Dáil Éireann díospóireacht -
Friday, 12 Apr 1946

Vol. 100 No. 15

Committee on Finance. - Public Health Bill, 1945—Committee (Resumed).

Debate resumed on Section 96.

Mr. O'Leary

I am very sorry that the Deputies who sit on this side of the House are not here. I know that some Deputies who are not here are interested in certain amendments on the Order Paper. I should like to make my position clear. I was in the House, with Deputy Pattison, when these Deputies left the House. I think if any Deputies have a grievance it is those Deputies who come from the country. We book a room in a hotel for a certain time and if we are kept here beyond that time the room may not be available. I am surprised that Dublin Deputies who are on the spot should object to remaining in this House. We were all elected by the people to the Dáil and it is a pity that we have only a few Deputies present to discuss this most important Bill and to safeguard the interests of the people. I am very sorry that I am the only Deputy on this side of the House, although my colleague, Deputy Pattison, is in the building. Yesterday we were informed by the Government that the Dáil would adjourn to-day. That should not have been changed overnight. I hope that in future Deputies from the country will be notified of what is going to take place in regard to the sittings of the Dáil.

As Deputy O'Driscoll said, these jubilee nurses do very good work in our towns and cities. They are supported by ladies who raise subscriptions for their association. They give great service in the nursing of the poor and, in some cases, bringing them extra comforts. I hope that under this section they will not be thrown on the scrap heap. I am sure the Parliamentary Secretary, who is a professional man, will see that their work is not interfered with. As to the dispensary midwives, I think that their position should be improved, because they are rendering very useful service. If the services of a midwife are not available there is the danger of two lives being lost. I hope, therefore, that under this Bill their conditions will be improved.

Every encouragement should be given to young girls to take up nursing. Under this Bill a lot more nurses will be needed. At present young girls are going to hospitals in Great Britain to be trained as nurses. We should do all we can to encourage them and to help them to be trained at home. At present if a young girl wishes to become a nurse there is no prospect for her except her parents can pay a fee for her training. I should like to have provision made so that these girls could be trained without having to pay a fee to a hospital. If the Parliamentary Secretary could do something to encourage such girls to take up nursing it would be a very good thing for the country. I think there is some doubt amongst people outside about some of the powers being taken under certain sections of this Bill.

An Leas-Cheann Comhairle

We are only on one section now, Section 96, which deals with the appointment of nurses.

Mr. O'Leary

Will the Parliamentary Secretary give us any guarantee that under this section these jubilee nurses will not be interfered with in any way? Like other Deputies, I have received letters from this nursing association.

Mr. Flanagan

I do not think the Parliamentary Secretary can give a guarantee that they will not be interfered with.

Mr. O'Leary

What does he propose to do with them?

Mr. Flanagan

I do not know.

Mr. O'Leary

Does he want to scrap them? If the jubilee nurses are not interfered with, I would be satisfied with this section.

Mr. Bartley

If the Parliamentary Secretary is retaining the voluntary nursing associations, which I presume he is, I should like him to make some arrangement whereby the nurses trained under the Gaeltacht nursing scheme, which is operated under his Department, will receive appointments in Gaeltacht areas through these voluntary associations. These girls from the Gaeltacht would, by reason of their natural knowledge of the language, be very suitable for appointments in these districts, and they would be spared the initial difficulty of having to acquire the language while performing their duties. I know that the Parliamentary Secretary is very sympathetic in this matter and takes a very keen interest in the nursing scheme which his Department operates, but the voluntary nursing associations are, in the main, the people who provide nursing facilities for the districts to which I refer.

Mr. Flanagan

The section says that a sanitary authority may appoint for their sanitary district, or particular part thereof, a nurse to give advice and assistance on matters relating to health and to assist sick persons. I cannot see, as was suggested by Deputy O'Leary, that any steps are being taken to interfere with the rights of members of the Jubilee Nursing Association in the discharge of their duties in the various districts. I am sure the Parliamentary Secretary realises fully that the work done by these nurses in the different centres has been very valuable. He realises that they have a very difficult job to perform and that they deal with the poorer sections, for whom we all have great sympathy. They have certainly done more than their share to comfort and assist these people in every possible way, and I would strongly oppose any action which might lead to a curtailment of the activities of these nurses.

I have known these nurses to make calls as often as twice and three times a day to the houses of labouring men or agricultural workers in cases where there was serious illness in the family, and, in my own area, I know that these nurses have done great work and have brought very great comfort into the homes of working-class people. Furthermore, in the case of old age pensioners or other old people, who, on account of a certain amount of pride for which they must be respected, do not desire to end their days in the county home or other institution, and who remain at home to be cared for by a son or daughter residing with them, it is sometimes very difficult to deal with them, if they are undergoing a long illness in bed, and these nurses do very valuable work in these cases and they give as good assistance as any person in the medical profession could give. Very often the other persons in the household are not qualified to deal with a person who may be suffering from a long illness and who may become difficult to cater for.

The work of these nurses is very much appreciated by all sections and I should be glad if the Parliamentary Secretary would give consideration to providing that, where a sanitary authority appoints a nurse—and there is nothing to compel a sanitary authority to do so; they may or they may not—they will be compelled to pay a certain high rate of salary, so that that nurse will be able to give all her mind to the discharge of the duties she has to carry out in the district to which she is assigned. As Deputy O'Leary has pointed out, nurses are very badly paid and the manner in which they have been paid is, I think, a downright disgrace to the Parliamentary Secretary's Department. They are a section we cannot do without and a section which should be put in a position in which they will be able to live up to their responsibilities and to meet the high cost-of-living. They should be in receipt of such remuneration as will enable them to live in decency and to perform their duties with satisfaction to everybody, and without having to depend on any allowance which they may get from a patient or the relatives of a patient. If such nurses are to be appointed, provision should be included in the Bill whereby the sanitary authority appointing them will be required to pay them a decent wage.

An Leas-Cheann Comhairle

The Deputy has repeated that at least four times.

Mr. Flanagan

It is no harm to keep reminding the Parliamentary Secretary of this very important fact.

An Leas-Cheann Comhairle

Repetition is against good order.

Mr. Flanagan

If a sanitary authority appoints a nurse, and if the nurse then finds that she has to leave because her wages are insufficient to keep her, I believe it will have very serious effects. I trust that the Parliamentary Secretary will see that there will be no interference whatever with the present jubilee nurses, who have done such very valuable work for the poorer sections in our large towns.

Mr. L.J. Walsh

I approve of this amendment. In certain parts of my constituency where these nurses carry out duties, they have rendered very valuable service to the community and I cannot see anything in the section, or in any other section of the Bill, which is designed to interfere in any way with any voluntary service. The section says: "may appoint or provide". I think that is pretty plain, and I cannot see any reason for the alarm which some Deputies seem to feel with regard to interference with jubilee nurses. It might be well for us to throw our minds back and to recall the reason for the bringing into existence of the jubilee nurses. These nurses were brought into existence following Queen Victoria's Jubilee as a beneficial service to the poorer community of this country, but the necessity for their appointment arose from the impositions of the conqueror and the economic system then operating in this country, and I would welcome the time when the necessity for such organisations had passed from our midst. The Parliamentary Secretary is doing nothing to interfere with the continuance of this service. As a matter of fact, it is the duty of the local authority to provide such services. In one part of my constituency—the town of Drogheda—the jubilee nurses have been replaced by the Ladies' Nursing Association. So far as I can see, there is nothing in this Bill which will interfere with these voluntary services. There may be some overlapping. That may be all to the good so long as the rates are not unduly mulcted. Deputy Flanagan seems to have a short memory regarding the increased salaries for nurses. It was the Parliamentary Secretary who introduced legislation not very long ago to provide increased salaries for nursing staffs— increases which were long overdue. These are considerations to which Deputies should attend before they jump to hasty conclusions.

Dr. Ward

I might remind the House that Section 96 cannot operate, nor is it intended to operate, to divest any nursing organisations of the functions they at present exercise. Section 96 states:—

"A sanitary authority may appoint, for their sanitary district or a particular part thereof, a nurse to give advice and assistance on matters relating to health and to assist sick persons."

So far from having any intention of depriving the people of any existing nursing service, the policy behind Section 96 implies very definitely an extension of the nursing services we have at present. When we were discussing the mother and child scheme, I pointed out more than once that, when this Bill became law, it was intended to provide a nursing service in every dispensary district. The provision of such a service is completely beyond the scope of any voluntary organisation. I do not deny—nobody could truthfully deny—that voluntary nursing organisations have done tremendous work in this country. I submit that, regardless of any scheme of organisation that the local authorities and the central authorities may bring into operation and regardless of how we can organise our people for the protection of their health, there will always be scope in this country or in any civilised Christian country for voluntary effort. That voluntary effort will always be welcome because, in so far as the effort is voluntary, in so far as Christian charity in the true sense is exercised, in so far as people voluntarily tax themselves for the relief of the distress of their fellowmen, that relief is much more acceptable than the relief we provide when, in the exercise of our statutory powers, we extract money from the people for the same purpose. That is my outlook on the voluntary nature of the service.

Our problem in the future will not be one of trying to get rid of nurses. Our problem will be to find sufficient nurses to man our services. When one contemplates the provision of sanatoria in the early future with 2,100 beds, one must realise at once that a very big demand will be made upon the nursing organisation to supply the necessary nursing personnel. When we couple with that the policy of the Bill before the House of providing a domiciliary nursing service in every dispensary district, we realise at once that the comparatively early future will necessitate the provision of probably over 600 additional nurses for the public health services, so that there cannot be any question of nurses being deprived of their means of living. I ardently hope that when the time comes we shall be able to find the nurses in reasonable time to bring the services provided in the Bill into complete operation throughout the whole of the State. I believe it will take time— probably a number of years—to train and recruit the necessary nursing personnel to give full effect to the public health policy which has inspired this Bill.

Apart from the considerations that have been mentioned here by Deputies, who have very properly paid tribute to the result of the domiciliary nursing services that have been provided in certain remote areas, I ask Deputies to appreciate that extension of that service throughout the whole of the State must inevitably bring about an easing of the pressure on our institutional accommodation. The tendency even 20 years ago was to remain at home when ill. Deputies who are not so old will recollect that, even within comparatively recent times, the doctor's principal difficulty was that he could not get his patient to go to hospital because the patient had not the confidence in our local institutions that he has now. We have practically gone the full cycle now. By reason of the standard of the service we are providing in our institutions, we are being faced with the difficulty of providing sufficient accommodation in the hospitals. In so far as the nursing service will operate to induce people who do not require specialised service to remain at home during minor illnesses, it will be an ultimate economy, because the cost of maintaining a patient in hospital who might be equally well treated at home amounts to a substantial figure per week. When I say that, do not let anybody suggest that we have in mind nursing anybody at home who should more properly be treated in hospital. Sensible Deputies will agree with me that the tendency has now swung too far in the other direction. Everybody wants to get into hospital and, if everybody gets into hospital, it will be an expensive business to maintain these institutions.

Deputy Flanagan complains that Section 96 is not mandatory. It is refreshing to hear that. During the past three weeks, from day to day, I was attacked by the Opposition. That was because of the powers of direction to be exercised by the Minister to the local authorities in respect of matters concerning not only the health of the people but the lives of the people.

We have had epithets thrown across the House at the Government and the Party behind it. We have had talk about Fascism, dictatorship and so on, because we take the necessary powers to ensure that the laws made in the people's Parliament will be obeyed, and that any policy the Government, democratically and freely elected by the people, may determine in the interest of the health of the community, will be made effective and that if there is any recalcitrant local authority, steps will be taken to bring that local authority into line. That can be translated into dictatorship, if the principal Opposition want to use the proposals put before the House in relation to the provision of nurses, the provision of institutions or any other health service, for a purely political purpose, but Deputies who are taking a proper view of this matter, who view the provisions of this Bill from the point of view of the greater good of the greater number, will agree with me that if a policy has been decided on for the general good, it should be made to apply uniformly. While we have not taken powers of direction in relation to the provision of nurses, of it is necessary to put pressure on local authorities to make the provision operative, I am quite sure that that pressure will be exercised and I do not care whether they call that dictatorship or not.

Deputy Bartley raised the question of Gaeltacht nurses and Gaeltacht services. Deputy Bartley is aware that so far as it is possible to achieve it, we are trying to provide Irish-speaking nurses for the Gaeltacht and that a preference is given to such nurses for appointments in the Gaeltacht but it is not always possible to have the necessary trained personnel avialable He realises that that is Government policy and that his particular local authority, so far as the Gaeltacht area is concerned, is co-operating with us to some extent in the operation of that policy. I think that his question relates more to the voluntary organisations. In the matter of sending Irish speaking nurses to the Gaeltacht we have not exercised any powers of direction towards these voluntary organisations, but they know Government policy in the matter and we would expect them to do anything that lies in their power to make Government policy in this regard operate satisfactorily.

As to the ultimate position of these voluntary nursing organisations, I am not sufficient of a prophet to be able to indicate to the House what the position may be in five, seven or ten years but I do say that our immediate problem will be to provide nursing services corresponding to the services which the jubilee nurses are providing throughout the rest of the country. It seems to me probable that the future must see the absorption of these nurses into the local authority services but that is a matter we need not concern ourselves about now. It is a development that cannot take place for some considerable time.

Mr. Cogan

I was waiting for the Parliamentary Secretary to make his statement, because I was anxious to have clearly outlined what the functions of the nurses will be under this section. The section is a very short one, but it is very wide and general in its terms. It seeks to provide nurses to give advice and assistance relating to matters of health and to assist sick persons. I am anxious to know what classes of persons will be attended by these nurses. What classes of persons will it be the duty of these nurses to attend? It will, I know, be the duty of these nurses to attend mothers and children up to the age of 16 years under another section in the Bill. I assume it will also be the duty of the nurses to attend persons other than mothers and children who are dependent upon the dispensary medical service—that is, poorer persons. I put down an amendment to another section of the Bill but, unfortunately, I was not in the House when it was reached and I did not get time to move it. I do not know if the Parliamentary Secretary accepted it, but I should like to make it the duty of such nurses, and also the duty of doctors, to attend aged and infirm persons who are living alone and have no one to take charge of them. Such persons might not be dispensary cases if they own a small amount of land. Nevertheless, they would be in a very peculiar and helpless position. I am just wondering if this section will enable nurses to attend them.

Dr. Ward

No. The Deputy need not labour the matter. It does not cover such persons, apart from persons who are entitled to public assistance under the Public Assistance Acts. This is a public health measure, mainly confined, so far as the nursing services are concerned, to mothers and children. Nursing services can also be made available to public assistance classes by the local authority. Other classes, except those affected by the tuberculosis scheme, are not included.

Mr. Cogan

The section to which I am referring would be a rather narrow section but, at the same time, such a system would be urgently desirable. Such people might not think it necessary to call in medical aid. You might have an old person living alone, who would be a more or less chronic invalid. If those persons were to call in medical aid, it would mean paying for such assistance and they might not feel that they required it. I feel that the medical officer or the district nurse would certainly know if they required assistance, if these poor people were in the position in which they might at any time lose their lives by reason of lack of attention. I think that if it was at all possible to extend the scope of the Bill to such persons the Parliamentary Secretary ought to consider it. It would be particularly necessary in rural areas.

Mr. O'Driscoll

I should like to ask the Parliamentary Secretary one question. Will the State pay any portion of the nurses' salary?

Dr. Ward

There is no intention in the immediate future to interfere with the present financial basis.

Question put and agreed to.

SECTION 97.

Mr. Cogan

I move amendment No. 150:—

Before sub-section (2) to insert a new sub-section as follows:—

(2) Where land is available a sanitary authority shall provide recreation grounds suitable for such games as football or hurling adjacent to all primary schools for the use of the pupils of such schools.

The purpose of this amendment is to ensure that, where land is available, it shall be the duty of a sanitary authority to provide recreation grounds attached to primary schools in all areas. I think there is no need to labour the desirability of having such a provision in the Bill. We all know that a great number of our primary schools have no accommodation for outdoor games. In many cases children have to play on the public roads. In other cases we find them, during the lunch interval, sheltering around by the walls, shivering with the cold, perhaps, and that is not a desirable state of affairs.

I think nobody can underestimate the value of well-regulated outdoor games for children. They are just as much a source of education as anything the children may learn in the schools, particularly if the games are well-regulated and conducted according to the rules. The ability to take part in one of these outdoor games, particularly national games such as football and hurling, not only develops the physical health of the children, but it develops their characters, it gives them confidence and assurance and I think it is a help to them from every aspect in facing the battle of life.

The Parliamentary Secretary should not hesitate to accept the amendment. In the section there is considerable provision made for the acquisition of land for recreational purposes. In this amendment we are seeking to do what Deputy Flanagan pointed out in regard to other sections, and that is, to provide a definite direction to the local authority to make such land available.

It might be contended that the acceptance of this amendment would place a severe additional burden upon the finances of the local authority. I believe the problem to be faced is not so much a problem of finance as of power to acquire the necessary lands. The amount of land required will not be extensive, but it might be difficult to acquire it without legal power. I believe that local areas, the parish or school areas, where such land is provided, will be quite happy to pay the cost, or a very substantial amount. In many cases local authorities make separate charges with respect to expenditure of this kind. I think the people in the local area will be prepared, in most cases, to put up a portion of the cost by way of subscription, as in the case of the building of schools. Whatever cost is involved, it will be more than offset by the saving achieved in the better health of our growing population and in the realisation that a healthier population will not be as great a burden on our institutional services as at present.

Mr. L.J. Walsh

I have the feeling that Deputy Cogan is shoving an open door in this matter. Being a representative of a local health authority. I may say that in our case we have already done what Deputy Cogan asks us in this amendment to do. We have provided playgrounds and football fields for the children of the town. Some of the smaller provincial towns have done so, too. I am not quite satisfied that the public health authority will have to get specific power under this Bill in order to do that. I would be very much surprised if the Parliamentary Secretary informed us that we have not got that power.

Mr. P. Burke (County Dublin)

I am delighted with this section because in County Dublin there is a crying need for parks and playing fields, both for children and adults. I am delighted that this section is inserted in the Bill to cover that particular matter.

Dr. Ward

I might, perhaps, point out that the power set out in Section 97 is a very extensive power. The sanitary authority may provide facilities for games or other recreation and for that purpose may, in particular, do all or any of the following:

"(a) acquire land in their district or at a convenient distance therefrom,

(b) appropriate land held by them which is not required for the purpose for which it is held,

(c) themselves manage any land so acquired or appropriated,

(d) provide equipment, appliances, boats, animals and other things for games or recreation on any land so acquired or appropriated and make charges for the use of such things,

(e) let any land so acquired or appropriated to any person for use for games or other recreation,

(f) contribute, subject to such conditions (if any) as they think proper, to the provision of land in their district or at a convenient distance therefrom for use for games or other recreation and to the provision of equipment for games or other recreation on any such land."

It is very interesting to hear Deputies telling us that we are not doing enough about anything. Once again the Opposition urges me to make it obligatory on the local authority, if the land is available, to provide playgrounds in connection with schools. I anticipate that if ever the main Opposition Party comes back to the House, there will be a split in the camp; that the members of the Farmers' Party and of the National Labour Party will keep urging me to drive and direct and insist that local authorities will perform all their functions under this Bill. If the people who will once again, presumably, occupy the benches opposite, accuse me of dictatorship should I exercise these powers, I look forward to protection and assistance from the Farmers' Party and the National Labour Party and the Independents, because, of course, Deputy Flanagan will assist me, too.

I think we have gone a long distance in this section in so far as we are providing the statutory machinery for making available these recreation facilities to which I have referred. I do not deny that the provision of recreation ground in the immediate vicinity of our elementary schools, and of our secondary schools for that matter, is very desirable. Nobody will deny that. But it is the function and duty of the educational authorities to provide that facility and not the function or the duty of the local authorities, acting either of their own volition or at the direction of the Minister. Hence, I think it would be desirable that members who have strong and enlightened views on this matter should make their views known to the education authorities concerned, particularly when they set out to acquire a new site, so that in acquiring the site for a new school the necessary recreation ground will be included in the site, if it is available.

Local authorities will, presumably, exercise the powers conferred by this section in an intelligent way, and with a view to providing the greatest possible facilities for the people of their district, whether they be school children or adults. Consequently, one would anticipate that local authorities, in exercise of the powers conferred upon them by this section, will proceed to acquire a site, if it can be acquired convenient to a school, so that the children attending can have the use of a playground that is also available to adults. The intelligent members of local authorities will take these matters into consideration. But, it will be found, as Deputies who recall their earlier days realise, that a pitch which would be suitable for hurling, football and games in which the adult members of the community participate, may not be available anywhere near a school site. Local authorities, when spending the ratepayers' money in the provision of this amenity will naturally try to ensure that they should provide them with a facility that would be of some immediate benefit to them. Their primary consideration will be to acquire a pitch. If, well and good, it cannot be provided in the immediate a double purpose is served. If is cannot be provided in the immediate vicinity of a school, we can scarcely ask local authorities to provide a playing pitch for adults, and, in addition, a sports ground for every school in their district. I do not think it would be reasonable to ask them. Where a new site has been acquired for a school, and where land is available, a smaller area that would provide the necessary recreation facilities for children ought to be acquired. That is not a matter for this Bill. It is one for the Minister for Education or for the managers.

Mr. Donnellan

This is a Public Health Bill and the Parliamentary Secretary realises that the health of the children is our greatest concern. I am sure he will admit that when he goes to rural areas he finds schools and within ten yards of the foundation there is a high wall, inside which the children have to remain from 10 o'clock in the morning until they leave at 3.30 in the evening. The Parliamentary Secretary will admit that that is not good for the health of the children, and that it will not help them to be stronger. As to compulsion, I hold that we should go to any length in order to improve the standard of health of our people. The Parliamentary Secretary referred to a certain Party which left the House coming back, and spoke about a split. I know nothing about any co-operation. Any Party in this House can do what it likes. That is their look-out. The Party to which I have the honour to belong, I can assure the Parliamentary Secretary, is not led by the nose by any Party in this House. We have independent minds. The Parliamentary Secretary stated that there is a hope for this proposal when new schools are being erected. It is happening to-day. The Land Commission in some parts of my constituency have helped in a few places by giving pieces of land for play-grounds. Deputy Killilea will confirm that. However, it must be remembered that it would take years to deal with the question, and that we would have to wait until new schools are erected before getting additional land for such a purpose.

The case has been made that a playing pitch for a school should be a first class one. I do not agree with that. Children of 12 or 14 years of age do not require first class playing fields for hurling or for football. I think the Parliamentary Secretary is looking too far ahead, when he suggests that these playing fields should be of standard size. Children would not require such a standard in play-grounds. As regards pitches for adults there is hardly a parish that has not a good playing field. I urge the Parliamentary Secretary to consider the amendment in the interests of the health of the children. If children are kept for hours inside school walls that does not tend to improve their health, either in rural areas or in cities.

Mr. P. Burke

The only point on which I differ from Deputy Donnellan is this, that the proposal would mean the provision, possibly, of two playing fields in a parish.

Dr. Ward

Not at present.

Mr. Burke

Take the position of a parish in which there is no playing field. There are parishes in my constituency without football or hurling pitches.

Mr. Donnellan

That could happen in the city.

Mr. Burke

That is the position in numerous places in County Dublin. If two playing fields are to be provided in parishes, that is going to complicate the position. While I agree that what is proposed is desirable, I think a number of parishes would be satisfied if they had one decent park.

Amendment put and declared negatived.

Dr. Ward

I move amendment No. 151:—

Before sub-section (3), to insert a new sub-section as follows:—

(3) A sanitary authority may on such days as they think fit (not exceeding 12 days in any one year nor four consecutive days on any one occasion) close to the public any land managed by them under this section or any part thereof and grant the use of such land or such part, either gratuitously or for payment, to any person for the purposes of any sport or entertainment.

This provides for a new sub-section to be inserted before sub-section (3). It will empower a sanitary authority who have acquired land for the provision of facilities for games or other recreation to close to the public such land or portion thereof on certain days in the year so that competitive games may be held thereon and the public admitted either gratuitously or for payment. It is a machinery amendment.

Amendment agreed to.

Dr. Ward

I move amendment No. 152:—

In sub-section (3), page 47, line 4, to delete the word "water;" and substitute the words "water and tidal lands within the meaning of the Foreshore Act, 1933 (No. 12 of 1933);"

This extends the definition of land.

Amendment agreed to.

Section 97, as amended, agreed to.

Amendments Nos. 153, 154 and 155 not moved.

Section 98 agreed to.

SECTION 99.

Dr. Ward

I move amendment No. 156:—

In sub-section (1), page 47, line 13, to delete the word "relates)" and substitute the words "relates or expenses declared by or under the Public Health Acts, 1878 to 1946, to be private improvement expenses)"

This is a drafting amendment.

Amendment agreed to.

Section 99, as amended, agreed to.

Section 100 agreed to.

Amendments Nos. 157 to 165, inclusive, not moved.

Section 101 agreed to.

SECTION 102.

Amendments Nos. 166 and 167 not moved.

Dr. Ward

I move amendment No. 168:—

In sub-section (1), page 48, line 5, to delete the word "provision," and substitute the words "provision and so informs such person,".

The object of this amendment is to ensure that the officer of a health authority who has reasonable grounds for believing that a person has contravened a provision of the Public Health Acts, regulations or by-laws which he is authorised to enforce shall before asking such person's name and address inform such person in regard to such contravention of the provisions of the Acts, regulations or by-laws. This amendment will facilitate the obtaining by the health authority officers of the desired information by making clear to the person accosted by that officer the reason for his being asked for the information.

Amendment agreed to.

Amendments Nos. 169 to 173, inclusive, not moved.

Dr. Ward

I move amendment No. 174:—

In sub-section (3), line 23, to delete the word "effect:" and substitute the words "effect unless the officer has reasonable grounds for believing that such person is a probable source of infection with an infectious disease:".

An officer of a health authority who is charged with the duty of tracing and detaining a person in respect of whom a detention order under Section 29 of the Bill has been signed by a chief medical officer of a county authority or port sanitary authority may discover such person in a street or premises. The effect of this amendment is to ensure that in such a case the officer of the health authority shall not apply to such person the powers granted in sub-section (3) of the Bill. In this way, the risk involved in bringing a probable source of infection into Gárda barracks will be avoided.

Amendment agreed to.

Amendments Nos. 175 to 179, inclusive, not moved.

Section 102, as amended, agreed to.

SECTION 103.

Dr. Ward

I move amendment No. 180:

In sub-section (1), page 48, line 45, to insert before the word "may" the words "(either alone or accompanied by such assistants as he thinks proper)".

On many occasions when an authorised person exercises the right of entry on premises provided for in this section, the duty which he may be called upon to carry out on entry on the premises may need the assistance of other persons. It is for this purpose an amendment has been provided.

Amendment agreed to.

Amendment No. 181 not moved.

Dr. Ward

I move amendment No. 182:

To delete sub-section (2) and substitute the following sub-section:

(2) An authorised person (other than the Minister, the manager for a health authority, or a chief medical officer) shall not enter any premises under this section unless he produces for inspection by the person in occupation or in charge of the premises, if such person requests him so to do, his appointment in writing as an authorised person.

This is a drafting amendment.

Amendment agreed to.

Amendments Nos. 183 to 188, inclusive, not moved.

Dr. Ward

I move amendment No. 189:

In sub-section (5), page 49, to insert before the word "by" in line 18 and line 22 the words "in writing".

This is a drafting amendment.

Amendment agreed to.

Dr. Ward

I move amendment No. 190:

In sub-section (5), page 49, to insert before paragraph (d) a new paragraph as follows:—

"(d) a chief medical officer,".

It is desirable that a chief medical officer should be designated as an authorised person for the purposes of those sections. It is only a machinery amendment.

Amendment agreed to.

Section 103, as amended, agreed to.

SECTION 104.

Amendments Nos. 191 and 192 not moved.

Dr. Ward

I move amendment No. 193:—

In sub-section (3), page 49, between lines 43 and 44, to insert the following:—

"(c) a chief medical officer,".

This is a drafting amendment, corresponding to the one we have just dealt with.

Amendment agreed to.

Section 104, as amended, agreed to.

Amendment No. 194 not moved.

Section 105 agreed to.

SECTION 106.

Dr. Ward

I move amendment No. 195:—

In page 50, to delete lines 33, 34 and 35, and substitute the following words "authority as respects functions conferred on a county authority by this Act in like manner as those sections, as so amended, apply in relation to a sanitary authority as respects functions conferred on a sanitary authority by this Act."

This is a drafting amendment.

Amendment agreed to.

Section 106, as amended, agreed to.

Section 107 and 108 agreed to.

SECTION 109.

Dr. Ward

I move amendment No. 196:—

Before Section 109, to insert a new section as follows:—

References in any statutory or other enactment in force at the commencement of this section to sanitary officers shall be construed as references to officers of health authorities, being officers whose duties relate to the administration of the Public Health Acts, 1878 to 1946.

Having regard to the repeal by this Bill of Section 11 of the Public Health (Ireland) Act, 1878, which provides for the appointment of sanitary officers, it is desirable, in view of references to sanitary officers in Section 58 (2) (b) of the Local Government Act, 1898, to provide for the adaptation of references to such officers so that they shall be construed as references to officers of health authorities. This is really a machinery amendment.

Amendment agreed to.

Dr. Ward

I move amendment No. 197:—

Before Section 109, to insert a new section as follows:—

In any prosecution for an offence under this Act, it shall not be necessary to negative by evidence any permit, licence or exemption under this Act or under any regulations under this Act, and the onus of proving any such permit, licence or exemption shall be on the person seeking to avail himself thereof.

This amendment is intended to provide that, where legal proceedings are taken in pursuance of this Bill against a person who relies for his defence on a claim to hold a permit, licence, or exemption under the Bill or regulations made thereunder authorising his action, the onus of proving the possession and validity of such permit, licence, or exemption will rest on the defendant.

Amendment agreed to.

Section 109, as amended, agreed to.

SECTION 110.

Dr. Ward

I move amendment No. 198:—

In page 51, line 6, to insert before the word "and" the figures ", 28".

The intention of this amendment is to refer to the repeal by this Bill of Section 28 of the Public Health Acts Amendment Act, 1890. It is a drafting amendment.

Amendment agreed to.

Section 110, as amended, agreed to.

SECTION 111.

Dr. Ward

I move amendment No. 199:—

In page 51, line 11, to insert before the word "shall" the words "(except Sections 92 and 93 repealed by this Act)".

The intention of the amendment is to refer to the repeal by this Bill of Sections 92 and 93 of the Public Health Acts Amendment Act, 1907, relating to bathing places and provision of lifesaving appliances, respectively.

Amendment agreed to.

Section 111, as amended, agreed to.

Sections 112 and 113 agreed to.

FIRST SCHEDULE.

Amendment No. 200 not moved.

Dr. Ward

I move amendment No. 201:—

Before the repeals in the Public Health (Ireland) Act, 1878, to insert the following repeal:—

“31 & 32 Vic., c. 87.

Vaccination Amendment (Ireland) Act, 1868.

The whole Act.”

This is a drafting amendment.

Amendment agreed to.

Dr. Ward

I move amendment No. 202:—

To delete the entry relating to the Public Health (Ireland) Act, 1878, and to insert the following:—

“41 & 42 Vic., c. 52.

Public Health (Ireland) Act, 1878.

Sections 11, 25, 26, 51, 72, 132 to 135, 138 to 156, 167 and 232.”

This is also a drafting amendment.

Amendment agreed to.

Dr. Ward

I move amendment No. 203:—

In the third column, opposite the mention of the Public Health Acts Amendment Act, 1890, to insert before the word "and" the figures "28".

Amendment agreed to.

First Schedule, as amended, agreed to.

SECOND SCHEDULE.

Dr. Ward

I move amendment No. 204:—

To delete paragraph 3 and substitute the following new paragraph:—

3. The requiring of adult persons to submit themselves, or the parents of children to submit such children, to specified measures in relation to the protection or immunisation of such adult persons or children against a particular infectious disease.

In the Second Schedule powers are given to make regulations, and the particular matters in respect of which regulations may be made are set out in the Schedule. Heading 3 of the Schedule sets out:—

The requiring of adult persons to submit themselves, or the parents of children to submit such children, to a specified treatment in order either—

(a) to protect or immunise such adult persons or children against a particular infectious disease, or

(b) to prevent such adult persons or children from infecting others with a particular infectious disease.

The House has very fully discussed the matters involved in the Schedule, as drafted. Various unreasonable interpretations have been put upon this heading, which is set out in the Second Schedule. The suggestion was made, with an air of seriousness, that within the powers set out here the most drastic measures might be taken in respect of a patient who was a probable source of infection, in order to ensure that the infection might not be transmitted to another person. Deputies who were then on the opposite benches asked the public to believe that we had in contemplation the removal of organs vital and otherwise. Well, there never was any intention to operate the powers in that way, and, in fact. there was nothing in the powers under heading 3 that was not already in the existing law. As I pointed out to the House, when we met the principle involved in this on an earlier stage of the Bill, the regulations that had been signed by Deputy Mulcahy himself. when he was Minister for Local Government in 1929, empowered a medical officer to take such steps as were necessary or desirable for the purpose of, amongst other things, preventing the spread of an infectious disease. He could take such steps as were desirable, if he considered it desirable or necessary, to remove vital organs; he had statutory power to do so, under Deputy Mulcahy"s own signature. I am not finding any fault with the power, but I am finding fault with the suggestion that the present Government was embarking on a policy that would only be operated in some of those totalitarian States that we hear so much about. That type of criticism can scarcely be accepted as honest in the light of the powers that Deputy Mulcahy himself gave over his own signature when he was Minister for Local Government to the officers responsible for the control of infectious diseases.

A certain amount of public curiosity was created following the misrepresentation that occurred in regard to these powers, and in order that there could be no question or no doubt in the mind of anybody that the powers that we are proposing to exercise were merely precautionary powers to prevent the spread of disease, and did not include either medical treatment, as such, or an operation of any kind on the patients themselves, amendment No. 204 has been circulated. It is to be taken in combination with amendment No. 211. Amendment No. 204 empowers the Minister to make regulations

"requiring of adult persons to submit themselves, or the parents of children to submit such children, to specified measures in relation to the protection or immunisation of such adult persons or children against a particular infectious disease."

The measures to which they would be called upon to submit are restricted to the measures that may be necessary for immunisation purposes, and in order that there could be no misunderstanding about the matter, a further Ministerial amendment has already been introduced and accepted to Section 29, providing that

"medical or surgical treatment shall not be given to the patient in such hospital or other place without the consent of the appropriate person."

We have now definitely ruled out by statute medical or surgical treatment, and we have further modified the heading in respect of which regulations can be made so as definitely to confine the steps that may be taken, in regard to a person who is a probable source of infection, to immunisation measures. When Section 29 was under consideration in the House, and when it was suggested that, notwithstanding these two amendments, there still remained some doubt, I undertook that I would further examine this whole matter, and that, if it were necessary to further clarify the position, I would make it so clear that a blind man could not fail to see it.

Major de Valera

There is one point that, referring back to the previous discussion on the section referred to by the Parliamentary Secretary, I wish to mention. This provision empowers the Minister to make regulations providing for compulsory immunisation and all the safeguards that the Parliamentary Secretary has mentioned would apply. In these regulations, is it proposed to make any particular allowance for individual cases, where, for instance. immunisation might be dangerous? For instance. you would meet a particular case where, because of the bad state of health of the person or because of a peculiar condition, immunisation might be rather dangerous for the person concerned. I take it the Parliamentary Secretary would cater for that in regulations, and that a provision would be made for, say, consultation with the person's medical attendant with a view to having taken whatever steps that might be appropriate to meet the individual case. It is quite proper to have this provision. I do not see that the Parliamentary Secretary can have anything less than this provision in order to implement his Bill, but I think the case I have mentioned should be catered for when it comes to the question of making regulations under the Bill.

Mr. Cogan

I raised an objection to this matter on Section 29 of the Bill. I had an amendment down which sought to provide exemption for persons who claimed exemption on conscientious grounds. I am still strongly of opinion that provisions should be made for such exemption. There is no absolute certainty that inoculation will be beneficial in all cases or that any particular form of inoculation or immunisation will be successful. We have had long and painful experience of vaccination against smallpox. and I think it is generally accepted now, since compulsory vaccination is discontinued by this Bill, that it was not as effective as it was claimed to be. As a matter of fact, I think it is now admitted that there was never any real vaccination against smallpox, because the effects of vaccination last for only six or seven years, and therefore the entire population over six or seven years were not vaccinated at all. In addition to that, there was always a very substantial percentage of the population that never obeyed the law in regard to that matter. Notwithstanding that, we have not been troubled very much with smallpox. As a matter of fact, that particular disease has been eliminated over the past 100 years by the adoption of better housing.

Major de Valera

And very largely by vaccination.

Mr. Cogan

If Deputy de Valera's contention is right, it is a rather strange thing that we should be discontinuing the provisions of the Vaccination Acts. I believe it is more or less universally agreed that smallpox was not eliminated by vaccination but by better living conditions——

Major de Valera

That is not the medical opinion.

Mr. Cogan

——and a better standard of living and, I think, a better standard of cleanliness. As far as diphtheria and other infectious diseases of that kind are concerned, better conditions of living and better housing will make for the elimination of the diseases to perhaps a greater extent than immunisation. But even if we accept the view that immunisation is generally desirable, there may be, as Deputy de Valera rightly pointed out, certain persons in regard to whom immunisation might be fatal because of the condition of their health. Deputy de Valera suggests the insertion of a provision which would enable, or which would more or less compel, the medical officer in the case to consult with the medical attendant of the patient. I would be inclined to go further and to say that the person directly concerned, the person who is going to be inoculated or immunised, or the parent of the child who is going to be inoculated or immunised, should have the right to object in the first instance, if he so desires. I think it will be found that people have a fair measure of common sense and, if it is proved beyond question that a particular form of immunisation or inoculation is effective generally, you will have the overwhelming majority of the people accepting it. There may be a few who will object on conscientious grounds but their number will be so small that it will not affect the general operation of the measure. I am not suggesting that there should be easy methods of evasion provided but, if a person feels very strongly in the matter in regard to his own health or in regard to the health of his child, there should be some means of evading the measure and, particularly, there should be some exemption for people who are prepared on oath to declare that they have a conscientious objection to submitting to such treatment.

Dr. Ward

I am not going to treat this in detail and I think Deputy Cogan will not expect me to, in the light of the fairly full discussion we had on the matter of immunisation in the earlier stages of the debate. When that matter arose on an amendment by, I think, Deputy McGilligan, I went into the question of immunisation fairly fully. I put on the records of the House certain figures and experiences that I think will impress Deputies when they find the time to read the debate, if they have not been present during the discussion. The discussion lasted so long that very few Deputies were present throughout the whole of the debate. I think, in the circumstances, that is very understandable and that it would have been a physical impossibility for anybody to remain all the time. The wonder is how so many of us did survive for so long a time. Regarding the point raised by Deputy de Valera as to a provision in the regulations for exemption of persons who, because of their state of health, might be particularly susceptible to severe reaction as a result of any immunisation treatment, that will, of course, be provided for and discretion will rest with the chief medical officer. Notwithstanding the fact that a scheme might compulsorily apply to an area, there will be provision for the exemption of persons on medical grounds. That usually works out all right in practice without much statutory intervention. Professional etiquette and the relationship between the family doctor and the chief medical officer of health succeed in getting over many difficulties that are very difficult to provide for in a code of law. The less interference in some of these matters that there is in a statutory way the better it is for all concerned. However, the regulations would provide for the exercise of special care in the selection of persons who might be exempt from an immunisation scheme. In fact, what we are doing under this code in relation to immunisation and vaccination, and in particular in relation to vaccination, is that we are providing that an immunisation scheme or a vaccination scheme or any such form of protection can be carried out under the direction of the Minister in any particular part of the State at any particular time.

It is interesting to hear the views of Deputies in relation to the powers we propose to take here. Before they got exhausted in this long-distance trial, one section of the Fine Gael Party was very critical of the proposed repeal of the vaccination law. But, in order to be sure that they would have all sides of medical opinion with them, another section of the Fine Gael Party attacked the Bill on the grounds that we were taking powers in any circumstances either to vaccinate or to immunise. No matter how persuasive I might have been before they left, I could not have satisfied those two schools of thought on the Front Bench of the Fine Gael Party.

Vaccination has been compulsory in this country without any conscience clause, not only in the olden days which we are all so glad have come to an end, but during the whole period that the country was blessed with the Cumann na nGaedheal Government, vaccination was compulsory; there was no conscience clause, and there was no protest. It has been compulsory, so far as the law is concerned, in the 14 years this Government has been in office, and there has been no protest from Fine Gael. But, when we proceed to do something that appears to be sensible, when we proceed along this line of reasoning and we say that, by the blessing of Providence, it is a very long time since we had any case of smallpox in this country, when we say that the chances appear to be that people are not likely to be stricken with smallpox in future in so far as it is possible to envisage circumstances, when we say that, in these circumstances and in that setting, it does not appear to be any longer necessary to retain these powers of compulsory vaccination and to impose them upon a people who doubt not that vaccination has ceased to be a protective agent against smallpox, not that it has a protecting influence, but the need for exposing their children to the reaction and other complications that sometimes occur arising out of vaccination, we have this protest from the Opposition.

As Deputy Cogan has hinted, it is scientifically sound to say that the protective effects of either immunisation or vaccination wear off in the course of time. Consequently, it appeared to me illogical that we should compulsorily vaccinate a child if we do not compulsorily re-vaccinate at a period when medical scientists are agreed that the effect of the original vaccination had about passed off. Consequently, I have advised the Minister, and he in turn has advised the Government, that we did not appear to be taking any serious risk so far as the health of the community was concerned if we abandoned compulsory vaccination in this country, so long as we retained the power to put at the disposal of the people that protecting agent in the event of the misfortune coming upon our people that smallpox would again appear.

That is what we propose doing in this Bill. We propose to retain the power to make vaccination or immunisation in any form compulsory in any particular area, if the circumstances of the time appear to demand such a step in the interests of the protection of the health of the community. It seems to be sound and sensible, but of course it does not matter a thraneen how sound or how sensible any proposal is coming from these benches; one or other of the sections of the Opposition must find fault with it if they can get any volume of opinion at all, however irresponsible it may be, to sustain them in their viewpoint.

When this matter was under discussion before, we were reminded that a number of medical gentlemen, with a number of letters before and after their names, had expressed the opinion that vaccination was, in fact, more of a danger than a protection to the people. I saw that communication in the Press and all I can say is that a search of the medical directory has failed to find the addresses of these gentlemen and, if they are as eminent in their profession here in the City of Dublin as the public are asked to believe, I can only say that they cannot be traced; and I have not met any eminent member of the medical profession, or indeed any other, who has been able to tell me that there are any distinguished men amongst the list of people who are alleged to have signed that document.

Amendment put and declared carried.

Amendments Nos. 205 to 210, inclusive, not moved.

Dr. Ward

I move amendment No. 211:—

In paragraph 11, page 53, lines 30 and 31, to delete the words "bacteriological and protozoological".

It is a drafting amendment.

Amendment agreed to.

Amendment No. 212 not moved.

Second Schedule, as amended, agreed to.

Amendment No. 213 not moved.

Third Schedule agreed to.

Amendments Nos. 214 to 217, inclusive, not moved.

Fourth Schedule agreed to.

Fifth Schedule agreed to.

Bill reported with amendments.

Title agreed to.