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Dáil Éireann díospóireacht -
Thursday, 24 May 1928

Vol. 23 No. 17

IN COMMITTEE ON FINANCE. - VOTE 44—HOSPITALS AND INFIRMARIES.

I move:—

Go ndeontar suim ná raghaidh thar £1,228 chun slánuithe na suime is gá chun íoctha an Mhuirir a thiocfidh chun bheith iníoctha i rith na bliana dar críoch an 31adh lá de Mhárta, 1929, chun Eilithe mar gheall ar Ospidéil agus Otharlanna maraon le hIldeontaisí i gCabhair.

That a sum not exceeding £1,228 be granted to complete the sum necessary to defray the Charge which will come in course of payment during the year ending on the 31st day of March, 1929, for charges connected with Hospitals and Infirmaries, including sundry Grants-in-Aid.

There are old grants to hospitals under existing statutes. They were originally given in accordance with the recommendations of a Committee of the House of Commons in 1854 and a Commission of 1855. Some of the hospitals have, in fact, received this grant of public money as far back as the eighteenth century.

It seems to me strange that this Vote should come up here in this fashion. Looking over the debates of former years, I find that in 1925 a promise was made by the Minister for Local Government and Public Health that a Commission or Committee of Inquiry—I think he called it a Consultative Committee—would be set up to examine this grant to hospitals and infirmaries. It was realised then that in the selection of these particular hospitals for grants something in the nature of favouritism was associated with them. Now we know that this House is not responsible for this list or for the amounts in this list. As the Minister has said, these grants were arranged for under recommendations by a British House of Commons Committee 70 years ago or more, and they have been granted these moneys from year to year since in accordance with these recommendations.

But this House has now been some years in existence, and while we would not expect that in the first year or two they would have time to look into everything, especially small matters of this kind—and this is a small matter— nevertheless when a promise was made three years ago, when this Estimate was up for consideration, by the Minister, who definitely stated that the matter would be looked into and a committee set up to see if some redistribution of these amounts might not be made. I would like to know why such a promise was not kept. I would not like to see these grants taken away from these particular hospitals. If we can afford it, I would like to see the grant increased, not alone to these hospitals, but to many other hospitals in Dublin and many other places in different parts of the country. The hospitals here selected are: Westmorland Lock Hospital, Rotunda Lying-in Hospital, Coombe Lying-in Hospital, House of Industry Hospitals, Cork Street Fever Hospital, Meath Hospital, Royal Victoria Eye and Ear Hospital, Dr. Steevens' Hospital, and the Royal Hospital for Incurables. These are all doing good work. There is no doubt in the world about that. But I believe that these grants were made to these hospitals under the opinion perhaps that these and most of the other hospitals that were then in existence were doing free work and giving free medical aid to the poorest section of the community. They are not giving that free medical assistance to the same extent now—either these or the other hospitals not included in the list. The poor do not get, to the same extent, the medical attendance free from these hospitals that they used to get. And that applies not alone to these hospitals, but all round, and that is owing to the subject we have been discussing just now, the National Health Insurance. There is something paid now in the vast majority of cases by the patients in these hospitals. In the majority of cases people cannot pay the full amount for their keep and medical attendance, but they do pay something.

I think it is time that an inquiry of some kind should be made into this Vote, and if there could be a redistribution on a fair basis all round amongst the hospitals that are doing work similar to what these hospitals have been doing in the past and are still continuing to do, it would be very welcome. These hospitals have been giving medical attendance to the poor and, in particular, to that element of the poor that is so poor that it cannot afford to pay anything. I do think such hospitals should be generously treated so far as our purse will allow. I made up my mind that the matter would not go without protest from me. I think this grant, as at present arranged under this recommendation of 1854 should not be continued from year to year; there should be a full consideration of the position and a redistribution on a fair basis. I want to be fair all round, and I think this House would like to be fair all round. There certainly has been time within the last three years to make investigation into this matter. I do not want to challenge the Vote in a matter of this kind. The least we expect is that before this Estimate comes up again all this matter will have been inquired into and the whole subject brought before the House so that a redistribution may be made.

I am glad Deputy O'Kelly reminded the Minister of his predecessor's promise, because I had intended doing so. The year 1855 is not so very fresh in the memory of any Deputy except, perhaps, Deputy Sheehy. It is more or less obvious from the figures given in the Estimates that the conditions have changed substantially since that early period. These figures, particularly the figures showing the estimated expenditure of the different hospitals, present a variety of anomalies. There is the Coombe Lying-in Hospital, which I will take as an example. It is in one of the poorest districts of Dublin and it is doing very valuable work. That hospital receives just about two and a half per cent. of its total estimated expenditure. On the other hand, as regards the House of Industry Hospitals, I do not know what they are or where they are. The only House of industry I know is the Dáil, and I do not know that there is any hospital connected with it at present. They get no less than 38 per cent. of the total estimated expenditure.

Let us take the last two on the list. Dr. Steevens' Hospital has a deficiency of income of £4,600, and, towards that deficiency we give £1,300. The Royal Hospital for Incurables has a deficiency of £5,780 and we only give them £250. It is obvious that the conditions have altered since the Committee of the House of Commons of 1854 and the Commission of 1855 made their recommendations. The most startling case is the Cork Street Fever Hospital. I would like to say the Cork very quietly and the Street very loudly, for fear any Deputy would be afraid that I wanted to extract money for the Southern metropolis. In fact, in this connection I believe that this particular street was so named in the hope that the Corkmen whom some unkind fate compelled to reside temporarily in the Metropolis would come and live there, but, unfortunately, the supply of Corkmen was not equal to the demand, and premises became vacant there and they were converted into a hospital. The hospital has an estimated deficiency of income of just about £1,800—£1,782 to be very correct. To make up that deficiency of income we give them £2,500. Cork Street Hospital is living, I must say, most admirably up to its name, and it succeeds in making £700 a year. I do not want to prejudge the case before the Committee. It is quite possible that the £700 a year is paying off a deficit created before 1855.

There certainly does appear to be a case for inquiry by a Committee into this payment and also, as Deputy O'Kelly said, into the position of other Dublin hospitals doing equally valuable work. There are some hospitals that have small endowments. No doubt the fact that they had endowments was held to rule them out of consideration by the House of Commons Committee. But these endowments are not worth now what they were worth in 1854 and 1855. There are, to my certain knowledge, hospitals doing useful and valuable work that would have a claim to appear before the Commission and submit a case. They might possibly be found equally deserving of State support, just as much as any of the hospitals that appear on this list here. I would urge the Minister to fulfil his predecessor's pledge and set up either a Departmental Committee, a Commission, or a Committee of the Dáil. I am quite certain that we would get fair treatment from any one of them. I think there is a case for inquiry, because 1928 is not 1855. I do not suggest that we should reject this Estimate. Obviously the hospitals rely on the receipt of this money, and they should have very full notice and fair warning before we alter the amount paid to them—increase or decrease it. It is really a case for setting up a Committee to go into the whole matter de novo, particularly from the point of view of the circumstances in which we are living and the circumstances in which our grandfathers lived.

There is one rather peculiar and conspicuous fact about this whole grant. We are honestly living in a most peculiar age. We have had five, six or seven years with Parliament under the full control of the Irish people, and here we are to-day accepting something that was handed down to us since 1854. The one most extraordinary fact—and I am certainly not going to be branded as a bigot in any sense of the word—is that there is not an institution amongst those to which we are about to give the grants-in-aid that is controlled by the religion of the Irish people. Also, the whole grants are confined within the City of Dublin. Certainly Dublin is not Ireland, nor is it the Free State. There are certain hospitals equally as well equipped throughout the rest of Ireland as we have in this little city that even, at the present moment, they are attempting to make greater than it is. We are perfectly satisfied with our own, but I think there are institutions outside Dublin that should be considered in a Vote of this kind, particularly when the payments are made out of the revenue of the nation. I would recommend to the Minister for Local Government and Public Health that the sooner he would change the allocation of this particular amount the better in order to suit the wishes of the Irish people. I am not going to press my first point, but I think it is a really peculiar fact, and it should be changed as soon as possible.

I would prefer that this nation would subsidise hospitals provided that they were institutions prepared to publish balance sheets and ready to receive poor people and those who are able only partially to subscribe towards their treatment. It would also come well within the Ministry's purview to consider whether local bodies should subscribe, and that the nation should take, more or less, the whole burden, even if it meant legislation and the striking of a new rate for the purpose. I am not going into that matter now, because I am afraid I would be ruled out. The point I want to get at is that it is not fair to ask the Dáil to pass any grant originated by people who never understood Ireland. We are asked to vote money on a recommendation made by a Commission of the British House of Commons in 1854. That explains the mentality of this House at the present moment.

We are dealing with that, not only upon this Estimate, but we dealt with it also on the last Estimate. This is a grant to hospitals in Ireland, but there is not a hospital in it outside Dublin. Let it be said that this is a grant to the Dublin hospitals and then we will understand it. We have in Ireland more modern hospitals outside Dublin than in the City of Dublin.

This is an estimate for £16,228. I think the reaction on Deputy French is probably to the reference to the British House of Commons, because the fact really is that we are discussing a continuance of this grant to nine hospitals in the City of Dublin, whose whole economy, during the last eighty years at any rate, has, to a certain extent, centred around the fact that whether the grant is a big or a small grant they get it each year. With the exception of one or two, there is not a single one of these hospitals, even though the grant reaches them, that has not a deficit. There is one that the grant leaves without a deficit. That is a hospital that discharges very valuable functions in the city in connection with infectious diseases, and we may leave that aside; but there are eight other hospitals ministering in the city, and the grant affects very materially their economy, and they have had it for the last eighty years or so.

I do not know what undertaking may have been given by my predecessor in connection with this matter, but what I feel very much myself in connection with it is that it would be rather unreasonable to propose to withdraw this grant from those hospitals that already, over and above the grants, have a deficit. If you set up a committee to inquire into what are going to do with this £16,000, you are going to find it very difficult to get out of any such inquiry without being forced, in one way or another, to open the State purse very much more towards the upkeep generally of hospitals. I think that if the question of State grants to hospitals is to be opened up at all it ought to be opened up in a general way; but owing to the amount of money involved and the traditions of these particular hospitals, I feel very reluctant, personally, to do anything but to recommend to the House the continuance of this grant.

The point I was suggesting was: Could not, for instance, a Deputy for Mayo establish a case for a hospital in Mayo as fairly as the Minister tries to establish a case for these particular hospitals?

He could, but the Deputy here is confusing the discharge of national duties to Mayo in present-day circumstances. None of these hospitals is in a very flourishing condition. They show a very definite deficit, and they are traditionally entitled to this particular grant. There is a kind of Statute of Limitations which, it will be agreed, has arisen in connection with their claim to it, but the idea of sitting down to discuss the taking away of £700 from a hospital with a deficit of £1,100, and so on, I must say, does not appeal to me.

If the Minister is convinced, on his own argument, that the Westmorland Lock Hospital, the Rotunda Hospital, the Coombe Lying-in Hospital, and the Houses of Industry have failed financially, it strikes me that there is a greater service for the particular area than is necessary. The City of Dublin has a particular obligation to support the Dublin Union, formerly the North and South Unions. Along with that there is handed down to us a sort of hospital expenditure from sources that never catered for the Irish people, for whom we are interested to minister. I am not really grumbling about the £16,000 being expended, but it is a strange fact that a certain number of institutions of a peculiar nature are subsidised out of national funds and that this should be handed down to this House, so that we are asked every year to pass this sum without considering any other part of the country. I, personally, would honestly prefer that the Minister would ask for this grant of £16,000 to equip the Dublin Union with a modern hospital for the service of the city poor. I strongly object to pass this Vote with out an assurance that the whole thing is absolutely necessary, and that the Irish people, of all religions, are getting fair treatment from these hospitals. This matter comes down to us from the English House of Commons since 1854, and that is sufficient to make me suspect it unless I have a definite assurance that it is absolutely straight and above board. I believe we have a responsibility for the Dublin Union, and ought only to give voluntary subscriptions to other hospitals outside. This Vote is a voluntary contribution by the English Parliament to certain institutions in Ireland. I am not going to agree to pass that until I know where I am. It is the primary duty today of this Dáil to look after the Dublin Union, and after that we can consider giving charitable donations to other institutions which we believe will give reasonable treatment to every citizen irrespective of every other consideration.

Question put and agreed to.
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