in Dublin, there could be a different impact on the rates by the Health Act more than in another. For instance, in one of the authorities which has a large residential area in which middle-class people reside and with many above the middle income group, the impact on the rates will be relatively small. If one takes an area in which great numbers of people in the lower income groups reside then the impact would be very large. Therefore, the joining together of these authorities levels out the charge and makes it follow that an application for a service from a person in one area, having identical income and commitments, will not be refused or accepted in another area as at present.

This is a good arrangement and the point I want to make is that before another decade has passed, the Minister will have to go further and bring other authorities together as he is doing in this Bill. I believe it is quite wrong that outside the scope of this Bill authorities should be in a position that they can do far more for the people of a rich area than for a poor area. I believe the Minister will have to take more steps to bring the whole country into line as he is doing in the case of the major boroughs.

At this late hour, I suggest that the matters which Senator O'Quigley raised in the course of his speech might be dealt with more appropriately on Committee Stage. I shall then perhaps be able to satisfy him that the fears he expressed for the staffs he mentioned are not well founded.

Question put and agreed to.
Committee Stage ordered for April 6th, 1960.
The Seanad adjourned at 10.35 p.m. until 3 p.m. on Wednesday, April 6th, 1960.