Dáil Éireann díospóireacht -
Friday, 20 Feb 1931

Vol. 37 No. 4

Private Deputies' Business. - Public Charitable Hospitals (Temporary Provisions) (Amendment) Bill, 1930—Second Stage.

Dr. O'Dowd

I move that the Public Charitable Hospitals (Temporary Provisions) (Amendment) Bill, 1930, be read a second time. Practically every Deputy in this House is aware that very many of our county hospitals, particularly our county surgical hospitals, are at the present time very poorly equipped, and that because of that handicap they are unable efficiently to perform the work which they are supposed to do. Deputies are also aware that in very many of these hospitals there is not sufficient accommodation for the patients who have to seek treatment there. In many counties in the Saorstát the hospitals are not a separate institution. Everybody who is acquainted with the working of hospitals will admit that to be effective an hospital should be a separate institution. In one case that I have in mind in particular you have the appalling condition that the county surgical hospital is part and parcel of the same institution as the fever hospital, the ordinary county home and the hospital for treatment of medical cases for the sick poor. Everybody will admit that that is an appalling condition and that no county surgeon can efficiently perform his work under conditions such as these.

The intention of this Bill, when introduced, was to provide better equipment for county hospitals, in particular for the county surgical hospitals, and better sanitation and more accommodation for the patients who have to seek treatment there. There are at least eight or nine county hospitals in the Saorstát that are not provided with X-ray equipment. No surgeon can perform his duty properly who has not the advantage of having an X-ray photograph taken of his cases before he is called upon to operate on them. There are at least four or five county hospitals which do not boast of a proper operating theatre. In many of the hospitals the patients are sent out before they should be sent out because there is no accommodation. The beds are wanted for somebody else and the patients are sent out before their time. It is not fair to the patients, and it is not fair to the surgeon who is called upon to treat them. It may be said that Boards of Health should provide such accommodation, such equipment, and better sanitation. We all know notwithstanding assurances to the contrary that there is pretty general depression prevailing at the present time amongst the farming community, and Boards of Health are naturally reluctant to increase their estimates to provide such equipment and more accommodation, and people in the country say they are entitled to secure some of the benefits accruing from the operation of the Public Charitable Hospitals Bill of 1930. They say if any person from the country goes to Dublin for treatment he has to pay two guineas a week in hospital. If he is not able to pay it out of his own pocket the County Board of Health is asked to contribute the two guineas for him. People in the country naturally say that when such a condition of affairs exists the hospitals which they help to maintain should not be the only hospitals that benefit under the Public Charitable Hospitals Bill. They naturally claim, and with a certain amount of right, that they are entitled to something from the Bill which was passed by this House.

I do not want to delay on this question. The Bill speaks for itself, but there is one other matter that I would like to mention. Several times, when speaking on the Local Government Estimate here, Deputies stressed the question of the treatment and care of unmarried mothers. It has been advocated time and again that separate institutions or hospitals should be established at some convenient centre for these people. I submit that if a sum of money were available outside the ordinary revenue of county boards of health, three or four or five county boards of health could co-operate and equip one of the disused workhouses into a hospital for unmarried mothers from three or four counties. These people have to seek shelter at the present time in the ordinary county homes. If that were done, it would redress a grievance which has long called for redress.

In this morning's Press there was an announcement that the Minister for Justice intended to introduce a Bill to provide for the better equipment of surgical hospitals. I expect he has in mind the provision of X-ray equipment where such is not in existence, the provision of proper sanitation, of operation theatres, and the isolation of surgical hospitals. Surgical hospitals should not be in the same buildings as fever hospitals and hospitals for the ordinary sick poor. They certainly should not be in the same building with those who have, through necessitous circumstances, to seek the shelter of the present county homes. The Minister will perhaps find it a bit difficult to define what is a surgical hospital. In many hospitals throughout the Saorstát at the present time obstetrics is not undertaken in the ordinary surgical hospitals. It is undertaken in the ordinary county homes. That is largely due to the fact that there is not sufficient accommodation in the ordinary surgical hospitals. I just merely bring that point to the Minister's notice, that a hospital that undertakes the treatment of obstetrics should be classed as a surgical hospital.

I do not think there is anything further that I have to say on this Bill, except that there may be some who will oppose this Bill because they are opposed to the principle of sweepstakes in general. To these I would say that that would be a poor reason for voting against the Bill. It would be a better and a more proper thing for them to introduce a Bill to repeal the original measure. This is to place hospitals in the country, which never get voluntary subscriptions, so far as I know, which get nothing except what the people pay, on an equal footing with some of the metropolitan hospitals and the hospitals in the larger towns and cities which now derive benefit from the Public Charitable (Hospitals) Act. Those who know the conditions which exist in the county hospitals will admit that it is necessary to provide funds from some outside source or else these hospitals will not be equipped as they should be. Boards of health, unfortunately, do not see their way to involve themselves in further liabilities and increase their estimates to equip these hospitals as they should be, because equipment is pretty expensive, and this House will be doing a good day's work if it passes this Bill and sees that these hospitals get the equipment that they need to carry out their work efficiently and properly.

It may be suggested that these hospitals will get a certain percentage of the moneys made available for hospitals in general under the original Act. If the percentage is sufficiently decent I personally would be quite satisfied. But the suggestion of a percentage would also involve that some one body in the State would have a monopoly in running sweepstakes for hospitals in general, and some way out should be found by which there would be State control of the moneys available under the sweepstakes and the moneys pooled and distributed to the hospitals on a percentage basis by somebody directly under the control of the Minister's Department. If that condition were suggested I would be quite willing to accept it, provided the percentage were a decent one.

Mr. Kennedy

I second the motion.

Minister for Justice (Mr. Fitzgerald-Kenney)

When the Hospitals Bill was first introduced it will be within the recollection of Deputies that I opposed it. I opposed it not because I thought there was anything immoral or wrong in sweepstakes of this nature, but because I considered that inevitably, when the thin end of the wedge was inserted, the wedge would be further and further driven in, until we would have legalised sweepstakes for all classes of objects of a charitable or semi-charitable nature. I am afraid that this Bill, and especially some remarks made by Deputy O'Dowd in introducing it, show that my fears are in very grave danger of realisation. It is suggested in this Bill that every county hospital, county infirmary, district hospital, or other hospital, supported in whole or in part out of poor rates, should be eligible to come under the provisions of this Act. I take it the object of the original Act was this: to supplement the inadequate supply of voluntary subscriptions which were coming in to support hospitals which rely largely upon voluntary subscriptions for maintenance and for carrying out the work upon which they are engaged, namely, affording medical relief to the poor. It is suggested under this Bill that the benefit of the Act should be extended to every State-aided hospital; in other words, that the Act should come to the aid of the local rates. I think that that is a very unsound principle. I think that if we establish sweepstakes for the relief of the general taxpayer or ratepayer we will be embarking upon a very bad financial system. I certainly would hate to see either local revenue or public revenue supplemented by any lottery or sweepstake of any kind or description. Therefore, as this Bill stands, I must ask the House to reject it.

I am not insensible to a great deal of what Deputy O'Dowd says. I am perfectly aware that there are a great number of county hospitals which are not properly equipped. For my part, I would be glad to see portion of the proceeds of these sweeps go towards those infirmaries or county hospitals, provided that it did not go directly to the relief of the rates. There is a need for certain surgical appliances, X-rays and other things, which Deputy O'Dowd mentioned, and I see that these will probably not be provided for years in some county hospitals and not provided at all in other county hospitals. For my part, I would be perfectly willing to see portion of the proceeds of these sweepstakes go simply to the surgical improvement of county hospitals or to their improvement by the building of proper operating theatres or the proper equipment of operating theatres or things of that kind. But for many reasons I would not wish to see that principle extended any further than I have mentioned. Deputy O'Dowd mentioned the possibility of building homes for unmarried mothers. These would not be hospitals at all.

Dr. O'Dowd

I did not suggest the building of them, but the equipping of some of the disused workhouses.

Mr. Fitzgerald-Kenney

The equiping of them for the purpose of establishing homes for unmarried mothers.

That would be travelling completely outside the scope of the original Act and would open the door for the holding of lotteries for every class and sort of work. Moreover, there is a very important matter upon which Deputy O'Dowd hardly touched and that is the question of distribution. For instance, the Dublin Union has got something like 1,800 beds. The largest Dublin hospital participating in this sweepstake, and the largest hospital, in fact, in the City—the Mater Hospital—contains only 412 beds. The next largest is the Cork Street Fever Hospital with 284 beds. The third is the Richmond Hospital with 250. If you distribute the money between the hospitals which are relying upon voluntary subscriptions and the Union Hospital on the basis of beds you would have little left for the voluntary hospitals. Almost everything would go to the Union Hospital. There are a great many other hospitals in the country. If you enlarge the participating hospitals to three or four times the present number there would be practically nothing left for the voluntary hospitals. In my judgment, at any rate, the voluntary hospitals have taken a certain risk of losing subscriptions, and though I do not believe the subscriptions will fall off altogether and I hope there will not be a substantial diminution in the voluntary subscriptions, still I am afraid that the hospitals will find that a great number of persons who used to subscribe to them in the past will cease to subscribe and say "you have got enough out of the sweepstakes scheme and there is no reason why we should give anything further." Therefore, in my opinion, the hospitals have taken a very considerable risk and if they took that risk, and at the same time did not get substantially what they thought they would have got when the scheme was launched, it would hardly be fair to the voluntary hospitals, because I again repeat that in my view, at any rate, it was to make up for inadequacy of voluntary subscriptions that the Dáil consented to the passing of the original Act.

I should like for a moment—because it is really germane to the issue, though it may not just for the moment appear so—to refer very shortly to the working of the present hospitals scheme as shown by the first results. There can be no doubt that the organisation and everything else of that kind in connection with the scheme was marvellously well done. There can be no doubt that the result of the scheme in cash was very much larger than I think anybody in his most sanguine moments could possibly have anticipated. Also, the working of the sweep scheme was so completely fair and above board, so completely above anything in the nature of suspicion, the draw was so public and so excellently carried out, that I believe this hospital scheme is thoroughly well established, and that future schemes which are authorised by this Act, will continue to bring in very substantial sums of money, even though they are now meeting with certain difficulties that I need not enumerate to the House, and also that certain rivals have come into the field against them.

I think, as far as we can see, that the mere collecting of the money has been admirably done. However, the fair distribution of the proceeds among the hospitals is very difficult, and I think, under the present system, will be practically impossible for the future. In the first scheme there was very little difficulty? The hospitals agreed immediately as to the proportion of distribution amongst themselves. There has been more difficulty about the second scheme, and about the third there has been very considerable difficulty in deciding what proportion of the proceeds each hospital should have. It is perfectly obvious that this would be the case, when you had a body of seventy or eighty people representing different hospitals coming together, each naturally and in the ordinary course of human nature, pressing the claims of his own hospital, and considering the needs of his own hospital rather than the needs of the neighbouring hospitals. I am not satisfied myself really that justice to all hospitals by the present method can be done, and my intention is to introduce a measure which will be to this effect: That a small committee should be set up which of necessity would be a committee containing experts, and that those experts should inquire into the eligibility of every individual hospital which wishes to participate in this scheme—that is every hospital a substantial portion of whose revenue was raised before the passing of the Act through voluntary subscriptions. That committee would draw up and submit to me a scheme on the basis of which the proceeds of each sweep available for distribution among the various hospitals, should be divided.

Of course, the distribution would depend upon such considerations as the amount of good work which the hospital is doing, its financial needs, what it is likely to want in the immediate future, how it stands at the present moment, what are its sources of revenue, what equipment or new buildings it might legitimately need— all these things should be inquired into and then a scheme on that basis should be drawn up. The proceeds of the funds available for the hospitals should be paid to that body of trustees, and distributed by them among the various participating voluntary hospitals, as they, in their unfettered discretion, consider to be just. I would suggest, and the Bill that I propose to introduce will suggest, that 75 per cent. of the proceeds of the sweep should go to the hospitals dependant upon voluntary subscriptions, and now in danger of losing those voluntary subscriptions, the hospitals that promoted this Bill, and that the remaining 25 per cent. should go amongst the County Surgical Hospitals in proportion to the population of the counties in which they exist. Otherwise there will be, I foresee, an impossible scramble between the various boards of health, each one claiming so much that it would be impossible to make a division. I think the fairest basis would be to distribute the sum available on a county basis, and then let the county boards of health apply the money that they receive to the improvement of the general equipment of their hospitals.

There are, I know, certain other hospitals and sanatoria which do very excellent work amongst the poor and which now cannot participate in the existing scheme. There is another Bill coming in very shortly dealing with institutions which help tubercular patients. I may as well mention now that, in my judgment, there at any rate are two institutions which do excellent work amongst tubercular patients. One is the Cappagh institution and the other is the new village scheme at Peamount. Both those are doing very good work of an hospital nature. I think it is quite possible that schemes like those should be included amongst the bodies which are entitled to receive portion of the proceeds of the 75 per cent. which will be available to voluntary hospitals. There may be others of a like nature, and when the Bill comes before the House they can either be included under a certain class or be included in a schedule to the Bill by name.

I have roughly outlined what particular amendments I consider that this Hospitals Bill at the moment requires. I do not profess to give the House any details. I would suggest to the House that discussion on both these Bills would remain until the actual Bill in completed form would be before the House for consideration. I want to make it clear that on general principle money in aid of the public revenue or in aid of the local rates should not be raised by lottery or by sweepstakes. I stand firm on that, and I think I am standing on very firm and sound ground indeed.

Mr. Kennedy

When the first lottery was being run for the Hospitals Sweep certain people wrote to the papers that this was an excellent method of doing away with direct taxation and raising revenue for the State. The Minister for Justice seems to be under some delusion about the enormous amount left after paying the prizes. The Minister seems to have a very poor opinion about county institutions of all kinds. He seems to have been bitten by Dublinmania. He seems to be of opinion that nothing outside Dublin is any good.

Mr. Fitzgerald-Kenney

The Deputy is probably not aware that a number of voluntary hospitals outside Dublin are participating in the Sweepstake. They have nothing to do with Dublin.

Mr. Kennedy

They are very few.

Mr. Fitzgerald-Kenney

I beg your pardon, they are not few.

Mr. Kennedy

The Minister referred to the fact that a number of county hospitals, county infirmaries or district hospitals were sustained out of the rates and there was nothing voluntary about them. I wonder is he aware that in a great number of cases special wards were constructed out of charitable donations, that wireless was installed, and that gifts of clothing to the patients were given. In one particular case I know that an X-ray plant was installed. There is one in Mullingar, one of the best in Ireland, which cost some thousands of pounds. That was installed by voluntary subscription. These hospitals served the poor, and they saved the county the expense of sending the poor up to the Dublin hospitals in the case of certain diseases at great risk. They have saved a great deal to the ratepayers in the cost of maintenance of those patients in the Dublin hospitals.

The Minister made the best case for this Bill when he indicated that in the South Dublin Union there were 1,800 beds, while in the biggest of the voluntary hospitals there were only 400 beds. I contend that through the medium of large voluntary subscriptions we were able to supply equipment of various kinds to these institutions. That equipment was of an up-to-date kind for the treatment of the poor, but the Minister said that he was afraid this money would be used towards the relief of the rates. Our contention is that in the present state of the country and as we anticipate in the state of the country for a number of years to come, no county board of health or county infirmary committee will be able to undertake the equipment which is so very necessary in these county and district hospitals and county infirmaries.

Mr. Fitzgerald-Kenney

That is the reason I propose that they should get 25 per cent of the proceeds.

Mr. Kennedy

When the Minister proposed that they should get 25 per cent. of the proceeds, he did not indicate to us when he was introducing the Bill.

Mr. Fitzgerald-Kenney

Almost immediately. The Bill will be in force before the next sweepstake.

Mr. Kennedy

Before the Derby?

Mr. Fitzgerald-Kenney

Oh, yes, but I presume the next sweepstake will start very soon after the existing one. The Bill will be in force before the middle of May.

Mr. Kennedy

When the Minister is introducing that Bill I suggest that he should make provision for at least 33? per cent. of the proceeds of these sweepstakes to go to the hospitals. If the Minister will understand me, what I want him to do is to make—

Mr. Fitzgerald-Kenney

Would it not be better to debate that on the Bill itself?

Mr. Kennedy

I suggest to the Minister that he would draft the Bill so that at least one-third of the proceeds would go to the hospitals. Then I would further suggest to him that with a view to a larger number of patients in the county hospitals, county infirmaries and district hospitals that at least 33? per cent., or one-third of the money available, should go to these institutions apart from the voluntary hospitals. The installation of special surgical equipment and the setting up of an operating theatre, which I understand from the Minister will come within the scope of the proposed Bill, are two things which will save thousands of pounds to the ratepayers. These things will save the sending up of patients to the Dublin hospitals.

Dr. Hennessy

I suppose I am correct in assuming from the Minister's statement that he is ready to introduce a Government Bill on the lines that he has now indicated. I think the sum that he has mentioned to be diverted from voluntary hospitals is on the high side. At the same time if there could be an agreed Bill put through the House as quickly as possible I think it would be better for all interests concerned and I would ask Deputy O'Dowd in the event of a satisfactory answer from the Minister that he would withdraw his Bill. In the circumstances I would also be ready to withdraw at a later stage item No. 12 on the Order Paper.

Professor Thrift

I think the Minister is quite right in his statement that there are other hospitals doing special work and that these hospitals are at present precluded from participating in the sweepstake. Would the Minister be prepared to receive representations from such hospitals immediately with the view of trying to include them?

Mr. Fitzgerald-Kenney

Oh, yes.

Professor Thrift

I know there are such hospitals.

Captain Redmond

Do I understand the Minister to mean in the course of the discussion, that within the purview of the Bill he intends to introduce, it will be possible to discuss and determine not only the amounts which are to be allocated amongst the hospitals that are to participate in the sweepstake but also that of the total sum of the takings of the sweepstake a certain proportion will be allocated to the hospitals.

Mr. Fitzgerald-Kenney

I presume it would be possible to debate that. My own impression is that it would be much better to let the promoters bear the responsibilities. You could not very well work out in the House the details of a scheme and I think it is better to leave that matter to a specially selected Committee. That Committee would be elected by the hospitals and they would make the best bargain they could on behalf of the hospitals. Of course it is quite on the cards that, by increasing the proportion of the total sweep money that the hospitals will get, you might really be getting a smaller sum for the hospitals; that is to say, there is a limit to which you can cut down the attractiveness of the scheme. The hospitals under the present scheme are getting 25 per cent. of the total proceeds.

Captain Redmond

I quite follow what the Minister says, but at the same time I think it is generally agreed throughout the country that a larger proportion of the sum raised could have been given to the hospitals and that practically not one penny piece less would have been subscribed by any of the purchasers of tickets if the prizes had been considerably less than they were. I cannot conceive a person purchasing a ten shilling ticket in the hope of getting £200,000 who would not equally purchase a ticket in the hope of getting £100,000 or even £50,000.

Mr. Fitzgerald-Kenney

The point is that a person will buy a ticket knowing that a certain proportion of the money accumulated in the sale of tickets, whatever it may be, is going to be divided; but if a person thinks that only one-third of the total amount subscribed will be given in prizes, then there are other sweeps that would be much more attractive and that person might not dream of investing in Irish sweepstakes. That is my individual view.

Professor Thrift

In point of fact, will they not get more than 25 per cent. after the necessary sum has been allocated for expenses?

Mr. Fitzgerald-Kenney

The sum allocated for expenses comes out of one fund. I think that the persons who buy tickets have got rights and some one should look after and safeguard the general interests of the purchasing public. There are people all over the world who buy tickets and we should see to it in our scheme that we are not a sort of grab-all people but that the persons who buy tickets shall get a very fair deal from us. I think almost everybody in the House will agree with me in that matter.

Dr. O'Dowd

In view of the Minister's statement, I desire, with the permission of the House, to withdraw my Bill. I would like to point out to the Minister that the Bill he has referred to should be introduced as quickly as possible. I am sure, as it will be more or less an agreed measure, that it could be put through all its stages rapidly. It is expected that the biggest sweepstake that will be run under the present Act will be the sweep on this year's Derby. The scheme in connection with that race has been submitted, but I understand it has not yet been sanctioned. I would like the Minister to introduce his Bill in a very short time so that we can make the improvements in the hospitals that require improvements.

Mr. Fitzgerald-Kenney

I may say the scheme is settled, but there are two hospitals the accounts in connection with which have not been submitted for the last financial year, and for that reason there has been a hold-up. The audited accounts of these hospitals have not been lodged, but apart from that the whole scheme has been settled; it is only waiting for formal sanction when these balance sheets which, I presume, will be correct, are lodged. If they are not correct the scheme will have to be reconsidered.

Dr. O'Dowd

I suppose we can take it that the promised Bill will be put through the House in time to have those hospitals to which we are referring included in the next sweep?

Mr. Fitzgerald-Kenney

Yes. Not only do I want to have the Bill put through all its stages, but I would like that the committee I propose to set up would have some little time to consider various proposals before the scheme is finally arranged. They could not actually make a distribution until the money is got in, but they ought to be in a position to examine the accounts of the hospitals fully. It is not heavy work, but still they should have time to do it.

Dr. O'Dowd

I thoroughly agree with the Minister in his statement on the question of distribution, and I suggest that these hospitals who have already got advantages out of these sweepstakes, should now abstain from seeking benefits out of future sweepstake schemes until such time as other hospitals will be given a chance, and if they do not do this voluntarily they should be made to do so compulsorily.

Mr. Fitzgerald-Kenney

That should be one of the matters the committee should carefully consider. If a hospital has already got substantial benefits from these schemes and has sufficient money to carry on with, but simply wants money to bank up and put on deposit receipt, I do not think such hospitals should be allowed to participate. If a hospital wants to get things which could hardly be considered strictly hospital work, I think such hospitals should have their claims postponed until the hospitals that require the money for the improvement of the condition of their patients are satisfied. All these are matters of an expert nature, and I think it would require a small impartial body to examine into the structural needs of the hospitals and matters of that nature.

Dr. O'Dowd

With the permission of the House, I beg to withdraw the Bill.

Bill, by leave, withdrawn.