I propose to take amendments 1 and 2 together and to put the question:—
"That the words `three-fourths' stand."
Financial Resolutions. - Public Charitable Hospitals (Amendment) Bill, 1931.—Report.
I move:—
"In page 3, Section 5, lines 33, 39, 50 and 54, to delete the words `three-fourths' and substitute in each line the words `sixty per cent'."
As Deputies are aware, under the Bill as it stands 75 per cent. of the divisible proceeds goes to the voluntary hospitals, and 25 per cent. to the county hospitals. The effect of the amendment would be to devote 40 per cent. to the county hospitals and 60 per cent. to the voluntary hospitals. It is calculated by some of the Deputies who opposed a similar amendment on the Committee Stage that there would be a very large amount of money available for distribution amongst the hospitals. Deputy Sir James Craig said that there would probably be about £63,000 available for each county and that that amount would be a very large sum. It is, of course, true that the amount would be large but it would not be too large. On the same basis, if Deputy Sir James Craig's prophecy is correct, the voluntary hospitals would have for distribution amongst them £5,000,000. They have already distributed amongst them over £1,000,000 so that they would have six millions available for distribution as compared with the £63,000 per county or one and a quarter millions in all.
We have been asked how a county would use £63,000. According to the Bill, the board of health would not be permitted to relieve the rates in any way by the expenditure of this money so that practically it all would have to be spent on building and equipment. It would be very much more difficult to answer the question, how the voluntary hospitals would, on the same basis, spend £6,000,000. Speaking in support of the 75 per cent. basis, Deputy Sir James Craig and others said that the voluntary hospitals wanted to build, to pay their debts, and to put money aside for investment so that the yield from such investments would be there to maintain the hospitals afterwards. In other words, they have no great hope that these hospitals will be entirely supported by voluntary subscriptions in future. If that is going to be done on a large scale and if the voluntary hospital is to do all the building it requires, to pay all its debts in addition to putting sufficient money aside to yield an annual amount for its maintenance, it will, in fact, be no longer a voluntary hospital.
I think that Deputy Sir James Craig and others who spoke in favour of that system of distribution will not be doing any great service to the idea of voluntary hospitals if they achieve what they are out for under the sweepstakes scheme. Again, it is claimed that the voluntary hospitals in Dublin and other cities are giving free treatment not only to their citizens, but also to people throughout the country. It has been pointed out here fairly definitely by many Deputies from the country that that is not so. As a matter of fact, people who go to such hospitals for treatment from the country are compelled in all cases to pay a certain amount per week, usually £2, and, if unable to do that, the board of health of their county has to pay that money, so that in that respect these hospitals are not doing any great service so far as the country is concerned. They may be, and, in fact, are a great service in the sense that Deputy Dr. Hennessy explained here during the Committee Stage—namely, that they are teaching institutions to a large extent where medical students can study and attend clinical lectures. These hospitals are useful in that way.
Another point made in their favour was that they do a great deal in regard to the treatment of special diseases, and that people from all over the country who are suffering from special diseases go to such hospitals in order to be treated by specialists. It has also been contended that they can only be treated successfully by means of the special equipment to be found in such hospitals. I remember reading an article in a medical paper some time ago in which the writer warned his readers against diagnosing extraordinary diseases. He said that it should always be remembered that the ordinary disease is much more common than the extraordinary. That is true here. There is much more ordinary disease treated in the county hospitals than special diseases which have to be treated in the city hospitals. It was also stated that the people of Dublin were under a double obligation inasmuch as they had to maintain the hospitals by voluntary subscriptions, and, in addition, had to pay rates for their own union hospitals. Again I say that that is not correct. It is not the people of Dublin alone who maintain these voluntary hospitals, but the people from all over the country who subscribe voluntarily towards them. There are people living in various counties who subscribe voluntarily to the hospitals in Dublin, and who have, in addition, to maintain their own county hospitals through the rates.
It has been stated, and, I suppose, with a certain amount of truth, that the voluntary subscriptions have fallen off since the sweepstakes were inaugurated. I am sure that is true, but in spite of the huge amount obtained by the voluntary hospitals from the sweepstakes, I saw for the last few days the streets of Dublin infested, if you like, with people who were selling flags for these voluntary hospitals.
What hospital?
These are not included in the Bill.
If they are not included in the Bill it shows that it pays them to remain voluntary. Taking the Dublin hospitals, there are general hospitals in the city and a few special hospitals, and all of these hospitals are not included in the Bill. Some of them are seeking money from voluntary sources, and some of them are still sending people out in the streets to sell flags. The county hospital in Wexford, Wicklow or any other county would have very little chance of getting money by that means. The bigger part of this money that is gathered in for the sweepstake, the money spent on the administration, the organisation, etc., of the sweeps, is spent here in the city, and none of it goes to the counties at all. The money spent on the enormous staffs, the enormous salaries that are paid them, and the enormous amount, above all, that is spent in free entertainment, after the drawing of the sweep, are all spent in the city. On the other hand, take the county hospitals. You have there poor buildings, badly in need of repair. You have very poor equipment, which I cannot say needs replacement, because, in many cases, it is not there at all. We want equipment for the county hospitals—instruments, etc. They are maintained by rates. The ratepayer must pay for the maintenance of these hospitals. On the other hand, a voluntary subscriber may, if he so wishes, cease subscribing to the support of the voluntary hospitals. That should be an argument, in my opinion, for giving relief to the ratepayers rather than to the voluntary subscribers.
Nobody can deny that the county hospitals, and with them I include the Dublin Union Hospital, are responsible for the treatment of 75 per cent. of the ordinary diseases of the poor, almost 100 per cent., one might say, of the very poor. Even here in the City of Dublin nobody will deny but that the very poor are treated in the Dublin Union Hospital. Our counties have gone to considerable trouble under the scheme of hospital amalgamation. They have gone to considerable trouble to get a competent staff, and they have paid what, in their opinion, amounted to a liberal salary. It was not perhaps as liberal as should have been paid to the very best men, and they have got very good competent men in those county hospitals. When they got these very good staffs they put them into buildings that were much more like prisons than hospitals to treat their patients. In spite of that, I say they have done remarkably good work for the last few years. They are doing work now in the county hospitals that was not expected a few years ago. They are doing all the operations that could be expected from a competent surgeon. I am very doubtful, if the most eminent physicians and surgeons were put into buildings such as these county hospitals are, they would do any better. We were told on the Committee Stage that these men were paid, and that, on the other hand, the surgeons and physicians in the voluntary hospitals give their services free. That is true, but, on the other hand, I think we all know that it is the highest aim of a young physician or surgeon here in the city to get on the staff of a voluntary hospital.
I have spoken already about the money that is spent out of these hospital sweeps, apart altogether from the question of medical treatment—the various sums that are paid to run the sweeps and the large amount that is paid for entertainment, and so on, after the draw. I think it would be only fair, then, that there should be a liberal amount of this money given to the various counties for building decent hospitals, etc., for the twofold purpose —first of all, to see that we have decent hospitals in the various counties to treat the sick, and secondly, so that we can give some employment in the country as well as the employment that is given from the money that is spent here in the city.
I believe that the forty per cent. that was asked for here is not just, because it is not sufficient for seventy-five per cent. of the population. As the Twenty-Six Counties represent, apart from the cities, seventy-five per cent. of the population, forty per cent. is not really a just percentage. I move that three-fourths be deleted and that we substitute sixty per cent.
I move:—
In page 3, Section 5, lines 33, 39, 50 and 54, to delete the word "three-fourths" and substitute in each line the word "two-thirds."
This whole question of the division of the money between the voluntary hospitals and the county hospitals has been debated at considerable length. I think it would be only labouring the question to go further into it. Were it not for those who inaugurated the sweep and carried the Bill through the House, I think the scheme would have been a failure. If it had been a failure we would not be discussing here to day the division of the money, but how we would make a success of the scheme. Now that it has been a success we ought to agree that a certain amount should go to the county hospitals. The ratepayers are contributing to the big hospitals in the cities, and also to their own district hospitals, but the voluntary hospitals in Dublin have a certain duty to perform, and I think it is only right that they should get a higher percentage than the county hospitals. If at any time the county hospitals are in need of funds for extension of their buildings or any other purpose, it would be an easy matter to resurrect this Bill. The Dublin hospitals will have to depend on the interest accruing on their investments.
Are we taking all the figures together?
Yes; there are two alternatives.
We are discussing both of these figures against twenty-five per cent. My difficulty is that no reasoned case has been put forward to justify the particular figure which is in the Bill. It seems to be an entirely open question. The only argument that was put forward was that by Deputy Sir James Craig, which was a preposterous argument. He gave us a particular case of a voluntary hospital, and in this particular case we are all in the one body, because we all are in favour of the voluntary hospital. We want everything that can possibly be done for them to be done. He put forward the case of a hospital which was receiving from voluntary sources £400 or £500 a year. Due to sweeps, it pulled down all its buildings. It got £80,000, and because it has got £80,000 he went on to say that it must get more. In other words, every penny of capital expenditure that we give involves us in the necessity of providing more. That is the only argument that was put forward, and it is a preposterous argument, that to those who hath shall be given, and be given because they have got it.
The second argument is that they are justified in getting this amount of money because any amount of money they get involves them in further expenditure which is to be found within this particular source. On that basis you can justify any amount. I want to see some scheme put forward to show how this five million pounds is going to be administered by the voluntary hospitals, so-called, because they have ceased to be voluntary hospitals now, to produce benefit for the community. It is not a question that we are arguing against some case which is bad. No attempt has been made to put forward any such case. There is simply an empirie figure of seventy-five per cent. That is to involve, roughly speaking, five millions, and because certain hospitals were in at the beginning they are still to get more; each and every penny they get is an argument for giving them more. Honestly, I do not think that that is an argument which ought to be offered to this House.
Another point is this. You have these voluntary hospitals. They came in on the basis of maintaining twenty-five per cent. of their beds as free beds. We are now going to endow with five millions of money institutions for the purpose of charging for seventy-five per cent. of their beds. Is there any principle of reasonableness in the seventy-five per cent.? On that basis, because seventy-five per cent. of the beds are paying, seventy-five per cent. of the total amount of the proceeds should go to these hospitals. I am asking for any reasonable basis. It seems to me that it is the duty of those who are responsible for the Bill to show that reasonable basis.
Deputy Dr. Ryan said that the voluntary subscriptions had already fallen off. They have. I can give you a number of instances. The Cork Harbour Board used to subscribe every year—I think illegally—a certain sum of money for the hospitals in Cork. The whole of that money has been withdrawn. A public body has openly and deliberately withdrawn its subscriptions to the hospitals on the ground that they are now receiving from this source an amount of money which makes them perfectly free from any claim whatever to voluntary subscriptions. If you are to go on that basis, it means that the whole of the voluntary subscriptions will go. The other argument is that those who did come in first because they had the enterprise—I think it was Deputy Carey said it—to start this particular money-collecting institution had a vested interest. If that is the argument that is behind it. I think that that ought to be the claim upon which they base it. Certainly this House, I think, will not accept the idea that there is that vested interest on the part of those who were first to come in, merely because they first came in, unless it can be shown that they have an actual need for the recurrent sums which are coming to them, and that they had a better use for all those sums than any alternative source. There are three figures before the House, twenty-five per cent., forty per cent. and thirty-three and one-third per cent. I do ask those who are responsible for this Bill to give us some logical basis upon which they justify the proportion of the total which they think should go to the hospitals which this Bill and the machinery behind it are ridding of their voluntary subscriptions.
On the Committee Stage of this Bill the amendment by Deputy Seán T. O'Kelly for 50 per cent. to the country hospitals was, on a free vote of this House, defeated by six, notwithstanding the fact that six Government Deputies and one Independent Deputy voted for that amendment. Deputy O'Kelly personally was in favour of the Minister's compromise of 33? per cent. This controversy is not good for the sweepstakes, and it is not good for the future success of the sweepstakes. It is not good for the hospitals, whether city or county. I think Deputy Ryan would be well advised to agree to the compromise of 33? per cent., because I may say here and now that if he does not agree, there is grave danger that on a division the 33? amendment may be beaten.
I endorse every word that Deputy Ryan has said with regard to the good work of the county hospitals, district hospitals and infirmaries. I am delighted that they are to participate in the funds that these sweepstakes will provide, and so develop the good work that they are doing at the present time, work that I hold is equal in every respect to the work done in the city hospitals. They are undoubtedly handicapped for want of equipment, and because of the fact that they are still forced to rely on primitive methods. The amount that will come from the sweepstakes will certainly give them a large sum. Let there be no doubt that it will do so to the advantage of the ratepayers, but not by way of relieving the ratepayers of their liability. The ratepayers are quite prepared to maintain whaever improvements are made by the capital expenditure provided out of the proceeds of the sweepstakes. They have never shirked any responsibility when called upon to provide money for any thing that was necessary in order to cope with disease and sickness. In no county in Ireland have the ratepayers shirked their responsibility in that respect. I feel that we ought to agree to what the Minister was prepared to accept, the compromise of 33? per cent. It was stated here that 25 per cent. would provide £60,000. You may take it that 33? per cent. will provide at least £70,000. It is quite problematical that by 1934 there may not be quite as much money going around, but I do throw out a strong suggestion here now that we ought not to take a division on this matter, and that we ought to accept the compromise of 33? per cent., which will yield, by 1934, £70,000 for the county hospitals, undoubtedly much more than they ever had the faintest hope of getting. I do appeal for the withdrawal of this amendment, and I ask Deputies to agree to what the Minister is prepared to give. I want again to stress the point that if this amendment is pressed there is great danger that the 33? per cent. may be defeated.
I quite agree with Deputy Shaw that there is grave danger of the sweepstakes not going on so successfully as they have up to the present, especially if this amendment is carried. We are now discussing something entirely outside the original proposals contained in the Bill introduced by Deputy Craig. That Bill was introduced to set up sweepstakes for the benefit of voluntary hospitals. Say what you like, county hospitals are supported by the rates. Some objections were made to the original proposal on the ground that it was the thin end of the wedge towards State lotteries. I think it must be admitted in all fairness, that if it is just and proper that the ratepayers should be relieved by the method of sweepstakes, the taxpayers have as good a right to be relieved by a similar method. The real difficulty that we are in to-day seems to be this—that this proposal to give any sort of relief whatever to county hospitals takes away from the original principle embodied in the original Act. Not only that, but it threatens to damage the propects of future sweepstakes.
Deputy Shaw has said that if the amount to be given to county hospitals is to be raised to 60 per cent. the sweepstakes may be damaged. I go further and say that already there is a great possibility that the coming sweepstakes will not be as successful as the previous ones. The great bulk of the money for these sweepstakes has come from outside this country. When it gets to be known outside this country that a large proportion, especially anything in the nature of 60 per cent. of the surplus, is to go directly or indirectly to the benefit of the ratepayers, then I do not think it will mean that the sweepstakes will meet with the same support elsewhere as in the past. Apart altogether from that, the Minister has made an innovation. He has introduced an entire innovation in the sweepstakes position. He has proposed to give a certain amount to hospitals which are certainly not wholly on a voluntary basis.
The amount he is proposing now to give—33? per cent.—seems to me to be not on the mean side. If the Minister is prepared to adopt this new principle, because it is an entirely new principle, foreign to the conception and the terms of the original Act; if he is prepared to adopt this innovation and give relief to the hospitals which are not voluntary ones entirely, I certainly think that 33? per cent. is ample in amount, and that to offer any more would be to endanger seriously the prospects and success of the future sweepstakes.
It has been said that the county hospitals cater for the very poor. That is so, but, with all respect to Deputy Dr. Ryan, I suggest that the very poor are more to be found in the City of Dublin than they are even in the rural districts of Ireland, and that there are no hospitals that contribute so much to the public health of the very poor as those hospitals that are known as voluntary hospitals in the City of Dublin. Again and again we have heard the argument that these hospitals in Dublin cater for the people of Dublin. I again say that they do no such thing. I have seen no hospital rolls produced to show that these hospitals relieve a large percentage of merely Dublin citizens. I would very much like to see some of the hospital rolls to find out whether exactly the contrary is not the case, and whether the majority of the cases are not cases from outside the radius of the City of Dublin.
I do think that in view of this innovation that has been proposed, this addendum or change of principle that has been adopted as apart from the principle contained in the original Act, it would certainly be a grave danger for us to go to the length which Deputy Ryan has suggested, and allow the enormous proportion of 60 per cent. to go in what would be considered, and in my opinion rightly considered, elsewhere as being in relief of the rates payable by the ratepayers of this country.
Mr. Byrne
I did not intend to say a single word in this debate, but representing the City of Dublin, I think that the drift of this debate is much to be regretted. I think this House should consider the national needs of the country before the local needs of the country. Speaking as a representative of Dublin City, I think that Deputy O'Kelly did not serve the national needs of the country, and he certainly did not serve the needs of the City of Dublin when he introduced this amendment. It seems to me that this debate resolved itself into an effort on behalf of Deputies who represent the county constituencies to obtain money by means of sweepstakes, not for the improvement of the hospitals, but merely by way of relief of the burden of the rates that have to be borne by the people. It has been stated here by Deputy Shaw that the ratepayers have never shirked responsibility for the maintenance of county hospitals. It has been stated here by many speakers in this House that county hospitals, in the matter of equipment and in some other ways, are in a very bad way. If these county hospitals are in a bad way whose fault is that? Where are the funds that support these hospitals coming from? Are they not coming from the ratepayers of the different districts? If the ratepayers of these districts were doing their duty to these hospitals, surely they would be in a sound position to carry on their duties as medical institutions? I hope that the Minister will stand firm by the 25 per cent. in the Bill. A very fair offer of 33? per cent. was made to the House by the Minister in order to prevent a division. That offer was rejected, and I hope the rejection of that offer will enable the Minister to come to the conclusion that 25 per cent. as the proportion to which the county hospitals shall be entitled shall stand part of the Bill. In my opinion Deputy Redmond was right when he said that they were being over-generously treated by giving them that proportion of the money. I also agree that once it becomes public property, as it will become public property, that this money received from the sweepstakes is going to be devoted, not to improving the health of the poor of the country, but by way of relief of rates, it is going to have a very injurious effect on the amount of money which will be received from the sweepstakes. I believe with Deputy Redmond that when English subscribers realise this fact the sweepstakes will be seriously injured.
Deputy Gorey as a sporting man always thinks that nobody will put a shilling into these sweepstakes except in the hope of winning a prize. Speaking for those who have subscribed in this country, I believe that that condition of affairs does not exist. Although I am willing to admit that a large percentage of people subscribe with the hope of winning one of the large prizes, I say that no negligible proportion of the people subscribe with the double object in view, and especially with the object of helping the poor. I believe that if the English people realise that we are going throw a large part of the liability which should be on the rates on to the English people who subscribe it is going to lessen the volume of support which the sweepstakes receive. I also believe that the British Government will take more drastic measures, if they can possibly do it, and I believe they can, to prevent the inflow of money by way of subscriptions. Under the 25 per cent. in the Bill the sum of £1,000,000 will go to the county hospitals. That to me seems a stupendous sum of money. They are only, as one medical man said, in the majority of cases, a one-horse show. They are institutions with a single doctor or two doctors. I know that one institution mentioned, the Galway hospital, is rather in a bigger way, but that institution stands out as an exception to the bulk of the institutions with which this Bill is about to deal.
It has been stated that it is not the intention to relieve the rates by the inclusion of the different amendments on the paper. Anybody who has read the speech of Deputy Kennedy can only come to one conclusion, and that is, that if that speech represents the point of view of the county Deputies it is relief of the rates that county Deputies are looking for, rather than the relief of the hospitals. In the course of his speech Deputy Kennedy said that a maternity ward was needed in the county hospital at Mullingar, for which an estimate of £10,000 has been submitted, and that an up-to-date sewerage system is needed for which an estimate has been put in. Is that what the people of Mullingar want? Do they want this money to go for the introduction of sewerage systems and schemes of that sort? Is that the way they are going to help the poor? Is that the way this money is going to be spent? Is that the object for which the scheme was originally launched? It has been stated here by a Deputy who is a county medical officer of health, who knows more about this question than I do, and who knows the position of the hospitals in the City of Dublin and the position of the county hospitals, that the hospitals in the City of Dublin should be regarded as national institutions, that they are doing national and not local work. Anybody who is connected with the City of Dublin knows that the work of these hospitals has been national and not local. I have been informed by medical men in this House that a great number of the larger hospitals in this city take in 40 per cent. of free patients, and that no question is asked, when it is necessary for a patient to go in for medical treatment, as to where he resides. He is taken in regardless of where he is living. These are facts which I believe no Deputy will dispute.
I dispute them. The county boards of health pay for the maintenance of the patients sent to the Dublin hospitals.
Mr. Byrne
I shall deal with that point in a moment. It has been stated by medical men in this House that the area for which the Dublin hospitals cater at present extends over 100 miles from Dublin. That would cover a very large portion of the country. Then you have the other hospitals in Cork and Limerick operating in a similar manner. Deputy Shaw tells us that local bodies contribute to the upkeep of the patients. Will the Deputy say that the £2 per week contributed by the local bodies keeps a patient in a Dublin hospital?
It is good enough.
Mr. Byrne
It is a well-known fact that £2 per week does not pay for the maintenance of any patient. Has it not been stated by medical men in this House that when serious cases come up for treatment in the city of Dublin hospitals, anæsthetics and dressings and things of that kind alone cost over £3 per week, leaving out the question of maintenance? In my opinion county hospitals are quite efficient for the treatment of normal diseases. I am perfectly willing to admit their competency in every way, but that is an argument in favour of the 25 per cent. The cases that come to Dublin to be treated are not ordinary cases. Ninetyfive per cent. of them are serious cases which need the skill of surgical and medical specialists, and that skill is at their disposal. In the county hospitals medical officers are paid by the State for dealing with cases. In the Dublin hospitals the specialists who attend these patients, for which this magnificent sum of £2 is paid, are men who are at the top of their profession. If a patient went to them in the ordinary way he would have to pay a fee of from £25 to £50 for similar treatment. I can speak from experience of that. These patients sent up by the county institutions are treated for £2 per week and receive the services of these eminent specialists, who do not get one penny of remuneration. I ask the House not to take a local view of the matter. What really matters is the steps that we are to take to help the poor. If there is one man more local in his ideas than another in this House it is Deputy Ryan, who moved this amendment. I have never seen the Deputy take a national view-point upon any question introduced in this Assembly.
Acting-Chairman
That is not the point.
Mr. Byrne
The point is: which of these proposals are we to adopt for the benefit of the hospitals of the country, whether they are to have 25 per cent. or 40 per cent? I have no hesitation in saying that if the House were to adopt 40 per cent. as the share that was to go to the country hospitals, it would certainly have done a very serious injury to the poor of Dublin and to the poor of the whole country as well. I have just been informed of one institution in Dublin City that has fifteen medical experts, every one of them giving their service without fee or reward. For any question that arises in that institution for consideration you have specialists in every branch of disease to which human nature is heir. When a particular complaint comes in from the country to that institution some one or other of these specialists knows that complaint intimately. It is quite impossible for that degree of medical knowledge to exist in county hospitals. I am making no reflection upon the county hospitals when I say that, because it would be impossible for them to have that degree of medical knowledge or skill. If we are going to spend this huge sum of money, surely we ought to see to it that we spend it in such a way that the greatest quantum of medical skill will be placed at the disposal of the poor of the country? If you spend this large sum of money on a one-man or a two-man hospital in the country, is it suggested that the same quantum of medical skill will be available as by the expenditure of a similar sum of money on a Dublin hospital? Anyone who considers this from the broad national point of view, can only come to one conclusion, namely, that it would be a great error to divert such large sums of money to the needs of the country. One million pounds is what the county hospitals will get by giving them 25 per cent. under the Act. In addition to that million pounds you have the funds of the State coming in in aid of these hospitals which the voluntary hospitals in Dublin have not got.
Deputy Hugo Flinn spoke from the same view-point on which he usually starts on this particular matter. Because much is given to the Dublin hospitals they are entitled to more, he says. The real facts of the case are not summed up by the statement of Deputy Flinn. The real facts are simply these: If the Dublin hospitals did not receive this money from the sweepstakes they would be unable to carry on.
Some of them.
Mr. Byrne
The bulk of them. I am quite ready to qualify that statement if the Deputy wishes, and I say if this money were not available, the bulk of them could not carry on. The House must recognise that if the county hospitals never received one single penny from the sweepstakes, they could still carry on. That is the great dividing line that should guide the House in deciding the proportion to Dublin and the other cities, Cork and Limerick, and the proportion that should go to the county hospitals. I have no hesitation in saying that if we divert the large sum of money that Deputy Ryan asks for, it will be wrong, or even if we divert the money that Deputy Shaw wants—
The Minister was agreeable to compromise with thirty-three and one-third.
Mr. Byrne
The Minister was agreeable to compromise with thirty-three and one-third because he wanted to avoid a division on this matter, but the other side forced him to a division, and as they forced that division, we should now stand by our guns and keep to the original division.
This Bill has been so changed since we last debated the subject that I do not recognise it. The debate has turned altogether into a question as to what proportion the county hospitals are to get as against the voluntary hospitals. As the Bill as amended in Committee now stands, there is not one word about the county hospitals getting anything. It is quite within the compass of the Bill whether you give twenty-five, thirty-three and one-third or fifty per cent. that the county hospitals will not get one penny under the Bill. That is how the matter stands now. Anyone who reads Section 6 will see that it is within the province of the Minister for Local Government to provide fifty per cent. for the county hospitals, and then to go and build hospitals here in Dublin with that very fifty per cent. without coming to the House to ask for its authority. I complain that the Bill is entirely changed from what it was when it was originally brought in. It was then definitely laid down in the Bill that the proportion of the division was to have regard to population. In the Bill as it stands now with Section 6 in it there is no restriction whatever upon the Minister for Local Government. The Minister for Local Government might allow you to give fifty-fifty, and then say "I take the whole of the fifty for the county hospitals," and afterwards build a sanatorium in Dublin for cases of tuberculosis in Ireland and apply all the money to that. He can say, "I will bring all the insane people up to Dublin, and house them in a big institution there."
Is there not enough of them here already?
Unfortunately there are too many of them already, but the Minister may if he likes add to the number. That is the situation under the Bill. Our whole debate is futile. I want a guarantee from the Minister that there will be money given to the county hospitals under the terms of the Bill, whether it is twenty-five, thirty-three and one-third or one per cent. There is nothing in the Bill since the new Section 6 was introduced to guarantee that anything will go to the county hospitals. I voted for fifty per cent. when there was some hope that something would go to the county hospitals, but the Bill will now have to be materially changed beyond the amendments on the Paper before we can be sure that the county hospitals will get a penny at all under it.
My attitude in this matter is still the same as it was when we were discussing it on the Committee Stage. We listened to-day to more hypocrisy and to statements closely resembling those that might be made by people who would benefit by mental hospitals. It was suggested by Deputies, and stressed by some of them, that it was going to do grave injury to the success of the sweepstakes outside this country if it was known that the basis of the division of the money was to be altered. Can anybody imagine anyone in England or America, or anywhere else, making inquiries from someone selling them tickets as to what proportion of the money would go to the city hospitals and the county hospitals in Ireland? The suggestion is one that might come from people who would be justly termed lunatics, and no one else. There would be no such question in anybody's mind, and there would be no question as to whether the money is going to the relief of the poor of the provinces or in Dublin. No questions are going to be asked whether the money is going to hospitals in Dublin or the country. Any suggestion otherwise is a fool's suggestion, and cannot be made seriously. Another thing talked about is the enterprise of certain voluntary hospitals. There is no enterprise in reality in these hospitals. The enterprise is in the people outside who promoted the whole thing. The first we heard of this matter was in 1923. There is no enterprise in the hospitals. They are the people that allowed their names to be used in the first instance, and that was the extent of their enterprise.
What would damage the prospects of future sweeps is if an unreasonable amount was taken out of the fund and given to the hospitals. That stage is got over and we have preserved the public confidence. This has no effect on the public confidence and it is utter hypocrisy to make the statement that it has. There are a few cities besides Dublin that are also going to get special treatment. It seems to me from the speeches of Deputy Redmond and others that they are all arrayed on behalf of the voluntary hospitals because of the natural tendency to get as much as possible for their constituencies. It is a question of the city hospitals being arrayed against the country hospitals. According to Deputy Byrne poverty exists nowhere except in Dublin. A great case has been made that a million and a fraction is more than enough for the country but no one has attempted to make the case that six millions is too much for the voluntary hospitals. The Deputies and the Minister for Justice sit quite and listen.
The question of medical attendance for mental hospitals has not been entered into at all and the mental hospitals' charge in the country is a huge one. When the county hospitals send a patient to Dublin £2 a week is charged and the case is being made that that does not defray their expenses. The Dublin patient can get accommodation free and surely if the citizen of Dublin gets everything for nothing we ought not to be making the case that £2 is justified in the case of a country patient. I want the House to look at this in the light of the new conditions. Six months ago we did not visualise the sweeps being as successful as they are. A much lesser sum was thought of. That sum has been multiplied by almost three and still the representatives of the City consider that the altered circumstances should not be taken into consideration at all.
I understood some of the Deputies to state that the proposition was to give the country hospitals 60 per cent. The case made was that the country hospitals should get 40 per cent. Deputy Byrne made a mistake. Deputy Redmond made a mistake when he thought 60 per cent. was in the amendment. We do not need to tell them at this stage that it is only 40 per cent. In my opinion that is not too much and I am going to vote for it.
There are a few matters I would like to have cleared up. I do not think this debate has helped the future success of the sweepstakes. There has been a very thin veneer put on the case. The case is that it is for the relief of the rates. Deputy Gorey, with his usual candour, has made that plain. I agree with Deputy Gorey and I do not think, even if it is diverted to the counties and away from the voluntary hospitals, that it would influence, to any considerable extent, the purchase of tickets or the mentality of the man who buys sweepstake tickets, but it will influence very strongly the action of the British Government. The British Government are aware of the fact that these sweepstakes are in relief of local rates, and there is a very strong feeling in England that if you support sweepstakes in Ireland for the relief of the rates that they ought to have sweepstakes in England for the relief of their voluntary hospitals. It is the Government you have to reckon with, and any Deputy who thinks that the British Government, if challenged, cannot make it an illegal act in their country, and make it impossible, I think are counting on too much.
A great deal has been said about what the Dublin hospitals charge for patients sent up from the country. I wonder how far will the £2 go in the maintenance of any Deputy in a hotel here in Dublin, apart from any medical or overhead charges?
It does me all right.
You must be an unpretentious man. Deputy Ryan speaks of 75 per cent. of the patients being distributed throughout the country. That is an arbitrary figure. The majority of the population will be found in the big towns and cities in Ireland, where voluntary hospitals are there to cater for the needs of these poor people. I would like to say a word on behalf of Dublin, Cork, Waterford, Limerick, and other big towns in Ireland. These are the principal subscribing people who, through taxation, are made to subscribe to agricultural grants and other things for the relief of the local rates in the counties. These people in the cities subscribe the bulk of that taxation, and I think they should get credit for it.
I have not too much sympathy with Deputy Shaw in his attitude on this case. Westmeath is a rich county, and if Westmeath did as much as the neighbouring county, Meath, Deputy Shaw need not indulge in any special pleading for grants for the county hospitals; but Westmeath County, to my own knowledge, failed very badly to do its duty to the poor of the hospital. I know how the Minister came to offer an increase on the 25 per cent. originally agreed upon, and I must compliment those Deputies on their strategy— I mean, those nominally his supporters —who spoke against the Bill here. It made him feel that he could hardly command a majority in the House with the result that it was left to a free vote. Nevertheless, he did command a majority for 25 per cent. I think, as the President said in another case, that there should be no sympathy with those who put out a grasping hand when they did not accept the offer of 25 per cent.
Unfortunately the scope of the Bill is very limited. I do not quite agree with Deputy O'Hanlon that it should be as limited as it is. I very much regret that it is limited, and that some of the money could not be devoted to medical research. I believe it is impossible to do it now, but if ten per cent. of the money could be diverted for medical research it would be of great national benefit to this country. We are dependent on subscriptions from American millionaires for any little medical research that is done in this country. I do not think sweepstakes will help us to get any money for medical research. Probably enough has been said on the matter, but I think if the House had stuck to twenty-five per cent. it would be quite ample. I believe the new arguments and the new amendments will not help the success of the sweepstake. As I said, these are simply a challenge to the British Government, and I believe that when the British Government takes this thing in earnest and considers the arguments put forward here, they will take such steps as will make the success of the sweepstakes very doubtful.
Deputy Dr. Hennessy asked if it was possible under the Bill to devote some of the proceeds to medical research. If so, is it possible that some of the proceeds could be devoted to district nurses?
The Deputy stated that they could not be. On the Committee Stage of the Bill I stated that it was very lamentable that this discussion should have been conducted in the terms in which it was conducted. I think it very lamentable that we should have a certain number of Deputies on one side finding fault with and attacking the Dublin hospitals, and I thought on the other hand it was very lamentable that certain persons had attacked the county hospitals and county infirmaries. My view is that they do admirable work in their own particular sphere, and I do not think attacks on either are proper, right or justifiable. I am afraid Deputy Dr. Ryan—though he has no doubt studied the Bill—never went to the trouble of studying and working out this particular scheme, because from start to finish he never spoke of anything but the Dublin hospitals, and he seemed to consider that it should be a case of Dublin on one side and the rest of Ireland on the other. It is nothing of the kind. Not only do the Dublin hospitals benefit, but hospitals in the City of Cork benefit. If you are taking any money out of Dublin by carrying Deputy Ryan's amendment, you are also taking money out of Cork, out of Limerick, and out of Waterford.
That is where the Minister got his majority.
You are also taking money from County Louth, and from County Galway, because Galway hospital is now one of the hospitals under the voluntary scheme.
Since when?
Since to-day. That shows how little Deputies opposite have really considered how these schemes work.
We could not be expected to know that.
Deputies could not be expected to know, but I am bringing it forward to show that the standpoint of Deputy Dr. Ryan, that it is Dublin hospitals alone that benefit, is entirely unjustifiable, and has no basis. If you are going to knock out Dublin hospitals you are going to knock out a considerable number of country hospitals also. Every one of these county hospitals that come under the voluntary scheme can show that there is voluntary aid and that they supply a certain number of beds to the poor. It has been said that the Dublin hospitals get too much under this Bill, and the question has been asked:—"Why should they get such enormous sums?" We are told that they charge large sums for country patients that come up for treatment. That is not invariably true. They charge, I know, when country patients are sent up by boards of health, though there are many patients, I know, of my own knowledge, not sent up by boards of health, but sent up by doctors or other individuals. I myself, and some of my relatives have got patients into Dublin hospitals and they have not been charged. To say that every country patient who goes to a Dublin hospital is charged £2 a week is not accurate.
I suppose there were exceptions.
As far as my experience goes a person who goes to a Dublin hospital pays the amount of money he is able reasonably to pay out of his own pocket, and if sent by a board of health, the board pays. As far as I know, that is the arrangement. As to the proportion between the different classes of patients I cannot speak. Supposing the Dublin hospitals and the other voluntary hospitals are put into a sound financial condition; they are not out for making money; they have no shareholders and no dividends to pay. They have nothing to do but to keep the hospitals fit and efficient for the benefit of the sick. If, in struggling along—and a great number of them are battling for life, and some, apart from this money, are not even battling successfully for life— they charge £2 a week for a patient, if they are put into a sound and solvent position, you will have a very reasonable case for going and saying—"Why are you charging so much for a patient? You are solvent; you are able to give free treatment; why do you not do so?" But hospitals on the verge of bankruptcy cannot be asked to give free treatment to patients in the fashion which hospitals on a sound financial basis can.
Coming to country hospitals, it has been said their means are limited. I think that we should stand, as far as we can, for principle. Our principle should be that this money should not go in direct relief of the rates. There are certain things that people ought to have done out of the rates, that have not been done out of the rates. It is the class of improvements which would not be done out of the rates that we should consider under this Bill. Any expenditure of money which goes to the direct relief of the rates would be bringing in an entirely new principle, and would be giving an entire justification to what Deputy Dr. Hennessy said, that people outside the country would not look on this scheme as being run for the benefit of voluntary hospitals, or for the benefit of the sick poor, but would regard it as being run for the benefit of the individual ratepayer, and in the public estimation it would stand on a completely different basis. I have been asked how the 25 per cent. basis was arrived at. In the present condition of our knowledge it must be only a matter of surmise what the needs of the Dublin hospitals are, or what the needs of the county hospitals are. I have spoken to several doctors and to other persons connected with the various county hospitals, and I have asked what amount of money these hospitals reasonably required in order to put them into what they considered would be first-class condition.
I discovered that the sums which were mentioned to me as necessary for a county will probably be doubled and trebled under the 25 per cent. arrangement. I think that 25 per cent. is, therefore, more than enough for the needs of these hospitals. It may be that when the schemes are put forward by the various boards of health to the Department of Local Government we will have such information before us as will enable us to know practically with certainly what are the needs of the county hospitals, over and above those needs which one might reasonably expect should be paid out of the rates. Over and above these, what are the needs? No doubt we will know when the schemes have been put forward and examined by the Department of Local Government. On the other hand, when the Committee of Reference will have examined the needs of the voluntary hospitals, we will be in a better position to decide what these needs are. If it turns out that the hospitals sweepstakes have been such a tremendous success that more than the legitimate needs of both the voluntary and non-voluntary hospitals can be satisfied, then, of course, this House will have to consider what steps it will take with regard to the sweepstakes altogether.
At present, however, when it is almost certain that there will be more than enough money to go round, it appears to me to be lamentable that this desire to get money should be so strong, that there should be jealousy because some hospitals may get more than others, and that we should have a debate like this attacking the management of the Dublin hospitals— prejudicial to their good name, and also, to some extent, to that of the county hospitals. It is difficult to know now what each county will get, because, as Deputy O'Hanlon pointed out, the population basis has been done away with. Take, for instance, a county like Louth. I leave Galway out, because it has only lately, only to-day in fact, come under the voluntary scheme. Take Louth or Waterford. There large sums have gone to the voluntary hospitals which do the big work in those counties. Further sums will go to them, and consequently the needs of Waterford or Louth will be comparatively small, either under my proposal of 25 per cent. or Dr. Ryan's amendment of 40 per cent. Apart from the big hospitals in the city, I think there are only two or three others, and they would be comparatively small, that would have a claim to this 25, 33? or 40 per cent., as the House decides. That would leave a much larger sum available for counties in which there are no hospitals receiving sums out of the portions of the proceeds set aside for the voluntary hospitals. As I say, this is a matter upon which it is very difficult to make up your mind with anything approaching mathematical certainty. We have not, and we could not have, before us the necessary facts and figures. I am personally satisfied that the needs of the county hospitals, other than those participating on the voluntary basis, will be more than met by the 25 per cent. arrangement. I think that the 40 per cent. proposal is hopelessly and entirely wrong. There has been talk about compromise. I tried compromise, and it failed. I think the 25 per cent. would be enough, and I ask the House to vote against this amendment. If the House thinks that 33? per cent. is a proper basis, then that is a matter for the House.
I would like to make clear that, so far as I am concerned, the attitude which I have taken in regard to the amendment has not been actuated by any prejudice against the Dublin hospitals. The principles on which I move are these. The distribution and allocation of funds to the county hospitals will be the subject of central supervision; the expenditure will be carefully considered and approved by responsible people in the Department of Local Government and Public Health; and, therefore, there is much less chance of this money, which is coming to us so easy and which there is a natural human temptation to spend rashly and without due prudence, being expended without careful supervision.
Is the Deputy aware that there is a Committee of Reference to be set up under the Bill?
I am, but I am not aware that it is in their power to determine how the money shall be spent. So far as I can see, it is the hospitals which come together to promote sweepstakes or to participate in them which shall determine the proportions in which the funds shall be allocated.
The Deputy is quite wrong.
And they will only be subject within limits to the Committee of Reference who may report to the Minister for Justice. They are entitled to make certain inspections and that sort of thing but the body which will really determine the matter of allocation, as between hospital and hospital, is going to be the Hospital Committee and not the Committee of Reference. I am afraid that that is how the proposal of the Minister is going to operate. There is another point which I would emphasise and that is the point made by Deputy Dr. Hennessy. There are some people whose attitude in this debate has been largely determined by the rosy prospects, the extravagant pictures, which the Minister, Deputy Sir James Craig, and others, have put before the House as to future sweepstakes. We hear people talking of sweepstakes going to make available for the hospitals sums of two millions and upwards and they talk as if these sweeps would go on until the Act expires. We hear people say that there are to be no less than nine more sweepstakes and, as a result, there will be so much money available, not only for the Dublin hospitals but also for the county institutions, that they will not know what to do with it.
My opinion is that very shortly they will come to an end because they are creating a problem in other countries for those charged with the administration of the law there which will inevitably compel the authorities responsible there to make representations here. These sweepstakes are not, and will not be, regarded abroad as private ones. They are really public sweepstakes run with the consent of, and regulated by the Government here. Ultimately I believe that they will create a big diplomatic issue between this and other countries. Therefore, if we are to maintain good relations with other States, we cannot try to organise and legalise what will be gambling bootlegging. That is what it amounts to. They will develop a bootlegging industry in sweeps in this and other countries, just as a bootlegging industry in liquor was created in America owing to prohibition. These sweepstakes will not be unlimited. The term during which it will be profitable to run them will be limited, and therefore in regard to whatever money comes to us now, every care should be taken to ensure that the community as a whole will get the best possible results. It is for that reason, and in the belief that the expenditure of the money allocated to county hospitals will be carried out with great prudence that I support the amendment allocating 40 per cent. to such hospitals.
I am surprised that the Minister has taken up the attitude that simply because of circumstances which really have no bearing on the merits of the case, he has been influenced to change his mind. In the last debate he was willing to enter into a compromise.
I offered a compromise and it was refused.
Has that anything to do with the merits of the case as between 25. 33 and 40 per cent.?
Mr. Byrne
The forcing of the division had.
I say that the intrinsic value of the 40 per cent. before and after the division, is something which has a bearing on the amount of money to be distributed, but I suggest it has nothing to do with the merits of the case if, on Wednesday, certain members of the House took the view that 33 per cent. or 40 per cent. was the correct figure to estimate on. Because we are going to estimate on that, and that somebody said something which ruffled the Minister's temper, he is going to insist on 25 per cent.
May I say that my temper is never ruffled.
It has no bearing on the merits of the case. I know it is very hard to ruffle the Minister for Justice, but there is a way of ruffling his legalistic temperament, if I might put it that way. Because he could not get the exact amount he wanted he thought he could get up on Wednesday——
The Deputy does not know the facts. It was Deputy Davin suggested 33? per cent., and I said yes.
The Minister is not going to draw a red herring across the track. Last week he was willing to accept a certain figure. This week, because something quite extrinsic to that figure is put forward, he will not accept it. It is quite inconsistent. I am in a peculiar position in this matter, because I happen to represent a constituency where the interests on both sides are involved. We have in Waterford City certain hospitals which are already under the scheme, but then there are other institutions in the county. On the whole, it is not like as if we were now starting out on the commencement of the distribution of the funds. All the institutions that have participated so far have been very fairly treated. They have got a considerable amount of money out of it, and I do not think any of the hospitals, either in the City of Waterford or elsewhere, are going to suffer if we raise the percentage for the county institutions. There is this aspect, however, involved, that there are some very poor people who would not be sufficiently seriously ill to be put on the rates, and who would not for that reason have money spent on them in sending them to central hospitals, whether in Dublin or in the City of Waterford. These people, at the same time, may require a considerable amount of attendance. I would like to have seen it possible to have portion of the money spent on the dental treatment of children, but one cannot send a number of children 15 or 20 miles in order to get that type of case attended to out of the rates. It is that sort of case, the case of people who are very poor, I have in mind, and if cases are not sufficiently serious to justify their being sent to a central hospital at the public expense, they could be dealt with in the decentralised institutions. The more the medical services are decentralised the better I think it will be. I do not think it would prevent any serious cases from coming to the central hospitals, or would prevent any doctors from becoming expert, as they are in certain diseases. On the other hand, the more we bring medical services to the people the better. Some time ago I had a conversation with a journalist who does not belong to this country. He told me that he was going to write an article—I do not know whether he has done so yet—in which he would emphasise that the idea behind the Hospitals Sweepstakes was to build up one of the best medical services in the world. I put that forward in answer to Deputy Dr. Hennessy. The more we spend on district medical services the more we are going to carry out that idea. I regret that the Minister has closed his mind like a rat-trap on this question.
Is it proposed to introduce the name of the Galway hospital into this Bill?
No. The hospitals which were able to bring themselves under the provisions of the original Bill that is that they received voluntary subscriptions, and that they gave 25 per cent. of their beds to the poor, can join with other hospitals in the scheme. The Galway hospital has, in fact, decided on going into the voluntary scheme, just as Louth, Waterford and Limerick County Infirmary did some time ago.
Will the Minister state how much the ratepayers of Dublin contribute to hospital maintenance, if anything? Is there any hospital in the county that is maintained by the rates?
Surely Dublin Union hospital is.
That is the only one.
I think the Corporation contributes to other hospitals.
The Corporation give several thousand pounds a year divided amongst 15 or 16 hospitals.
The case has been made that the country people have their own hospitals to keep up and that the Dublin people escape that.
They have to support the Dublin Union hospital, which has got something like 1,500 beds.
I would appeal to Deputy Dr. Ryan to withdraw his amendment and to agree to the 33 one-third per cent. suggested the last day.
On a point of explanation, the Minister stated that I attacked the Dublin hospitals. I did not, as far as I know. I challenge anyone in the House, when the report of the speech comes out, to challenge anything I said about the Dublin hospitals. If I told the truth about them it is not attacking them. I tried to correct some of the things that have already been said, and I think the Minister should not accuse me of that.
Might I suggest to Deputy Dr. Ryan to withdraw the amendment and to agree to the 33 one-third per cent.? It is a fair offer and I think he should accept it.
I would also ask Deputy Dr. Ryan to withdraw the amendment, seeing that Galway has now joined the other scheme.
Would the Minister agree to the 33? per cent.?
It is a matter for the House.
If Deputy Dr. Ryan withdraws the amendment I am sure the House will agree to the 33? per cent.
Deputy Dr. Ryan will not withdraw his amendment, so what is the use of talking? If he wanted to, Deputy Allen will not allow him. He said so.
Acting-Chairman
I propose to put the amendment.
The Minister says it is a matter for the House. What is the use of our withdrawing it if he is not prepared to accept 33? per cent.?
I know perfectly well that in no circumstances is the Deputy prepared to withdraw his amendment.
I do not want to put it to a division if the Minister would agree to a 33? per cent.
I would ask the Minister to accept that.
It is really a most lamentable thing that Deputy Dr. Ryan did not take this course before, instead of making a long speech and having the long discussion, and I think myself, the very harmful discussion which ensued. If the view of the House is that 33? per cent. should be taken, I will not press the matter to a division. I will not answer for other Deputies.
I think the suggestion that is made ought to appeal to the Minister. I think it will have the unanimous support of the House. Notwithstanding the debate and the many speeches that were made, I think it would be most undesirable to have a division.
Amendment 1, by leave, withdrawn.
Amendment 2, to delete the words "three-fourths" and substitute the words "two-thirds," put and agreed to.
I move amendment 3:—
In page 3, line 52, Section 5 (4) (b) immediately after the word "concerned" to add the words "and the reasons for the adoption of such proportions."
This is rather ancillary to the next amendment. The next amendment is an amendment by which the Committee of Reference have got specifically powers which, I think, they would in fact have possessed, but Deputy O'Kelly said it would be pleasing to his side of the House if those powers were explicitly set out. They are explicitly set out in amendment 4. Amendment 3 is really consequential upon that.
Amendment put and agreed to.
I move amendment 4:—
In page 3, Section 5, to insert before paragraph (c) a new paragraph as follows:—
"(c) for the purpose of making the report to the Minister under the foregoing paragraph of this section, such committee of reference may visit all or any of the premises of any of such hospitals and shall be entitled to inspect and examine such premises and the fittings and equipment thereof, and shall also be entitled to call for and be furnished with full information in relation to the management and the financial position of any such hospital and to see and examine all accounts of the receipts and expenditure of the governing body of any such hospital and also all or any books and other documents containing any record of such receipts or expenditure."
I do not think the amendment gives all the powers that I understood the Minister would ask to have given to the Committee of Reference. For instance, there was one that was mentioned, an amendment of mine. That was that the Committee should report in writing to the Minister. That does not appear, as far as I remember, anywhere in the parts of the Bill relating to the Committee of Reference. Also that the Committee of Reference should have power to question the hospital or hospitals as to whether they complied with the provisions of the Principal Act or not. I do not see that that is included. These are small items admittedly, but they were discussed, and they were certainly set out in an amendment by me on the first Committee Stage, and I thought the Minister would include them.
In amendment 3 you have "and the reasons for the adoption of such proportions." Of course the Committee must give its reasons in writing. The Committee of Reference also has full powers to see any books, and on that they will report.
A third point is as to whether they would be able to insist on statutory declarations or otherwise. That point was not met.
The old point of statutory declarations still remains. The accounts will be submitted to me as a matter of fact under the old Act, and I am entitled to insist upon a statutory declaration, and in fact do.
Amendment put and agreed to.
Amendment 5 not moved.
I move amendment 6:
In page 4, Section 6, line 1, to delete the words "one-fourth" and substitute the words "one-third."
This is a consequential amendment.
Amendment put and agreed to.
There is a matter that I wish to raise on Section 5.
Acting Chairman
The sections do not come up now. Would not the point arise on the motion that the Bill be received for final consideration?
If the Bill is to be received for final consideration it would be too late.
Perhaps the Chair would waive the rules and allow Deputy O'Kelly to make whatever remarks he wishes.
Acting Chairman
I think it would save time if Deputy O'Kelly would say what he wants to say now.
I would like to be satisfied that the Committee of Reference would have full power to inquire into all the facts relating to all the hospitals, voluntary and otherwise. Of course, in regard to the sweepstakes that have been held up to the present, the Minister told us recently that he inquired in a general way into the amount allocated to the different hospitals, but unless for grave reasons he would not interfere with the allocations made by the Hospitals Committee So for all practical purposes the Hospitals Committee decided the allocation. I have a list of the amounts allocated to the different hospitals under the different sweepstakes up to this, as published in the "Independent" some days ago, hospitals in Dublin, Cork, Limerick, Waterford, Louth, Kildare and Wicklow.
I do not know anything about the hospitals in places outside Dublin, but it did appear to me in regard to some hospitals in Dublin City that the allocation did not appear to be fair. I rather gathered that some of the Deputies of the House here thought that I, in suggesting a different allocation of the available surplus of the sweepstake money, that the county hospitals should get a higher proportion than originally proposed, that I was by that fact doing an injury to the Dublin hospitals. I suppose I was, to some extent, but I would like to be taken in no way as being hostile to the Dublin hospitals. I wanted to see a fair proportion of division between the city and the country hospitals.
I have some knowledge of some Dublin hospitals. For 25 years I have had close association with the Mater Hospital. Speaking for myself, I can say with regard to the very poor that I never failed to get a patient into that hospital when a patient needed attention. I never once failed. I mentioned that to people in Dublin in recent times, and I was told that I was evidently an exceptional person. That was true with regard to me and the facility with which I got people into that hospital. I can only speak of my own personal experience. That is true of the Mater, and to a limited extent of other hospitals. Certainly the Mater never refused a patient that I wished to get in. I now say that as to that hospital, which is one of the biggest in Dublin, and has probably the biggest number of beds, there is only 4 per cent. of the surplus allotted to it, while other hospitals that have not half the number of beds get a considerably higher percentage.
I do not want to interrupt the Deputy, but I may possibly help him if I explain how the percentage is arrived at. Various representatives of the hospitals came together, they then decided that they would draw up a principle upon which the money should be allocated. They did draw up a principle; they applied it, and the hospital representatives agreed. The unanimous report came to me. One hospital was very angry; it said it did not get enough; another hospital was not very pleased.
Was the Mater included in that?
They did not kick, but they were not very pleased.
I had reason to be in touch with the Mater. I was more or less at their mercy, and I heard a considerable amount of dissatisfaction.
I think it was very unfair to talk shop to the Deputy when he was ill.
They seemed to me to make a good case, seeing the number of beds that they set aside as free beds. They produced figures to show that they had 37 per cent. of beds for a certain number of years free.
For the future that will be a matter for the Committee of Reference.
The Hospitals Committee will draw up a scheme and submit it to the Committee of Reference.
The Committee of Reference will make the allocation.
I was given a list of the hospitals here and the arrangements set out for the next sweepstake. The hospitals have now certain deductions taken off the percentages previously arranged to be given to them in order to provide 5 per cent. for the Galway Hospital. The figures are: Sir Patrick Dun's Hospital, 6 per cent. less 1.25; the Meath Hospital, 6 per cent. less .75; the Richmond, 6 per cent. less .75; the Coombe, 6 per cent. less .75; the Temple Street Hospital, 4 per cent less .5; the City of Dublin Hospital, 6 per cent. less .5, and the Cork Street Fever Hospital, 6 per cent. less .5. The amounts these hospitals will get will be proportionately reduced. Comparing these figures as they stand with the reduced amounts, it does appear to me that there is a strong case for reconsideration of these percentages by the Committee of Reference, especially taking into account the number of beds and the number of free beds. I am told, with regard to Sir Patrick Dun's Hospital, that nobody is ever refused admission there no matter from what part of Ireland they may come. I am glad to hear it. They may be able to put up a very good case for a higher percentage than has been given to that hospital. The same applies to the Meath, the Richmond and the Coombe. They have all got a high percentage. I do not know anything about the percentage of the poor, but there is a very strong case for a close examination by an expert committee that the Minister will put up to go into these percentages and see that there is, according to the number of beds given to the poor and according to the financial and other requirements of the hospital, a just division of the available surplus.
If I may speak of Section 6, I want to say that I called the Minister's attention already to the wording of that section, and asked him if it would not be possible to do for the local authorities what has been done for the Hospitals Committee in another part of the Bill. In Section 5 of the Bill the Minister brought in an amendment to the effect that the Hospitals Committee ought not to be ignored. The Hospitals Committee should be consulted when the proportion that they should allot to the hospitals was being discussed. There is an equally strong case for consultation between the Local Government Department and the local authorities. The local authorities are not to be ignored altogether in this matter either. If there was a case for an amendment being brought in specially, so as to make it necessary to consult the Hospitals Committee before the allocation of the funds, I think there is an equally good case for consultation with the local authorities before allocating the funds.
The Minister said that he would consult his colleague, the Minister for Local Government and Public Health, and see if some amendment could not be brought in to that section. I would like to know if he has consulted him, and if it were not possible to pay that courtesy, if it were nothing else, to the local authorities. The same applies to the first paragraph in Section 6, where it says "it shall be paid to the Minister for Local Government and Public Health, and shall be applied by him in such manner as he shall think fit...." There is no reference whatsoever to any consultation with the local authorities as to whether they are to be allowed to have any say as to how that money is to be spent. The same applies to sub-section (2) (a) of Section 6, which says: "such application may be made conditional upon the fulfilment by such local authorities of such conditions as the said Minister shall think proper to impose." There is no question of consultation with the local authorities there. I think that is unfair, and not at all just to the local authorities, that the Bill is to give absolute power to the Minister to impose his will upon them as to how this money should be disposed of without consultation of any kind with the local authorities. Of course, the Minister has the final say. He has the money, and as long as he has the money the local authoriites will have to make up their minds to fall in with his views before they get that money. I think the least that ought to be done is that the compliment or courtesy should be paid to the local authorities before any scheme would be adopted by the Minister and imposed on them without consultation.
As far as the last part of the Deputy's statement is concerned, of course the local bodies will get no money from the Minister for Local Government until the scheme has been before him, and naturally that will have to be presented by the local body concerned. As far as the sub-section is concerned, "subject to such conditions as the Minister shall think proper to impose," that is obviously to ensure that the money shall be spent according to the provisions of the Act; for instance, if money is got for one particular thing that it shall not be expended on doing something else.
I agree. But ought not there be consultation?
I do not think there is any necessity.
Why was it necessary to bring in a special amendment to have consultation with the Hospitals Committee?
For the reason that the Hospitals Committee will have drafted the whole scheme and will have themselves put forward what is their view as to their needs and requirements. That is what they do now. They have always been agreed, and their agreed view should go before the other judges. There is no harm in anybody ever being heard, but there is no analogy between that and the local bodies, because it is not suggested by the Deputy that all local bodies should come together and put their case before the Minister for Local Government, whereas all the hospitals will be represented at the same time, and will be able to put their case, if it is a consultation—that they shall be heard, each one putting his own case.
There will be local bodies in each county that should have some say in that matter, and they would like to be consulted.
I think there is really only one local body in each county.
Question put and agreed to.
Question—"That the Bill do now pass"—put and agreed to.