I move:—"That a sum not exceeding £4,738 be granted to complete the sum necessary to complete the charge which will come in the course of payment during the year ending on the 31st March, 1925, to pay the charges connected with hospitals and infirmaries and certain miscellaneous, charitable, and other allowances, including sundry grants-in-aid."
COMMITTEE ON FINANCE. - VOTE 41—HOSPITALS AND CHARITIES.
I should like to bear some tribute to the good work done by the hospitals receiving this State grant. I do, however, intend to suggest to the Minister that one of these hospitals might be abolished, that is, the Lock Hospital, which is receiving £2,600 and which is working undoubtedly entirely upon this grant. I think I could give good and sufficient reasons to show that it might very advantageously be abolished, as its work could be done in one of the other institutions at least in the city where we have 100 beds available. Not more than 20 or 25 beds are occupied for the treatment of this particular disease, as practically it is out-patient treatment that is required in most cases and only about 5 per cent. perhaps require intern treatment. This institution has a matron and a secretary and all the paraphernalia of an hospital, whereas the out-patient work could be done equally as well at a general hospital as it is undoubtedly being done well in the Lock Hospital. The only argument I have been able to find against the abolition of this hospital is that if a certain class of patients treated there were to be treated in a general hospital in this particular department it might prevent married women and others who are there for that class of treatment from coming to the hospital, and I would like to suggest to the Minister that it might be worth his while to ask the superintendents of the Dublin hospitals to give him a report on this matter and see if it would not be possible to abolish it. So far as I know, no such institution exists in either Belfast or Cork, and I do not know that such an institution is a credit to the city of Dublin.
I want to go further than Deputy Sir J. Craig and to consider this whole question on a general and broader basis. I do not think anybody will quarrel with the principle of State aid to hospitals, but I do think that the manner in which the State aid is applied is open to reconsideration and possibly, to revision. We are told that these grants which we are now voting were recommended by a committee of the House of Commons in 1854, and by a commission in 1855. That is a very considerable time ago. The Ministers were not alive then. I was not alive and even my father was not alive when these grants were voted. During that time circumstances have altered, just as Deputy Sir James Craig says the circumstances of one particular hospital have altered. I think that the circumstances of other Dublin hospitals, which do not receive these grants, have also altered. I am the Governor of an hospital which has an endowment which, probably, in 1854 and in 1855, at the prices then prevailing, was a sufficient and adequate endowment, but which is now struggling with considerable difficulties. I would suggest that the time is ripe for the appointment of another commission, and that instead of Deputy Sir James Craig bringing his evidence before the Minister that a small Commission might well be appointed to consider all the circumstances of the hospitals in Dublin. I say hospitals in Dublin and not Dublin hospitals, because they serve practically the whole of the State—all the provincial counties—I do not know what Cork does or Limerick, but the patients in Dublin hospitals do not come from Dublin alone. They come from practically every county in the Saorstát, and in the case of one hospital they certainly come from the Six Counties as well. That being so, I think that, without alarming the Minister for Finance in suggesting that this grant of £15,850 should be increased, we might reasonably argue that the distribution might be reviewed and reconsidered, and that a small Commission composed of people versed in the matter might go into the whole case for the Dublin hospitals. Dublin is full of comparatively small hospitals which are worked on the whole uneconomically. A common purchasing Board for the Dublin hospitals would probably be very advantageous. There is a prestige and pride in one's own hospital that one would not wish to destroy. I think the hospitals should preserve their separate existence. Some system of grouping and specialising, so that certain hospitals could be used for certain diseases, might be devised, but the buying of the common necessities, food, stores and so on, that are needed for them might be done more economically if it were done on a large scale. All these points are points that we could not well consider here just as we cannot consider here the merits of one hospital as compared with another, but I think that some consideration by a Commission, or if necessary by a Departmental Committee—not a very large body—that would work quickly and report quickly, would be to the advantage not only of the State but of the hospitals themselves and of the sick to whom they minister.
I think it is rather difficult to understand on what lines these particular grants have been allocated. I agree with Deputy Cooper when he says that it would seem as if re-consideration of the whole of this grant was a bit overdue. On the question of the hospitals in Dublin the man in the street thinks that there are too many hospitals for the size of the place. No doubt, there are arguments against that, but on this Vote I think the matter is worthy of consideration. Deputy Sir James Craig has raised a question about the necessity of maintaining a very small hospital in Townsend Street, Dublin, which is entirely supported by the Government grant. It does not seem to be run very economically or to be very necessary for the type of work it carries out.
There is just one question I would like to raise in reference to the hospitals. It is pretty well known that the hospitals are one of the chief means of educating doctors and perhaps this may not be an inopportune moment to be informed in some official way of the position regarding medical practitioners in view of the statements made by the President of the medical council. Perhaps it may not be out of order to ask that some indication might be made as to the position.
What position?
The position of doctors or those trained in these hospitals and going in for examinations.
No, that question cannot be raised now.
On the last occasion on which this Vote was before the Dáil I suggested what Deputy Cooper suggested this evening, that the time had come when the matter should be enquired into by a Commission. I pointed out that there were 28 or 29 hospitals in Dublin, not counting the mental hospitals, the convalescent hospitals and other classes of hospitals, as well as the hospitals in Blackrock or Monkstown. These would have to come into a scheme, if there was to be a reconsideration of the amount to be distributed. I could not speak very strongly upon the matter because the hospital I am attached to receives no grant from the State, and therefore it might be felt that I was fighting the matter and was jealous of the other hospitals that get the grant. I do not take up that attitude at all. There is another point that I urge very strongly upon the Ministry and it is that the Government should get some control over the establishment of new hospitals. I pointed out what was a very true fact, that anyone who was dissatisfied with an hospital which refused to appoint him could start an hospital of his own. He gets a small committee gathered around him and after a time he can appeal, not only for public funds to support this hospital, but for other funds from the State. There is no controlling influence whatsoever over those hospitals except what is known as the Hospital Sunday Fund Committee. This Hospital Sunday Fund Committee, of which I am a member, discovered in looking through the figures that one hospital was putting down £180 as the cost per bed, and that a similar hospital situated on exactly similar lines was cosing only £60 per bed.
Some excuse or reason had to be given for this great discrepancy, but no real reason was ever given. These two hospitals were each relying on the public for funds to support them, and they were each receiving a Corporation grant. As I say, I would be very pleased indeed if the Government were able to institute some sort of control. I remember mentioning, when I spoke about the institution of a new system of public health, that the Minister for Health should take under his control the Dublin hospitals, and exercise some sort of supervision over them, but if the Minister appoints a Commission to inquire into this matter and hear the evidence from 25 or 30 hospitals that would want to be brought into the scheme it would be a good thing.
This question of the grants is a rather peculiar one. Some of these grants go beyond the Act of Union, and they have been granted in the most arbitrary and most irregular way. I am quite willing at the earliest opportunity to go into the question of all these grants, and see that they are put on a sounder and more equitable footing. These grants have only recently come under our Department. They were formerly under the Chief Secretary, and not under the Local Government Board. I agree, as a layman, with Deputy Sir James Craig's point of view, and with Deputy Cooper, but I consider that this matter will have to be considered by a Committee. It is very technical and only a body of medical men, and people with training in hospital work, would be competent to express an opinion on this matter. It is really an ideal case to be left to that Consultative Council which is to be established under our Bill. I hope the Deputies will take this as an additional argument in favour of hurrying through with the Bill as soon as possible.
The Minister cannot advocate legislation at this Stage.
No matter what you say now you are told about the Bill.
Motion put and agreed to.