I beg to move:—
To delete the section and to substitute a new section as follows:
(1) For the purpose of giving advice and assistance to the Minister in connection with the exercise and performance of his powers and duties in matters affecting or incidental to the health of the people there shall be established a public health council.
(2) The public health council shall consist of the following persons:—Eight persons representing boards of health, appointed by the Minister after consultation with such boards or a representative association thereof: Four persons representing councils of county boroughs, appointed by the Minister after consultation with such councils: Three persons being registered medical practitioners, appointed by the Minister after consultation with organisations of such practitioners, at least two of such persons being registered on the medical register in respect of a diploma in sanitary science, public health, or State medicine: One person being a registered dentist, appointed by the Minister so as to represent such dentists after consultation with any association thereof: One person being a registered veterinary surgeon, appointed by the Minister so as to represent such surgeons after consultation with any association thereof: Two persons representing registered nurses, appointed by the Minister after consultation with association thereof: Two persons representing certified midwives, appointed by the Minister after consultation with associations thereof.
(3) The Minister may make regulations for the purpose of increasing the membership of the public health council so as to provide for the representation of insured persons or of approved societies under the National Health Insurance Acts, 1911 to 1924, or any Act amending those Acts.
(4) The public health council shall meet at least twice in every year for the purpose of considering matters of public interest in connection with the health of the people and giving such advice to the Minister thereon as he shall think fit.
(5) The Minister may make general regulations for regulating the proceedings and quorum of the public health council, and the council shall act in accordance with those regulations.
(6) The Minister shall be ex officio a member of the public health council, but shall not, save as hereinafter provided, vote at any meeting of the council.
(7) The Minister may take the chair at any meeting of the public health council and in such case shall have a casting vote.
(8) In the absence of the Minister, an officer of the Minister appointed by him may attend a meeting of the public health council.
(9) The Minister may require any of his officers to act as secretary or other officer of the public health council.
(10) The public health council may appoint committees consisting of members of the council or of members and other persons for the purpose of considering matters referred to such committees by the council.
(11) Payments may be made by the Minister, out of moneys provided by the Oireachtas, to members of the public health council and committees thereof, to such extent as may be sanctioned by the Minister for Finance, in respect of the following matters, that is to say:—
(a) repayment of travelling expenses.
(b) payment of subsistence allowance.
(c) reasonable compensation for loss of remunerative time.
Section 17 gives power to the Minister to establish consultative councils in connection with such matters affecting, or incidental to, the health of the people as may be specified in the order. Every consultative council established under this section consists of persons having practical experience as to the matter in respect of which they are to give advice or assistance. A few moments ago the Minister indicated what he meant when he asked for power to establish consultative councils. A specific evil is present and he wishes to establish a consultative council to advise him with respect to that specific evil. That is very good, but I do not think that the Minister, when proposing to get these powers, is meeting the requirements of the case to any appreciable degree. The proposal is that the Minister may appoint such a council to deal with specific subjects, to be constituted in any way he pleases. It is not intended that these councils should have initiative. They shall not be required to consider subjects for suggestion or submission to the Minister. It is presumably intended that a council should be formed ad hoc to deal with specific matters referred to them by the Minister. The Public Health Council that was set up some years ago made a report which was, I think, a very valuable one in many respects. That body reported in favour of the establishment of a health council to advise the Ministry generally respecting all matters affecting public health. The recommendation was: “The formation within the Ministry of a health council composed of representatives of public and professional interests, to which will be entrusted the general direction of policy in regard to the administration of medical and health services in Ireland.” The body that made that recommendation was a body of very experienced and responsible persons. It included the Medical Commissioner of the Local Government Board, Dr. Coey Biggar, Sir Henry Robinson, Sir Joseph Glynn, Dr. Maguire, Mrs. Dickie, Dr. Rowlette, and several others, and it was a very carefully considered and well thought out report. In one or two respects it is out of date, inasmuch as we have now a definite Ministry of Public Health, but there is still required a body such as a public health council, which will be permanently in existence to advise generally and inspire, if I might say so, the public health side of the Minister's work.
We must bear in mind that the Minister is a Minister not only of public health. His functions are very much wider than the mere consideration of public health and medical affairs, and it was believed by that council, and I believe that it would add very greatly to the prestige and authority of his Department, on the public health side, if there was in existence a council of the kind that is proposed in the amendment. Within that council, or from that council, there may well be selected consultative committees to deal with specific matters that may be referred to them by the Minister, such as are touched upon in this section. But much more than that is needed. There was some difference of opinion on the part of this committee that made its report in 1920 respecting the internal organisation of the Ministry of Public Health, but there was no difference of opinion amongst these fifteen or twenty persons, of long experience and a good deal of responsibility, in respect to the necessity for a health council, and giving that council considerable powers, not, let me say, depriving the Minister of his powers and his responsibility, but a council advisory and fitting in with the scheme of government which we have adopted, and yet a body which might be looked upon by the Minister as capable of giving him authoritative advice and expert direction.
The proposals in the amendment are that such council shall be somewhat different from the proposals in the report of the Public Health Council, set up in 1920. The proposals in the amendment follow the plan somewhat of the late Council of Agriculture, and the composition is somewhat different from the composition recommended by the Public Health Council, or as represented by Deputy Sir James Craig. We make provision for eight representatives of the boards of health, four representatives of the county boroughs which are outside the county health districts, three of them to be representatives of the medical profession, one of the dental profession, one of the veterinary surgeons, one of the nurses, perhaps one of the midwives, and leaving open the question of the representation of health insurance societies, inasmuch as there is sitting a committee which presumably will report upon the relations of the health insurance societies to the Ministry of Health. It may be desirable that there should be representatives of the health insurance societies upon any public health council.
There is not at present anybody or any authority, except the Minister himself, which might be said to be a unifying, co-relating, or stimulating authority in matters of public health. As I said, the Minister has very much wider responsibilities than the supervision of public health. No doubt he has expert advisers, but the expert advisers are unknown to the public; they cannot speak with the same authority as an advisory council of the kind that is referred to in the amendment, and they cannot stimulate or educate public opinion in the same way that such a council would. I would suggest for the consideration of the Minister and the House that is a very important part indeed of the work of public health administration, the interesting of the public in matters of public health and getting the consent, approval and co-operation of the public in the administration of public health laws. When a proposal comes out from the Minister on the advice of his expert representatives, who may or may not be known to the public — in the main are not known to the public — it will not have the same force as a proposal of the kind would if it were backed by a council of this kind. If there is a council representative of all the interests whose business it is to promote public health, to prevent disease, advising the Minister, stimulating public action, creating public opinion — and shall I say?—directing public policy in respect of health affairs, the hope of general co-operation will be very much the greater and it will more likely be realised than if there is no such council. If there is any fear that the creation of a council of this kind will cut across Ministerial responsibilities I think that fear may be dispelled.
The proposal in the amendment would not at all deprive the Minister of his powers and responsibility, but the council would be empowered to consider proposals, schemes and plans on their own initiative, and make those proposals to the Minister. If he thought well to incorporate them into administrative action or into legislation he would have immensely more authority, both with the public and the legislature, than he could have without such a body. The intention of the amendment is that such a council shall meet twice a year at least, and that the Minister would preside at such conferences. I think that the proposal is one which will add very greatly to the Bill and give a good deal more confidence in public health administration in the future, and will inspire the public, I think, with a desire to assist in that administration and co-operate in the general work of public health. I commend this proposal to the Dáil as a better one than the proposal in the Bill, one which would not necessarily cost more money, perhaps would cost less money, if there are to be many consultative councils set up. I would say that the extra cost, if there is to be such, would be very well repaid in value received. Consultative councils or consultative committees, as I have said already, for specific purposes, can still be appointed, and are likely to be much more satisfactory if appointed from or by this council than by the manner set out in the section. I would ask the Dáil to give fair consideration to the proposal, and eventually, I hope, to embody it in the Bill.