The Bill is intended to give effect to a recommendation made by the Commission on the Relief of the Sick and Destitute Poor including the Insane Poor. It will be remembered that in paragraphs 266, 267 and 268 of their Report of August, 1927, the Commission wrote:—
"266. It would seem from the evidence given before us that in the City of Dublin there are a number of poor class maternity homes from which children are placed out to nurse.
"We are of opinion that all private maternity homes should be licensed annually by the local authority and that no licence be granted unless the home is properly and suitably equipped for the purpose, and that it was in charge of a respectable person trained in maternity care and nursing.
"267. From the Registrar-General's Report for 1924, it appears that one in every three illegitimate children born alive in 1924 died within one year of its birth, and that the mortality amongst these children is about five times as great as in other cases.
"268. It is high for many reasons, but there is one to which we wish specially to refer. The illegitimate child being proof of the mother's shame is, in most cases, sought to be hidden at all costs. What frequently happens is that the mother, or the mother's family, at the time the mother leaves the hospital or home, make arrangements with someone to take the child, either paying a lump sum down or undertaking to pay something from time to time.
"These arrangements are often made or connived at by those who carry on the poorer class of mater nity homes, and the results to the child can be read in the mortality rates.
"If a lump sum is paid or if the periodical payment lapse, the child becomes an encumbrance on the foster mother, who has no interest in keeping it alive."
At present there is no means of obtaining information as to the where abouts of the homes referred to by the Commission. Neither is there any power of inspecting them except that provided for the purposes of the Midwives (Ireland) Act, 1918, by Section 17 thereof. This section relates chiefly to the supervision of midwives. It is quite insufficient to insure the suitable and efficient management of the maternity home.
The aim of the present Bill is to bring all such homes under proper control and to provide machinery to insure that the patients who enter them will get skilled treatment, and that the interests of the infants will be protected.
It will be noted that "maternity home" is defined as any premises which are, either wholly or partly, used or intended to be used for the reception of pregnant women or of women immediately after childbirth. Any hospital or premises maintained or controlled by a Department of the State or by any local authority or by a body constituted by Special Act or by Charter will be excluded from the provisions of the Act.
The local authority for the purposes of the Act will be that entrusted with the supervision of the Midwives (Ireland) Act, 1918, that is the board of health in joint county districts, and the county borough councils in county boroughs.
The local authority will be required to keep a register of the maternity homes in their administrative area. The register will show in relation to each home the name and address of the person carrying it on and also such particulars of the premises as may be prescribed by the Minister.
The local authority will have power to refuse to register a home if
(a) the applicant is not a fit and proper person to carry on a maternity home, or
(b) the premises in which it is proposed to carry on the home are unsuitable for the purpose, or
(c) in the case of a home which was not in existence before the passing of the Act, the superintendent nurse is not a qualified nurse or a certified midwife.
The local authority will also have power to cancel registration if satisfied
(a) that the person registered is no longer a fit and proper person to carry on a maternity home, or
(b) the person registered has been convicted of an offence under the Act.
They may also cancel registration in regard to any particular premises if satisfied
(a) that the premises are no longer suitable for use as a maternity home, or
(b) that an individual who is neither a qualified nurse nor a certified midwife has been appointed after the passing of the Act to be superintendent nurse.
Provision is to be made for an appeal to the Minister against the refusal of the local authority to register a maternity home and also against the cancellation of registration by a local authority. The Minister will have power either to uphold the decision of the local authority or reverse it as he thinks proper.
When the local authority has registered a home they must issue a certificate of registration to the person carrying on the home, and such person must keep the certificate of registration exhibited in a conspicuous place in the home. It is felt that this is the most convenient way of giving assurance to the patients seeking admission.
The Minister is to be given power to exempt from registration any hospital or institution which is a maternity home but is not carried on for private profit.
A very high penalty may be imposed for carrying on a maternity home which is not registered, namely a fine not exceeding £50, and in case of a continuing offence a fine not exceeding £10 for every day during which the offence is continued.
Detailed provision is to be made for the records to be kept in registered homes. The records will cover receptions into the home, and discharges therefrom, confinements, miscarriages, births and deaths occurring in the home. The records will give the local authority full information as to the work carried on in the home. An important record for protection of the infants will be that showing the name of the person by whom an infant is removed from the home and the address to which it is removed. This record should enable the local authority to keep a check on the disposal of children referred to by the Poor Law Commission.
The Bill provides for the inspection of any maternity home within the functional area of a local authority, and also of the records kept in a registered maternity home by an authorised officer of the local authority.
