Health Bill, 1947—Committee Stage (Resumed).
Section 26 agreed to.
SECTION 27.
I move amendment No. 22:—
To delete sub-section (5) and substitute the following sub-section:—
(5) Regulations under this section may provide for and authorise the making of charges for the purposes of the regulations or for services performed thereunder and may provide for the recovery of such charges.
This might be regarded as a drafting amendment. We were rather confined in the charges that might be made but, as well, the sub-section which it is proposed to delete was rather badly worded. It was not clear whether the cleansing and disinfection might not be held to be cleansing and disinfection of rats. The wording of the proposed amendment is clearer and wider and I think it also covers the idea embodied in the next amendment by Deputy Cosgrave.
The amendment reads:—
"Regulations under this section may provide for and authorise the making of charges for the purpose of the regulations or for services performed thereunder and may provide for the recovery of such charges."
I think it was pointed out yesterday that in a subsequent part of the Bill provision is made for the compulsory treatment or isolation of persons in connection with infectious diseases and, if the element of compulsion is brought into play, the full cost of treating them will be borne by the State. I think it was Deputy Dr. O'Higgins who pointed out that if it is intended to make any charges in connection with the treatment of infectious diseases, and if the fact of raising an objection to being treated, will mean that the State or the local authority will have to provide for the whole cost of treatment, that will induce people to resist complying with regulations or the procedure that might ordinarily apply, in order to escape the known costs or even the unknown costs in which they might otherwise be involved. I submit, therefore, that either a little more explanation or a little more safeguarding of the position is required in connection with this amendment. Under this amendment it would be possible for the Minister to make regulations which would provide for the making of charges for any kind of work done or any kind of service performed in connection with the treatment of infectious disease.
I should mention that it is not intended that charges in connection with the treatment of infectious diseases will be made except in such cases as the destruction of rats in vessels or in connection with the disinfection of premises or aircraft. It is not intended to make any charges where a person is treated.
For the destruction of rats?
Yes, or the cleansing of premises, the disinfection of aircraft or services of that kind.
Will the Minister undertake to amplify his amendment on the Report Stage by the inclusion of a specification of that kind?
I should say that in Section 34, which deals with the compulsory detention of a person, sub-section (7) definitely lays it down that the local authority will pay the costs.
That is why I suggest that this amendment is too wide to warrant its inclusion in the section as it stands. If it is intended to restrict it to the destruction of rats or the cleansing of premises or vessels, it is desirable that the amendment should be so worded as to restrict the possibility of making charges in other cases.
There is rather a difficulty in laying down specifically where charges may be made. While I say it is not intended to make any charges for personal treatment, if we have a person, on the other hand, who comes into a county hospital and wishes to get a bed in a private ward attached to that hospital, naturally there should be a charge. It is difficult to define the cases in which a charge would be made. That is why I think it might be better not to try to enumerate these cases.
There are a few questions which arise on this section to which I should like to get an answer. Firstly, if regulations are made under this sub-section, will these regulations come before the House and can they be annulled by the House?
Is it the intention that any charge so made will be made by the local authority or is the Minister clear that he may not have to pass a financial resolution to enable such charges to be made? I do not know whether the financial resolutions, a number of which have been passed in relation to the measure, were so widely drawn as to safeguard him and enable him to do that.
I have been assured they were. Perhaps I shall look into it again. I have been assured that the financial resolutions covered all these charges and would include provisions giving power to the Minister to enable local authorities to make charges.
Amendment put and agreed to.
Amendment No. 23 not moved.
Amendment No. 24 was discussed in connection with amendment No. 21.
When we were on amendment No. 21, we were on the question of the medical treatment of children but I should like to ask the Minister, now that we have passed over to the question of infectious diseases, whether he does not see a case for saying that regulations made to deal with infectious diseases should be approved by the national health council. I, therefore, move amendment No. 24:—
To add a new sub-section as follows:—
() Regulations made under this section shall be subject to the approval of the national health council.
It is quite true that the service in connection with which we have discussed this matter already has very wide ramifications, perhaps as wide as those of infectious diseases, but I should like to hear from the Minister what relation he expects the national health council to have with the direction or the advising of the work of himself and his Department in connection with the very wide ramifications of the matter covered by infectious diseases.
I am afraid I can only briefly reiterate what I said last night on a similar amendment. I do intend to set up a health council and the principal purpose of that health council will be to advise me on the regulations that are made. Generally speaking, the regulations would be sent to them and they would be given time to study them. Then we would get their advice on the regulations and, if they make a case, they could be changed accordingly. But, as I said last night, sometimes you have to make an amendment to a regulation which might be a very short matter and perhaps rather urgently required and we could not expect the health council to come along and deal with it because it will be composed of men who are very busy in their own spheres and could hardly be expected to come along more than once every two months or maybe, in the beginning, once a month. That is as far as they are concerned.
On the other side, I said that in principle I think the Minister should be responsible for whatever is done. He is responsible to the Dáil. The regulations are laid before the Dáil and the Dáil can reject them. But I think the Minister should take full responsibility and he should be in a position to disagree with the health council if he wants to take the responsibility of doing that. I stated last night that in a long experience of consultative councils I never had to disagree with them and it is very unlikely that I ever should have to disagree but, if it comes to a contest between what I think, and their advice, I should be able to reject that advice. I also made a point which, if you like, is not perhaps a very good point, that I would like in selecting a health council to select people who would be likely to be critical of anything I am doing but, if I am going to be bound by their decision, I might be inclined to select people who would be more amenable in their advice.
With your permission, I will leave further discussion of this matter until we reach No. 92.
Amendment, by leave, withdrawn.
Question proposed: "That Section 27, as amended, stand part of the Bill."
The Minister mentioned, in reference to charges for people who are treated for infectious disease, that an individual who might ask for a special room in an institution, should be charged. I feel that if a man is asked to go into an institution for treatment, in the interest of public health, because he is suffering from an infectious disease, he ought to be entitled to ask for conditions analogous to the conditions in his own home. I wonder whether the Minister has considered that aspect of the case or not because, in the ordinary way, he might desire to be treated at home but in the public interest he is asked to go to the institution. He enjoys conditions in his own home that are somewhat above the average, possibly, and I think he is entitled to look for conditions analogous to those conditions and, in these circumstances, does the Minister suggest that he should be asked to pay?
I think if Deputy Hughes were the medical officer in charge of the institution he would find it very difficult if we were to lay down that as a principle because most people will think that they are entitled to the best treatment the institution can give and that means most people would be looking for private rooms. The only easy way, if you like, and perhaps the fairest was is that the head of the institution can say: "You are entitled to free treatment if you take the same treatment as everybody else"—which I hope will be very good treatment—"but if you want special rooms, you will have to pay the extra cost." Take the big fever hospitals in this city at the moment. That is the rule, really, and it appears to work very well on the whole. I should say, perhaps, that I think the person Deputy Hughes has in mind, who has a very good home, in certain cases may not have to go to hospital where the poor person would have to go.
Sub-section (2) says:—
"Regulations under this section shall not require a person to submit to surgical treatment."
We will discuss surgical treatment later on.
On amendment No. 31, I think it is.
That refers to sub-section (2) of Section 34.
I am moving to delete this section and, if the Dáil will agree, this will have to be taken out on Report Stage.
Regulations shall not require persons to submit to surgical treatment. Has the Minister considered why medical treatment has been left out of this? As this stands, the Minister makes provision that no person, contrary to his own consent, will be made submit compulsorily to surgical treatment. It implies that a person, contrary to his own consent, may have to submit to medical treatment. Does the Minister deliberately intend to leave the Section like that and is he looking for powers compulsorily to treat persons medically, who may object to that treatment?
I think that when we come to discuss amendment No. 31, we can cover that point of medical treatment as well as surgical treatment.
Question put and agreed to.
SECTION 28.
I move amendment No. 25:—
To add a new sub-section as follows:—
() Where an adult person or the parent of the child is required under this section to take any action he shall at the time of being so informed be provided with a copy of the prescribed terms in which he may, if he so desires, submit his objection.
This section makes certain provisions for exemption from the requirements to submit to measures for protection and immunisation against infectious disease and it is intended by the amendment that where an adult person or the parent of a child is required to take any action under this section he shall at the same time as he is being so informed be provided with a copy of the prescribed terms in which, if he so desires, he may submit his objection. The section definitely makes provision by which there will be machinery for objecting and it is desirable that when a person is being told by the State or somebody acting for the State that he has to submit compulsorily to a particular type of treatment that if there is a way of objecting that he will be told quite clearly and simply the form which the objection has to take so that if he desires to object he will be able to do so in the proper way, without confusion.
I think there is a case for something being inserted here to let the person know but I think it should more appropriately be put in, perhaps, in Section 28 and if the Deputy would agree, I will try to draft an amendment for Report Stage.
This is Section 28. Is the Minister suggesting that a more appropriate amendment may be put into Section 28?
Amendment, by leave, withdrawn.
Section 28 agreed to.
SECTION 29.
Question proposed: "That Section 29 stand part of the Bill."
This is a very important section. We ought to be told something about it.
This is one of the sections that are readopted from a previous enactment—Section 144 of the Public Health (Ireland) Act, 1878. There is no change made as far as the present law is concerned, as far as I know. It is merely a redraft, as some of these sections are. It is thought necessary that we should have control over a person selling or letting a dwelling after infection. I do not think there is any more arising out of it.
Would the Minister say if there has ever been any case before the courts in this matter?
All right. There is to be no change in policy?
We do not intend to apply some of these sections to all diseases. For instance, you would not apply this section, let us say, to a case of influenza. Tuberculosis or typhus would be examples where you would apply the section.
I want to ask the Minister does the insertion of the section in this Bill imply any change of policy?
No, none. It is just in order to rescind one of the old Acts it is brought in again.
Where there has been a very serious case of tuberculosis, say, a whole family being infected with tuberculosis, and where it is inevitable that the disease will remain in the home notwithstanding the disinfection that may be carried out, what is the policy of the Department with regard to that particular dwelling? The safest way to get rid of the disease is to blow the house up.
In a case like that I would have to take the advice of the medical officer. If he says it can be disinfected, very well, but if he says that nothing short of destruction will suffice then it must be destroyed.
Question put and agreed to.
SECTION 30.
Question proposed: "That Section 30 stand part of the Bill."
The same principle applies to Section 30 as applies to Section 29?
Question put and agreed to.
Section 31 agreed to.
SECTION 32.
I move amendment No. 26:—
To delete sub-section (2) and substitute the following sub-section:—
(2) In this section, the word "premises" includes a temporary dwelling.
The deletion of sub-section (2) is consequential on amendment No. 3, because the definition was put into the definition section of what the dwelling should be, and in addition to that amendment here includes a temporary dwelling.
Amendment agreed to.
Section 32, as amended, agreed to.
Section 33 agreed to.
SECTION 34.
I move amendment No. 27:—
In sub-section (2), page 18, line 38, to add at the end of paragraph (e) the words "for which he acts and to the health authority of the area in which the patient is detained and to the appropriate person."
If his first amendment is merely a drafting amendment—
"where the committing officer amends the order, he shall forthwith send a copy of the order as amended to the Minister and to the health authority for which he acts and to the health authority of the area in which the patient is detained and to the appropriate person."
The case of a person outside his own area being dealt with was overlooked in that.
Amendment agreed to.
I move amendment No 28 standing in the name of Deputy Cosgrave:—
In sub-section (2), paragraph (g) (iii), line 55, to delete all words after the word "patient" down to and including the word "test" in line 57.
Could we leave that amendment over until we discuss the surgical question?
The Minister wants amendments Nos. 28, 29 and 30 postponed until we discuss amendment No 31.
Amendment No. 31 is to delete the sub-section relating to surgical treatment.
Is the Minister accepting, say, amendments Nos. 29 and 30?
As regards amendments Nos. 29 and 30——
What about amendment No. 28 first, in order to preserve the continuity.
We withdraw the amendment for the moment.
Amendment, by leave, withdrawn.
I move amendment No. 29:—
In sub-section (2), paragraph (g) (iii), line 57, after the word "test" to add the words "the consent of the patient having been obtained".
Sub-section (3), paragraph (g) (iii), as it reads at the moment, says that where an order is made it will be possible to carry out the medical examination of the patient and the taking from him of blood or other specimens for examination or test. My proposal is that there will be added after that "the consent of the patient having been obtained". If amendment No. 29 is passed, the patient will have to give his consent before the medical examination is carried out or before the taking from him of blood or other specimens for examination or test. I submit that that is quite a reasonable amendment to insert and I would find it very difficult to understand the circumstances in which the Minister would insist that a patient would be medically treated contrary to his own willingness or that blood or other specimens would be taken from him contrary to his own consent.
I can understand the Deputy's argument when he says that this power is hardly required. That is medical examination, the taking of blood or other specimens for examination or test without the consent of the person concerned. What we had in mind in putting in this was the clearing up of diseases. We had some hopes that when this Bill was passed we might be able to deal with some of those people who are spreading venereal disease. Such people are rather intractable and rather uncooperative when they are taken into hospital. The only possibility of dealing with them in an effective and expeditious manner is to get blood tests. Blood tests are absolutely essential in such cases where there is a suspicion of syphilis or other venereal disease. I cannot see that a doctor will have to rely on that particular subparagraph in any particular case apart from that but I do think that it might be necessary in such a case. A blood test is required also for some other diseases but it is very unlikely that resistance would be offered. For instance in a case of suspected tuberculosis a blood test might be required. That also applies to typhus. One of the tests for typhus is the Weil Felix test for which blood is required. Of course, with regard to typhoid, blood culture is necessary. For diphtheria swabs from the nose and throat are required. Blood is necessary for testing purposes in three or four of those diseases. I do not anticipate any trouble whatever, except in regard to venereal disease. If we want to get the person's consent it is hardly necessary to put it in the Bill at all.
I thought that the Minister might have had the question of typhus or smallpox in mind. Outside of these I could not see why the Minister might want to press any other aspect of it. The Minister's remarks in regard to venereal disease give a new aspect to this case and I think, Sir, I would like to consider it further. I would like the Minister to reconsider the whole question and have some further consultations on the matter. In view of that, I do not want to press amendment No. 29.
Amendment, by leave, withdrawn.
I move amendment No. 30:—
In sub-section (2), paragraph (g), (iv), line 58, to add after the word "patient" the words "the consent of the patient having been obtained".
I am moving this to hear what the Minister has to say on it. I am thinking here of the consent of the patient in a case of inoculation or immunisation.
As Deputies are aware, getting consent means getting the consent of the parent. If amendment No. 29 or amendment No. 30 were accepted by the Dáil it would mean that the medical officer in charge of the institution would have to get the consent before taking a blood test or a specimen, or before immunising or inoculating. I do not think there would be much of a case against amendment No. 30 if it were dealing with adults. Let us suppose, however, that there was a very bad outbreak of diphtheria and that children were being brought into the hospital hourly. In that situation the doctor knows that it is not a matter of hours but of minutes to give the necessary inoculation in order to try and cure the patient. If he has to go through the formality of getting the parent's consent it may possibly mean the death of the child. I mention these as some of the difficulties that we are up against. Perhaps we could get an amendment that, in the case of a child, the parent's consent should be got if practicable. Deputies, I am sure, will realise that it would be a terrible thing if a doctor were faced with the position that he had to let a child die because the parent's consent was not available.
Would the Minister be prepared to accept the amendment if it ran in this way: "the consent of the patient having been obtained, or, in the case of a child, the consent of the parent or other appropriate person, if practicable".
I would like to say that there may be various other contingencies that may not occur to me at the moment, but I will consider that before Report Stage.
I am trying to get the Minister's mind on the matter, and I do not want to press him at this stage. I would be content if an amendment on the lines I have indicated were accepted by the Minister.
Amendment, by leave, withdrawn.
I move amendment No. 31:—
In sub-section (2), to delete paragraph (h).
On the Second Reading I drew attention to paragraph (h) which says:—
"no surgical treatment of the patient shall be carried out during his detention except with the consent of the appropriate person."
I said then that I would like Deputies to consider that paragraph and to help me, if possible, to get over certain difficulties that I foresaw. First of all we must consider what we mean by consent. In the case of an adult we mean the consent of that person himself. As far as this Bill is concerned, an adult person is any person over 16. Consent, in the case of a child, would mean the consent of the parent or guardian, and in the case of a person of unsound mind, the consent of the parent or guardian. There cannot be much objection to a section like this where you are dealing with adult people, but there would be a very strong objection where you are dealing with a person of unsound mind or a child. I should have said, perhaps, that there would not be any strong objection if the adult person were conscious himself, but if he were unconscious another difficulty would arise. In a bad diphtheria case, for example, it is sometimes necessary to do a tracheotomy to save a child from smothering, and that tracheotomy has to be done suddenly and rapidly when the time comes. If the patient is an adult person over 16 and is practically unconscious at the time, you cannot properly get his consent. You may assume his consent by indicating to him in some way that you are going to do a tracheotomy. If he does not make any answer, you may go ahead. If, however, the patient is a person of unsound mind, or a child, you must under the Bill get the consent of the parent or guardian. That may place the doctor in a difficult position because there is not time to get the consent. In that connection, I would like Deputies to bear in mind that during the severe storms of last winter several parts of the country were isolated. It would have been impossible to get in touch with the parents of children in hospitals from some counties for ten or 12 days, even though an operation for, say, appendicitis might have been urgently necessary. You could not wait for the parent's consent.
Deputies will see that there are great difficulties in leaving the section in the Bill at all. What I would urge on them is to rely on the law as it stands because I think it is all right. I would like to tell Deputies what the law is at the moment. First of all, a surgeon who performs an operation against a person's will commits an assault and is liable to an action for damages. Therefore, if you allow the law to stand as it is an adult person is quite well protected because if he refuses to allow the surgeon to operate he is as well protected by the law as it is as he would be by the law we are passing now. In the case of a child, or of a person of unsound mind, if a surgeon were to attempt to operate without getting the consent of the guardian or parent it would be equivalent to an assault. In any case where an adult person is in a position to decide for himself, or in any case where the surgeon might reasonably look for the parent's or guardian's consent, he has no right to do the operation. If he does an operation on a child in a case where he could have looked for the parent's consent, the parent can accuse him of an assault for doing the operation.
The next point is that if a patient is incapable of exercising a discretion— that is where the patient is unconscious —and if he is an adult and an immediate operation is necessary to save his life, then the surgeon does not commit an assault if he performs the operation. The surgeon is guilty, or may be guilty, of malpractice in such a case if he operates where it is not necessary or essential. Under the present law, therefore, where he is up against a proposition of that kind, he usually gets the opinion of another medical man so that if anything should go wrong with the operation he can be protected by having at least another medical man to corroborate his view that the operation was essential. The same thing applies to the guardian of a young person as it does to an adult person in his own case.
The law is as I have given it, but we have very few recorded cases of actions.
There was one case where a surgeon proposed to do an operation for goitre on a young person and he told the parents that he thought the operaction was necessary and said it could be done with a local anæsthetic. The parents agreed to that, but while he was operating the child lost his nerve and got uncontrollable and they had to order a general anæsthetic before they could finish the operation and the child died. The parents in that case did not allege any negligence, but took an action against the surgeon on the ground that they had consented only to an operation by a local anæsthetic and he had, as it were, broken his contract. In that particular case, the parents lost the action.
I just wanted to state the law on the point and I would urge very strongly that we should leave the law as it is. I think that Deputies will agree that a person is very well protected. As I have said, in the case of an adult person, no surgeon can operate upon him as the law stands, unless he wants to commit an assault, and no person can operate on a young person or on a person of unsound mind without the consent of the parent or guardian. The present law has the advantage that, in a case of urgent necessity, the surgeon, after getting the opinion of another doctor if the other doctor is available, will perform the operation, if he thinks it is absolutely necessary, and only if he thinks it is absolutely necessary.
I am prepared to accept the Minister's argument as fairly sound. This section deals with the treatment of people who have been declared to be a possible source of infection and ordered to subject themselves to detention and isolation. We are dealing with things that may happen after this Bill has been put into operation. I do not think we need introduce any additional regulations or safeguards in the ordinary way to protect the ordinary people against the medical profession. The outline of the law position as it stands at the moment is, I take it, an outline of a state of affairs which has worked satisfactorily in regard to people who have their freedom.
There is always a feeling that people who have been detained and isolated in a compulsory way may tend to be brought under a more rigorous system of treatment than people who are free. If the Minister's intention is to leave the position between the patient and the doctor or surgeon, even though the patient may be under detention or isolation, exactly as it is where there is no compulsory detention or isolation, then from the point of view of safeguarding the person and the will of the person concerned that should be regarded as satisfactory.
The manner in which this point was originally presented has, perhaps, coloured people's minds with regard to things which might or might not happen, but I accept the Minister's statement now, that the intention is that the relationship in law between patient and doctor will stand under Section 34 as it would stand if they were ordinary patients of the doctor.
Does it mean that the previous Act still stands? It is not repealed?
No. It is the common law and practice. In fact, it would be very hard to change it, if one tried.
Amendment agreed to.
I move amendment No 32:—
In paragraph (o) of sub-section (2), page 19, line 34, to insert before the word "the," the words "where an appeal is made under paragraph (j) of this sub-section".
Amendments Nos. 33 and 34 are consequential.
I do not know if this section will be very much used. It may be used at a particular time or in a particular district. If people are nominally forced into hospital, probably by the time they arrive there they have got over the compulsion part and are fairly contented to settle down and get well. They have the regulation handed to them and know they can appeal to the Minister. I think it should be sufficient if the Minister sends his officer down where there is an appeal, but he should not have to go automatically to visit a case.
Amendment agreed to.
I move amendment 33:—
In subparagraph (i) of paragraph (o) of sub-section (2), page 19, line 37, to delete the words "patient is detained," and substitute therefor the words "appeal is received by the Minister."
Amendment agreed to.
I move amendment No. 34:—
In subparagraph (ii) of paragraph (o) of sub-section (2), page 19, line 39, to insert before the word "not", the word "thereafter".
Amendment agreed to.
I move amendment No. 35:—
In sub-section (2), paragraph (o) (ii), line 39, to delete the words "three months" and substitute the words "one month".
If a person is detained, he should be entitled to an examination at least once every month. As it stands, he may be detained for a period of three months. If he recovers at the end of the first month, he may still have two months more in an institution or of incarceration in some form. So as to avoid any possibility of a person being detained longer than is actually necessary on account of the illness or infection, the examination should be at least once a month. That would prevent any possibility of excessive delay.
First of all, the Deputy may take it for granted that the medical people or the charitable institution will be only too glad to get rid of any person as quickly as they can. However, I think that three months is a long time and maybe we could compromise on six weeks.
Very well.
Amendment altered to:—
In sub-section (2), paragraph (o) (ii), line 39, to delete the words "three months" and substitute the words "six weeks".
Amendment, as altered, agreed to.
I move amendment No. 36:—
In sub-section (3), page 19, line 46, to delete the words and figures "paragraphs (c) and (h) of sub-section (2) of".
This is a purely drafting amendment. There is no necessity to confine it to paragraphs (c) and (h).
Amendment agreed to.
I move amendment No. 37:—
In sub-section (3), page 19, to insert before paragraph (c) the following new paragraph:—
(c) where the patient, being 16 years of age or over, is for any reason unable to act for himself—the person for the time being in charge of the patient.
This is the point to which I have already referred—the adult over 16 years who is not capable of speaking for himself, such as a person of unsound mind and so on.
Amendment agreed to.
I move amendment No. 38:—
In paragraph (c) of sub-section (4), page 20, line 7, to insert before the word "from" the words "or attempts to escape".
It is felt that this phrase should be included.
Amendment agreed to.
I move amendment No. 39:—
In paragraph (b) of sub-section (5), page 20, line 16, to delete the words "the escape" and substitute therefor the words "an escape or an attempted escape".
This is the same point.
Amendment agreed to.
I move amendment No. 40:—
In sub-section (7), page 20, line 30, to delete the words "of this section".
This is a drafting amendment.
Amendment agreed to.
Question proposed: "That Section 34, as amended, stand part of the Bill".
In sub-section (2) (j), provision is made for the making of an appeal for release to the Minister by a person detained and, in the subsequent paragraphs, there are arrangements for deciding such an appeal. I want to appeal to the Minister to reconsider this, with a view to ensuring that such an appeal will come before the national health council for review. I am not suggesting that each appeal should be decided by the council, but rather that the Minister should decide each appeal in consultation with the national health council. That would mean only a minor alteration of sub-section (2) (m) to provide that the Minister should consult the council before taking a decision.
The important thing to remember in connection with this section is that you will be dealing with people in a somewhat different class from those who have been detained because of infectious disease in the past. You will be dealing with people suffering from tuberculosis who might be detained for, perhaps, years and there are many important issues to be considered. For example, a person might claim that he would be in a position to safeguard his health and that of the community in his own home and there might be room for a wide divergence of opinion. For that reason, it is desirable that a more independent body than the Minister should have an opportunity of considering such a claim.
The objection I put forward some time ago to being compelled to put things to the health council applies all the more to the case now raised by the Deputy. We can only expect the council to meet at regular intervals and we could hardly justify calling the council together to consider an appeal of this kind; but, in any case, I am afraid that, even if we did as the Deputy suggests, the council would be entirely guided by whatever report I submitted to it. If I submitted a report that it was extremely dangerous to allow such and such a person out, what could the council do but say: "Keep him in"? If I submitted a report stating that he should be let out, all they could say would be: "Let him out." Deputies need have no great fear in this matter, because, as they know, all our institutions are overcrowded at the moment and there is a desire on the part of medical men to get people out of these institutions as soon as they can. There is no desire to keep them longer than is necessary. There is the further safeguard, in case there is any suggestion that the medical officer of health in a particular area might be over-cautious, that the medical inspector of the Minister would go down and try to keep things uniform in the various institutions. I think it should be left at that. I should like to refer again to what I said on Second Reading, that this section has been operating since 1940 in the form of an Emergency Powers Order. There were 38 cases dealt with and we never had the slightest complaint from any of the people involved. They all thought they were fairly well treated and that they had got out as they should have got out.
I do not think so. They were mainly typhoid carriers.
I should like to stress again our concern in this matter, because, while we appreciate some of the difficulties which exist in the practical application of the law, we are concerned with a fundamental principle, the violation of the fundamental right of the individual, his absolute power over his own body and the danger of permitting the State to violate that right. The Minister has pointed out certain difficulties in the case of persons unable to give their consent with regard to surgical treatment and certain difficulties under sub-section (2), paragraph (g) (iii), but, no matter what the difficulties are, I think the Minister ought to have amendments in connection with them very fully examined before Report Stage, because it is a very grave matter for an assembly of this sort to put into legislation sections which may violate these fundamental principles. While practical difficulties must be met and solved, every effort should be made by the Minister and his Department to preserve these fundamental rights. With regard to sub-section (7), I should like to inquire what financial provision will be made. The sub-section requires a local authority to finance the cost of the maintenance and treatment of persons under the section. Does that mean that the local authority is to be called on to finance this treatment fully?
All the expenditure under this section will be on a half-and-half basis.
The Minister indicated, on the Financial Resolution, that the cost of the provisions in relation to infectious diseases under the Act would be about £150,000. Is that a conservative estimate?
It is very hard to say whether it is or not, but we have to make a guess.
That is the estimate the Minister gave the House today?
Does the Minister think that, in view of these very elaborate provisions and the inevitable high cost of carrying them out, it is fair to throw 50 per cent. of the cost on the rate-paying community?
I should like to impress on Deputies that I do not think there will be very much cost under this section. There are two diseases as to which I think Deputies will probably agree that very drastic action must be taken. One of these is typhus, which is a very infectious disease. You have to clean up a whole district. You may have to remove people and sometimes burn their houses in order to get rid of the disease. The same thing applies to small-pox. You have other diseases where it may be necessary, such as tuberculosis and diphtheria and, possibly, infantile paralysis. Then there is the other case, that of venereal disease, where it will be absolutely necessary if we want to clean up the disease. There is no chance, I am afraid, of cleaning up that disease except we get the prostitutes into some institution where they can be treated and that can only be dealt with under this section.
I should like to remind the Minister, on the question of cost, that it is not in the interest of a particular county you are doing it, but in the national interest. Whatever expenditure is incurred is in the national interest so as to prevent the spread of infection outside the bounds of a county. On that basis, I think the contribution ought to be greater than 50 per cent. from central funds. When the Minister is throwing it back on a county, he is throwing it back mainly on a particular section of the community.
The contribution varies. In the case of tuberculosis, 50 per cent. is contributed by the State. In the case of venereal disease, the State contributes 75 per cent. As Deputies know, a White Paper has been promised, and I hope it will be possible to have it circulated in three or four weeks' time. When that White Paper comes along, we will be able to get down to this question of the proper rational financing between local authorities and the State in connection with all these things.
What will the White Paper deal with?
One of the things the White Paper will deal with is the financing of the services.
Will we see the White Paper before the Estimate?
When the Minister speaks of typhus and small-pox as the principal diseases we may have to tackle, the question arises as to whether, when dealing with a particularly heavy piece of work in a rather localised area, 50 per cent. of the cost should fall on the local authorities. From the financial point of view, it is not a local problem related to the local position. If the expense in connection with a serious epidemic of typhus was very great, it would be unfair to ask the local authorities to bear 50 per cent. of the cost. Small-pox would be a matter of a crisis and it would be unfair to impose the cost of a crisis like that on the local authority. Venereal disease has a social stigma attaching to it. When the Minister talks about facing up to the problem drastically, I doubt if it can be dealt with entirely on the basis of the local authority knowing 50 per cent. about the matter and the State knowing the other 50 per cent. and bearing the cost in that relation. If there is any kind of a serious problem with regard to venereal disease to be dealt with, I do not think it can be dealt with out of the local rates. If it has to be brought out in the open, there will be simply concealment and avoidance and the Minister will fail to deal with any problem that may arise out of that diesease.
I should like to say that our proposals are not quite ready yet for publication, but I think they will show anyway that the increased cost for health services will be divided between the State and the local authority. The result will be that there will be very little increase on the local authorities for all these new services; that the greater part of the expenditure will fall on the State as time goes on.
That means that there will be a further favourable adjustment?
There will be a much better percentage anyway.
So far as I can gather, there seems to be no provision for any choice on the part of a person who is to be detained in the institution in which he may be detained. If possible, I think that some choice should be given. We all know that it is desirable, wherever possible, to give the citizen the choice of a doctor.
There might be only one institution.
In many cases it is possible that there may be only one institution for the particular disease, but in the case of certain diseases there may be two or three, and it would be desirable to give a patient some voice in the selection of the institution.
I think it would be extremely difficult to give a choice in a case like this.
There is very little choice anyway.
Question put and agreed to.
SECTION 35.
Question proposed: "That Section 35 stand part of the Bill."
This section provides for the disposal of the remains of a person who dies in an institution. There does not appear to be anything in this section with regard to the disposal of the clothing of persons who die from an infectious disease. I am not sure if there is any provision in any other part of the Bill. I think that in this section at least there should be some definite provision to ensure that the clothing of persons who die from an infectious disease is not allowed to fall into the hands of other people. It is only two or three days ago that a case was brought to my notice of a perfectly healthy man who purchased a suit of clothing at a stand in a public fair and within three days he was down with infantile paralysis and subsequently died. I did not get an opportunity to inquire into the full facts of the case and I do not know whether infantile paralysis can be conveyed by clothing or not. I think it is important that we should ensure that the clothing of persons who die from an infectious disease is not put on the market and sold.
That is dealt with in the Second Schedule.
Question put and agreed to.
SECTION 36.
I move amendment No. 41:—
In sub-section (2), page 20, line 54, to delete the word "shelter" and substitute therefor the word "accommodation".
The word "shelter" crept in from some old Act. "Accommodation" I think is the proper word.
Amendment put and agreed to.
Question proposed: "That Section 36, as amended, stand part of the Bill."
Could the Minister tell us whether he proposes to compensate people for any destruction of their equipment?
We will come to that on Section 100.
Question put and agreed to.
SECTION 37.
I move amendment No. 42:—
Before Section 37 to insert the following new section:—
(1) A health authority may make provision for the training and education of persons suffering or recovering from an infectious disease for employment suitable to their condition of health and for that purpose may provide and maintain such premises, workshops, farms, gardens, materials, equipment and similar facilities as are necessary.
(2) The Minister may by order direct a health authority as to the manner in which and the extent to which they are to exercise their powers under sub-section (1) of this section and such health authority shall comply with such direction.
This is the section which, I mentioned, had been inadvertently left out of the Bill. It deals with the rehabilitation of persons suffering or recovering from infectious disease. The section is fairly obvious to anybody who reads it. The idea of rehabilitation was referred to by Deputies on every side of the House and there was a desire that this section should be inserted.
Does this apply particularly to the training and education of persons suffering from tuberculosis?
Who bears the cost in these cases?
That will be dealt with in the White Paper with regard to cost. At the moment it would be the local authority.
In the case of tuberculosis it would be half and half.
Amendment agreed to.
I move amendment No. 43:—
To add at the end of the section a new sub-section as follows:——
(3) A charge under sub-section (2) of this section for the attendance of a nurse on any person may be recovered as a simple contract debt in any court of competent jurisdiction from—
(a) such person or, in case such person has died, his legal personal representative, or
(b) any other person liable to maintain such person for the purposes of the Public Assistance Act, 1939 (No. 27 of 1939), by virtue of Section 27 of that Act or, in case such other person has died, his legal personal representative.
This is a necessary corollary to (2) (b). I think it was referred to by some Deputies on Second Reading and they suggested that it should be put in to safeguard the position.
Is it the local authority decides the rate of charge for the individual?
Yes, the local authority.
I take it this is intended to apply in cases where the local authority provides nurses for attendance on persons suffering from infectious diseases other than in institutions; that is, where the local authority would provide a nurse at a person's home or elsewhere?
It might, in its present wide terms, be read that where nurses were provided to deal with cases compulsorily detained under Section 34 a charge might be made.
There is no charge there.
The section reads:
"A health authority may provide nurses for attendance on persons suffering from infectious disease."
Then it says that they may make a charge for that. Does the Minister think that will require amendment?
Amendment agreed to.
Question proposed: "That Section 37, as amended, stand part of the Bill."
I should like to inquire, on Section 37, if the Minister will elaborate on the policy with reference to charging and the discretion given to the local authority. The discretion will be given to the county manager, and my experience is that some county managers are pressing rather unduly on people who find it difficult to pay for treatment in an institution. The council have little or no discretion in the matter, and I think the Minister ought to have some definite policy. It may look all right from one point of view that the county manager is pressing for contributions, but if you carry that to extremes it may become a hardship.
The section covers cases where a local authority, for some reason, must treat a person in his own home and provide a nurse; that is, when the person cannot be removed, being either too ill to be removed or for lack of accommodation in the hospital. Having provided the nurse, they can make a charge. The Deputy's point is that the county manager will have too much discretion with regard to the charge. I may say this whole matter will be fixed up in the White Paper. It will deal with what will be the county organisation with regard to health and the proposals for that will be published.
What the Deputy feels is that somebody must have discretion to make a charge. I do not know whether we should leave the discretion to the local authority or whether it should be covered by legislation, but there must be some discretion. You cannot just say to the local authority: "You must charge something" or "You need not charge anything". There must be discretion.
Question agreed to.
SECTION 38.
I move amendment No. 44:—
In line 24, after the word "satisfied" to delete the brackets and words down to and including the word "defendant" in line 25.
I think the provisions in this section are extremely undesirable. It is a generally accepted maxim in criminal law that if a person is prosecuted the State must prove the charge before that person can be found guilty. In civil proceedings if one individual takes an action against another he must prove whatever he alleges before he is entitled to sustain his action. Under this section if one person becomes infected as a result of contact with another and subsequently the infected person takes an action for damages against the other person for not taking adequate precautions to prevent people becoming infected, the responsibility of satisfying the court lies on the defendant. I cannot think of any Act in which the onus is placed on the defendant, with the exception of certain stringent provisions in the Offences Against the State Act which, I think, is now being repealed. In a criminal prosecution the onus always rests on the State and in a civil prosecution on the plaintiff. In this case the onus is transferred to the defendant.
I quite agree it would be undesirable that a person who infects another should be enabled, by reason of the phraseology of legislation, to get away without any penalty. When a person has been infected as a result of another person's neglect, by reason of the fact that the other person omitted to take precautions, there should be some remedy for a grievance of that sort. The onus should be allowed to remain as it has always remained in normal circumstances, on the plaintiff. If a person is taking adequate precautions and is in a position to say that he has not exposed himself to any risk of infection, then the onus of proving that the infection was due to the neglect of the defendant should lie on the plaintiff. I think the Minister should accept this amendment and I would like to hear strong reasons given before we can allow this section to remain as it is.
I recognise, of course, that the Deputy makes a very strong case from the point of view of ordinary legal practice but I should like the Deputy to consider the person who has a grievance in these cases. For instance, let us say that a landlord has a room to let in which there has been a case of typhus or small-pox—I am putting an extreme case. He was informed that he should take every precaution to disinfect it but he took no precautions and let the room that night. I do not think that that particular landlord deserves very much sympathy and we should not enable him to get off with some technical defence in court. In other words, we should put the onus on him to prove that there is no neglect on his part. I am told that there are other examples or provisions of this kind in the Transport Act but I do not want to argue the case on precedent. I want to put it on its own merits. I think that a person who is likely to give infection to another person should take every precaution to prevent that and if he does not take that precaution, well we should not have too much sympathy with him. After all he may be endangering the life of another person by not taking precautions. The trouble is that I am told that people have got off in the past on some such technical point, that after all the onus was on the prosecution to show whether they were responsible or not. I do not think we would be going too far if we put the onus on the person who has been responsible for the particular infection.
The Minister is taking an extreme case.
The Deputy will admit that if it is not an extreme case the court will not be too hard on the person charged.
The only point about the extreme case is that once the case is brought to court the court will have no option even in cases where there is considerable doubt, but to decide it in accordance with the provisions of the Act. It is perfectly true that if a person has a room which has been occupied by a person infected with typhoid or typhus, and if he subsequently lets that room without taking proper precautions, to another person who may become infected, the owner should not be allowed to escape responsibility for his neglect, but there is an alternative means of checking neglect and that is to have a penalty imposed on the person responsible. Again the person who became infected would have a good cause of action against the landlord in that particular case. At the same time the Minister or the local authority could prosecute the landlord. Certainly it would not alter the opportunity which an infected person would have of taking action and recovering damages against a landlord who is responsible for any lack of the necessary precautions.
I have every sympathy with the section with which this amendment deals when it tries, I take it, to prevent infected people from infecting others. I think in the past the law did not go into that matter very closely because I do not suppose that medical science, until quite recently, knew how people were infected with very many diseases. Medical scientists just knew people got diseases but they did not know how they got them. Although I should like to see every effort made to prevent people from infecting others, I think the section would be strong enough without putting this onus on the person charged. It seems to me that you might leave a citizen open to what the Americans call a frame-up. This provision might make it rather easy for certain persons to pretend that they were infected in the hope that they might get some notoriety or damages out of it. I sympathise very much with the efforts made to prevent people from infecting others but I think Deputy Cosgrave's amendment would leave the strong part of the section still there.
I should like to ask the Minister whether the section applies to infected persons only. Must a person who becomes liable to these penalties have been infected himself? Otherwise, the section would open a very wide door. Take the case of a milk purveyor. He might possibly be charged with not taking the necessary precautions to prevent milk from becoming infected and spreading typhoid.
It only refers to a person who has been asked to take precautions.
A cow keeper is compelled to take precautions to prevent his milk from becoming infected and becoming a possible source of typhoid. If it can be proved afterwards that he did not take the necessary precautions, if it is found that his milk is infected, and that typhoid may be spread as a result, under this section he is left open without any prior knowledge on his part to action by persons who may become infected with typhoid. I want to put that aspect of the case. Is it only a person who has been infected with disease who must take precautions or can any member of the community who fails to take precautions in that respect, become liable under this section?
The point Deputy Allen has made is a good one. In cases where vendors of milk are prosecuted, very often the vendor, a retailer or a wholesaler, may have got the milk from another supplier. If you follow the passage of the milk from the byre to the ultimate seller, it may happen that the infection began a considerable distance from the person who is actually prosecuted. In fact the usual case is that a person purchases milk which is found to be deficient in fats while that person may have treated it properly or may not have interfered with it in any way. The milk was originally deficient. In cases of this kind, it may well happen that action will be taken against a person who had himself taken adequate precautions but the milk might have been infected before it reached him. I think the point Deputy Allen made is worthy of examination. I cannot say that the same thing is likely to happen in the case of letting a room, but in the case of food it is quite likely that the particular commodity was affected by contact at a far earlier period than that at which it reached the individual against whom the action is taken or against whom proceedings might be taken subsequently.
It must be remembered that this refers only to offences under this part of the Act—that is, against infectious diseases regulations. Where a person is asked to take precautions and where he fails to take such precautions and another person suffers damages as a result, all these conditions must be fulfilled.
With regard to the case Deputy Cosgrave raised, I would like to put it this way: If you like, it is a rather serious case I am taking. I am taking the case of a man who has let a room having failed to take the precaution to disinfect after a case of typhus, or as might be more likely, after a case of tuberculosis, and the incoming tenant gets the disease. The difference between us is this: under the present law that incoming tenant can take action against the landlord and can sue him for damages, but he must prove that he has suffered as a result of the neglect of the landlord. He never succeds under the present law because, when the question is put to him: "Could you not have got it elsewhere?" he cannot say no; he must admit it is possible that he could have got it elsewhere. He may say he is almost certain that he got it in that house. That is not enough. The court must dismiss the case because it is not conclusive. I must say the landlord, in such a case, was very negligent in exposing people to great damage and I do not think it is too hard on him to say that the landlord must prove that he did not get it there. In other words, instead of putting the question to the complainant, the court must put the question to the landlord: "Can you show that he was likely to get it elsewhere?" There is not much difference, but at least we are putting the onus on the landlord to argue that he may have got it elsewhere instead of making the complainant prove that he could not have got it elsewhere. There is not a lot of difference in fact, but there is a great deal of difference in a technical way as far as proving the case in court is concerned.
Would the Minister not consider making that section applicable to offences under Sections 29, 30, 31 and 32?
It is only to this part of the Act.
They are the sections of the Bill that apply to public dwellings.
The Minister says he must take the precaution. Is the precaution prescribed by the local authority? Supposing he takes the precaution and disinfects a house that has been inhabited by a family in which there were cases of tuberculosis and, notwithstanding his disinfecting the premises, the incoming tenant develops tuberculosis, is he responsible in that case?
If he proves to the court that he took the precaution, I think the case fails, as far as I can see.
If he let him in under three months he may run the risk of such action.
If three months is prescribed, then he would be wrong.
Take the case of two persons suffering from an infectious disease travelling in a bus. A third person is in the bus and he is in contact with both. He becomes infected. He subsequently takes action against one of them because possibly he discovers that that individual is suffering from the infectious disease. He could have contracted it from either or, possibly, from both. In that particular case it might be impossible for the defendant to prove that he did not infect the person and, at the same time, it might well happen that the person had been infected as a result of the neglect of the other individual.
I suggest that it could be argued that the first section there applies to local authorities if the court held they did not do their job as they should.
Yes. The person might have an action against the local authority. That is true. In answer to what Deputy Cosgrave says, the last few lines would appear to be a good defence for the person he has in mind where he says the defendant could plead that it was unlikely that such failure caused such infection. I think he could argue that very strongly if there was a second equally potent source of infection.
It strikes me that this section is going to be better for the lawyers than for the doctors.
The doctor will be all right, too. He will be there as an expert witness.
Amendment, by leave, withdrawn.
Section 38 agreed to.
SECTION 39.
I move amendment No. 45:—
In paragraph (b) of sub-section (1), page 21, lines 30 and 31, to delete the words "under the supervision of a registered medical practitioner" and to substitute therefor the words "to the satisfaction of the chief medical officer of the health authority in which such person ordinarily resides".
This section deals with the maintenance of the relatives of a person who is ill with an infectious disease. I think Deputy Allen was one Deputy who pointed out on Second Reading that it was rather loosely worded and there seemed to be no proper person to control the expenditure under this section. We are putting the onus on the medical officer of health to certify that this maintenance should be allowed.
Might I ask who is meant there by "chief medical officer of health"?
The county medical officer of health.
Then should not it be, in conformity with this Bill, "chief medical officer" or "county medical officer," because in this Bill you are changing the title?
It is in the definition, I think.
But in your amendment you are keeping the old title whereas in your Bill you are changing it. "Of health" should be dropped.
The chief medical officer is either a county or State medical officer of health. We will look into it. It means a county medical officer or a county medical officer for a county borough. That is right.
Amendment agreed to.
I move amendment No. 46:—
In sub-section (3), page 21, line 49, before the words "make provision" to insert the words "on application being made to them".
It would appear that the section as drafted would make it obligatory on the local authority to send this maintenance allowance to a person even if he never applied for it. I think it would be better that he should apply.
Amendment agreed to.
I move amendment No. 47:—
To add at the end of the section a new sub-section as follows:—
() Every person who in connection with an application for provision for maintenance under this section makes any statement which is to his knowledge false or misleading in any material respect shall be guilty of an offence under this section and shall be liable on summary conviction thereof to a fine not exceeding £50 or at the discretion of the court to imprisonment for any term not exceeding six months or to both such fine and such imprisonment.
This is the usual amendment dealing with fraudulent claims through false information.
Amendment agreed to.
Section 39, as amended, agreed to.
SECTION 40.
I move amendment No. 48:—
In sub-section (1), page 22, line 25, to insert before the word "the", the words "either absolutely or subject to specified conditions".
This section, which deals with the treatment of infectious diseases in particular institutions, gives the Minister power to prohibit the treatment of infectious diseases in a particular institution. It was thought on reconsideration that where, say, an institution is rather isolated, it might be better to allow the Minister to make an exception. The amendment would enable us to make a regulation that would permit an infectious disease to be admitted in certain circumstances, say, in the case of great urgency or perhaps if there was an outbreak in the area. At any rate, it is better, I think, to have this power of qualifying the Order.
You may have to use the institution for another purpose.
Amendment agreed to.
I move amendment No. 49:—
To insert before sub-section (2), a new sub-section as follows:—
() An Order under this section shall not be made where the Minister is satisfied that adequate precautions are taken in any institution to prevent persons suffering from an infectious disease infecting other persons.
On Second Reading I mentioned that a number of hospitals—I think it is almost confined to teaching hospitals; certainly the point at issue affects teaching hospitals only—have different categories of patients in different wings or words. If a person or persons are suffering from a particular type of infectious disease, invariably, I think, adequate precautions are taken to ensure that these patients do not infect or come in contact with other patients. The advantage of that segregation is that medical students are in a position to view patients in the hospital and to diagnose the various types and stages of diseases. That experience helps them to diagnose rapidly particular diseases and to recognise the different stages of diseases and the various types of infection.
It has been put to me that if, under the regulations which the Minister has power to make under Section 40, a person suffering, say, from tuberculosis is prohibited from admittance to one of these hospitals, while it might be possible for the student to see such patients in other hospitals and to gain considerable experience from the point of view of diagnosis and from comparison with other patients which ordinarily enables a student to diagnose a particular stage in a disease or a particular type of a disease, that experience may be lost if restrictions are enforced and regulations are made whereby only patients suffering from some ordinary illness, or at any rate not an infectious disease, are entitled to be admitted to particular hospitals. I put this amendment forward so that hospital authorities—I think it is reasonable to assume that the medical profession would be anxious to take all necessary precautions—will take these precautions to ensure that no other patients become infected, thus making it possible for permission to be received or granted by the Department whereby these hospitals may have as patients in the hospital people suffering from infectious diseases.
It will be seen from the next amendment, amendment No. 50, that, possibly, Deputy Cosgrave and I had the same point in mind, although we may not have arrived at the same conclusion. In amendment No. 50 the word "institution" includes a department of an institution. I was rather anxious to meet the case made by Deputy Cosgrave, that is, that infectious diseases could be treated if no great danger existed in the institution and also the case made to me on behalf of some of the teaching hospitals. I thought the best way out of the difficulty would be to say that the word "institution" includes a department of an institution. In other words, that we do not think infectious diseases should be included in a particular department, but that they might be included in some other deparment. My objection to Deputy Cosgrave's amendment is one of administration more than anything else. It implies a good deal of inspection from time to time to see that there is no danger from infectious diseases being admitted. From the administrative point of view, my own amendment, which follows next, would be easier to work. We will say that there would be no objection in certain wards while there would be in other wards.
Does "department" in that context include "ward"?
Yes. I think we are both really aiming at the same thing.
Amendment, by leave, withdrawn.
I move amendment No. 50:—
To add at the end of the section a new sub-section as follows:—
(4) In this section, the word "institution" includes a department of an institution.
I have already explained this amendment.
Amendment agreed to.
Amendment No. 51 not moved.
Section 40, as amended, agreed to.
SECTION 41.
I move amendment No. 52:—
Before sub-section (3) to insert the following sub-section:—
() A person shall be deemed conclusively to have reason to believe that he or any other person is verminous if he is notified accordingly by a medical officer of health or a health inspector.
The meaning of this amendment is fairly obvious. It simply means that if a person is notified that he is verminous, that is conclusive proof that he is, in case of any action.
Amendment agreed to.
Section 41, as amended, agreed to.
SECTION 42.
I move amendment No. 53:—
In sub-section (3), page 23, line 16, to delete the words "a person or" and substitute therefor the word "an".
A person is dealt with in Section 41. Cross out "a person or" and substitute "an", thus referring to the article only.
Amendment agreed to.
Section 42, as amended, agreed to.
SECTION 43.
Question proposed: "That Section 43 stand part of the Bill."
There is a provision in this section that where a district medical officer of health becomes aware that a child residing in his district is verminous, he may serve in the prescribed manner notice on the parent of the child prohibiting the attendance of the child at any school until such district medical officer gives a certificate (for which no charge shall be made) that the child is fit to attend school. I would ask the Minister to look into that sub-section and see that, in the issue of such a certificate no stigma is cast on the parent of that child. If a doctor issues a certificate which, I suppose, would have to be presented to the teacher of the school in order to explain the absence of the child definitely stating that the child is verminous, the matter will be more or less public property. In this connection I think a doctor would be unwilling to hurt the feelings of the person concerned. If, under this Act, a doctor will be compelled to notify the teacher or all concerned that the child is verminous, I think that it should be sufficient to declare in the certificate that the child is a probable source of infection or infectious disease and thus avoid, in some way or other, the issue of a certificate stating that the child is verminous. In my opinion that would be more agreeable even to the medical profession.
I agree with the Deputy in the point he has made. As a matter of fact, we repealed an Act dealing with this subject—the Childern Act of 1908—largely for that very reason. In that case the authority could notify a manager that a child was verminous or was in a foul or filthy condition. We though those words were rather strong and we put them in a milder form. Although the Act is there, I am sure no doctor ever issued a certificate in those words.
I am quite satisfied so long as there will be no compulsion to use the words.
I do not think so. I feel sure that a doctor would say that the child was not fit to attend school. Such conditions are very quickly cleaned up nowadays as a result of new treatment, D.D.T., etc.
I wonder, with regard to sub-section (1) if that sub-section has been very very carefully considered not only within the Department of Health but between the Department of Health and the Department of Education. I know and agree with the Minister that we have remedies to our hand at the moment which clean up the particular condition referred to very very rapidly. We are a long way from that knowledge being within the reach of everybody and of that material reaching everybody.
According to the definition of "verminous" in this Bill, a very slight condition constitutes a case of vermin. In certain areas at periods of the year we have a tremendous percentage of such cases in every school. If the section were to be applied in its fullness all over the country on Monday next, I do not think you would have a 5 per cent. attendance in most rural schools, certainly not until such time as the cleansing machinery had got going, with the medical authorities being made aware of the situation and with the necessary certificates of freedom being given to individuals. The section may be well intentioned, but it is much too far-reaching. There is ample information in the Minister's Department as to the percentage of school children affected with this particular condition and as to how slowly D.D.T. is getting into the homes of the people. It will take a good two years of intensive propaganda before it becomes an article of ordinary use in the home like soap and water. When we reach that point, then the number of verminous cases that we will have to deal with will be just 1 or 2 per cent. It would be reasonable to prohibit 1 or 2 per cent. from getting the benefits of education as long as they were suffering from that particular disability. It is not right, however, to prohibit 70 or 80 per cent. from getting such benefits. We do not feel too comfortable when discussing a thing like this in public, but the percentage of it is terribly high. If the section were to be implemented in a great number of areas at the present moment it would mean closing nearly all the schools. I am not opposed to it, but I am asking that full consideration be given not only to what is desired but to the immediate results.
What is the position with regard to a child who is suffering from ringworm and attends school? That can be very troublesome for other children.
There is power in the Bill to deal with that. With regard to what Deputy O'Higgins has said, I am inclined to agree with him that this section might do a great deal of harm. I do not think it is going to do a lot of good. I will consider whether I shall strike it out or not.
Question put and agreed to.
Amendment No. 54 not moved.
Section 44 agreed to.
SECTION 45.
I move amendment No. 55:—
In paragraph (b) of sub-section (1), page 24, line 4, to insert before the word "his" the words "or with the consent of".
Amendment agreed to.
I move amendment No. 56:—
In sub-section (1), page 24, line 10, to add at the end of paragraph (d) the words "or on the application of his agent".
Amendment agreed to.
Section 45, as amended, agreed to.
SECTION 46.
I move amendment No. 57:—
In sub-section (1), page 24, line 19, before the words "A health authority" to insert the words "For the purpose of the execution of their powers and duties under this Part of this Act" and to delete all the words from the word "for" in line 20 to the end of the sub-section and to substitute therefor the words "or may make arrangements with any person for the provision of such facilities".
This amendment will enable a local authority to employ an agent. The local authority may not have an expert rat catcher in its employment. This will enable it to employ one.
Amendment agreed to.
Section 46, as amended, agreed to.
Sections 47 to 50, inclusive, agreed to.
SECTION 51.
I move amendment No. 58:—
In paragraph (a) of sub-section (6), page 26, line 35, to delete the word "which".
Amendment agreed to.
Section 51, as amended, agreed to.
Section 52 agreed to.
SECTION 53.
I move amendment No. 59:—
In sub-section (1), page 28, line 12, after the word "Act" to insert the word "may" and in lines 13 and 18 to delete the word "may".
Amendment agreed to.
Section 53, as amended, agreed to.
SECTION 54.
I move amendment No. 60:—
In paragraph (b), page 28, line 56, to delete the word and figures "section 88" and substitute therefor the word and figures "Part IX".
Amendment agreed to.
I move amendment No. 61:—
In paragraph (b), page 29, to delete lines 5 to 9 inclusive and substitute therefor the following:—
(iii) materials or articles used or intended for use in the preparation or manufacture of such food, which are diseased, contaminated or otherwise unfit for human consumption or which do not comply with the regulations.
Amendment agreed to.
Section 54, as amended, agreed to.
Sections 55, 56 and 57 agreed to.
SECTION 58.
I move amendment No. 62:—
In paragraph (a) of sub-section (1), page 29, line 41, before the word "or" to insert the words "or bartered" and after the word "sale" to insert the words "or barter".
An article might be sold or bought, but may also be bartered and we want to cover that possibility.
Amendment agreed to.
I move amendment No. 63:—
To add at the end of the section, a new sub-section as follows:—
() Where it appears to the authority or officer enforcing any provision of this Part of this Act or the regulations made thereunder that an offence has been committed in respect of which proceedings might be taken against some person but that such person could establish a defence under paragraph (d) of sub-section (1) of this section by proving that the offence complained of was due to an act or default of some other person, such authority or officer may take proceedings against that other person without taking proceedings against the first-mentioned person.
Where a person selling food has a warranty, this will make it possible to take action against the original seller of the food, the wholesaler or the manufacturer as the case may be, instead of taking the action against the seller of the food, that is, the retailer. It does not prevent the possibility of going back to the retailer if we find he has put us on a false errand.
There has been great need for the introduction of this amendment, but I think it is unwise for the Minister to take power to deal with retailers at all in such cases. We have had these cases up and down the country, particularly in connection with the infestation of certain foods by accri or mealmites and invariably the traders who got these containers were prosecuted. While it is true that a notice could be served under the food and drugs code whereby the manufacturers could be prosecuted, there were many legal difficulties. When this matter can be traced to the manufacturers and when it is solely their fault, and when these packets go in sealed containers to the retailers, there should be no liability on the retailers, as they have no way of finding out whether the packets are up to the warranty or not.
That is what this amendment is intended to cover.
May I make this observation on the matter to which Deputy Moran so properly referred? I do not know whether public health authorities all over the country have yet awakened to the dilemma in connection with the preparations to which Deputy Moran referred. They are all preparations of the nature of custard powder or cornflour. The retailer and manufacturer is in this dilemma: you bring in corn starch from the Argentine, and there is no means known to science whereby any person, no matter how vigilant he may be, can discover infestation of that corn starch without the assistance of a microscope. The mites are not of the character which ordinarily occur in other cereal products. You may find mites in pig-meal and wheaten offals, which are tiny black objects easily perceivable, but the infestation of corn starch is by a creature which is truly microscopic.
What is a manufacturer or shopkeeper to do? The package of corn starch may on Monday be perfect and, without having broken the seal, without having interfered with the contents, a change takes place between Monday and Tuesday and if that sample is submitted to a public analyst and examined under a microscope it is found to be infested. It is a very serious hardship on perfectly conscientious distributors to hold them up to the public odium of making them criminally responsible for offering to the public a commodity of that character, when there is no precaution they can take, short of sending a sample every day to a public analyst—and even if that extravagant plan were adopted, they would not get the report back for at least 48 hours and so it would not be in time to stop the sale. Therefore, I suggest to the Minister that that problem is one deserving of very special consideration.
I would be interested if he would indicate whether he knows of any means whereby that problem can be met by manufacturers and distributors; and, if he does, whether he would consider addressing a circular to public health authorities throughout the country describing the method whereby the particular evil to which Deputy Moran refers can be reasonably overcome.
The section deals with all types of food and the amendment is put in to cover cases such as Deputies Moran and Dillon have in mind. Under the section as it stands, it would appear that public health authorities have to take action against whoever is selling the article. Now they will not have to do that—if there is a warranty they can go beyond him to the wholesaler, agent or manufacturer and take action at that level.
Does the Minister not think it is a hardship to make something an offence which is not within the control of the person to be prosecuted? If he consults the chemical experts and the biological experts of the Department, they will tell him that a package of corn starch may be, from the laboratory point of view, perfect on Monday and, with the seal unbroken, on Tuesday may present all the characteristics of infestation. Is it justice in these circumstances to hold that person criminally liable, when there is no possible precaution he can take which will avert that occasional occurrence? I do not for a moment suggest that the public health authority should not be vested with power to require him to dispose of the article once infestation is established and not to offer it for sale, but to prosecute him for having offered it for sale when there was no conceivable possibility of his having a guilty knowledge, seems to be a very extreme hardship and one of which the Minister should take special cognisance. Has the Minister had that particular problem brought to his attention before, in relation to corn starch?
Not that particular item. It would appear to be a question to be dealt with when we are fixing standards.
I take this opportunity to draw the Minister's attention to the peculiar problem of corn starch, as distinct from other cereals.
Amendment agreed to.
Section 58, as amended, agreed to.
SECTION 59.
I move amendment No. 64:—
In paragraph (c) of sub-section (3), page (30), line 54, before the word "club" to insert the word "restaurant".
This is to insert the word "restaurant" as well as "club", and the next amendment is to change the word "institution" to "establishment", which is the more appropriate word.
Amendment agreed to.
I move amendment No. 65:—
In paragraph (c) of sub-section (3), page 30, line 55, to delete the word "institution" and substitute therefor the word "establishment".
Amendment agreed to.
Section 59, as amended, agreed to.
SECTION 60.
Amendment No. 66 not moved.
I move amendment No. 67:—
In sub-section (1), page 31, line 13, to delete the words "for use" and substitute therefor the words "which may be used".
This is to deal with the defence sometimes put up that a proprietary article was designed for use by animals.
Amendment agreed to.
I move amendment No. 68:—
In sub-section (1), page 31, lines 16 to 18, to delete the words and brackets "(not being a therapeutic substance within the meaning of the Therapeutic Substances Act, 1932 (No. 25 of 1932),) which is sold for use" and substitute therefor the words "which may be used".
The Therapeutic Substances Act, 1932, deals with the manufacture and import of certain scheduled substances. It does not deal with the retailing of these preparations, and, if we were to leave the section as drafted, it would not be possible to cover, for instance, the sale of penicillin which is a commodity we may find it very necessary to deal with. The difficulty about some of these substances like penicillin is that, if used too widely, they may have the effect of developing bacteria resistant to penicillin which would create a very serious situation. Deputies will agree that penicillin is one of the things which may have to be regulated and we think it wise to cut out these words as set out in the amendment.
Amendment agreed to.
I move amendment No. 69:—
In paragraph (a) of sub-section (3), page 31, line 30, to insert before the word "sale" where it first occurs the words "manufacture, preparation, importation, distribution".
What is the significance of this amendment and amendment No. 70?
We have been dealing so far only with manufacture and importation and we find that it would be very difficult to deal with these matters properly, unless we also deal with preparation and distribution.
Amendment agreed to.
I move amendment No. 70:—
In paragraph (a) of sub-section (3), page 31, line 33, before the word "sale" to insert the words "manufacture, preparation, importation, distribution or".
Amendment agreed to.
I move amendment No. 71:—
Before sub-section (4) to insert a new sub-section as follows:—
() Save in so far as is provided for in sub-section (3) of this section no restriction shall be placed on the sale of medical preparations or of substances with proprietary designations by way of confining their distribution to members of specified trades to the exclusion of other wholesale and retail distributors.
This is an amendment of very great importance to a large body of deserving persons in the country. I refer to the retail merchants in rural Ireland. To begin with, I want to make it perfectly clear that, so far as the average country shopkeeper is concerned, he has no desire to limit the discretion of the Minister in the making of any regulation designed to prevent the reckless distribution of dangerous therapeutic substances, such as poisons or rare substances which ought to be used with due economy and consideration, such as penicillin, and this amendment is not designed in any sense to place restrictions of that character upon the Minister. On the contrary, it specifically provides that if a regulation is made by the Minister or with his approval, the retail shopkeeper is prepared to assume that it is done in the interests of the community at large and to accept it as such.
The problem to be cured by this amendment has a history. When the pharmaceutical chemists came to be recognised as a skilled body, a series of Acts of Parliament were passed from time to time giving to the person holding a diploma from the controlling body of the pharmaceutical chemists the right to dispense certain medicines and to deal in certain preparations, notably poisons, to the exclusion of the ordinary shopkeeper. This arrangement was justified on the ground that people should not be afforded an opportunity generally of purchasing poisons which might be used for felonious purposes, without at least leaving after them a record of their purchase, which should include a reasonable account of what they intended to use the poison for, and so, in every chemist's shop, there is a poison register and if a person goes in to buy strychnine to poison rats or arsenic to poison something els—if a farmer wants to lay poison on his land for the protection of sheep or a householder to lay poison for the destruction of vermin—he must declare his purpose to the chemist who will record the quantity of the poisonous substances supplied and the person purchasing must sign that he received it.
To these arrangements, no reasonable shopkeeper takes the slightest exception, but the original purpose of these arrangements was to ensure that people would not buy poisons for a felonious purpose, that is, to poison their neighbours. Then the pharmaceutical chemists' association proceeded to introduce a new finesse, that there was a different reason behind this—not only the purpose of deterring criminals who wanted to poison their neighbours but to deter desperate people from buying it to poison themselves. The moment you could establish that reason for these precautions, a glorious vista opened up, because, if we were prepared to control the sale of certain things in order to deter desperate people from destroying themselves, it was only a short step to saying that many people, without destroying themselves, can do themselves considerable injury and therefore we ought to confine to pharmaceutical chemists every comestible which, if improperly used, might do the purchaser an injury, and from that position it was a very short step to the position of saying that every therapeutic substance being consumed to excess is capable of doing the person who consumes it an injury and therefore every therapeutic substance ought to be confined to the chemist shop.
The chemists would defend it on the ground that aspirin, if you swallowed a bottle of it, would do you an injury. That is perfectly true, but when you come to examine the thing more closely, you discover that it was not primarily solicitude for the perils of the purchaser which was moving the pharmaceutical chemists, because the suggestion began to be made that things like cod liver oil should be confined to pharmaceutical chemists. The pharmaceutical chemist charged 4/6 for a 20-oz. bottle of cod liver oil and the poor, old, despised country shopkeeper only asked 2/6 for it. If you went in with a prescription to a chemist, when he compounded the prescription he put on the back of it a rubber stamp setting out the date and three or four little hieroglyphics, two of which gave him a reference in his prescription ledger, and two of which belonged to a code employed by every pharmaceutical chemist in the country which told any other chemist to whom that prescription might be brought how much the first fellow charged when he made it up. So that if you brought in a prescription to a chemist and he charged 3/6, he put a rubber stamp on the back and he managed to put a little cipher on it which would tell the next chemist: "Whatever else you do, do not charge this fellow less than 3/6 for the next bottle or you will scandalise me."
All the professions do the same.
There is nothing very criminal in that. They wanted to make their living. All I am asking is that commodities such as aspirin, cod liver oil, tooth paste and a variety of other diagnostic, prophylactic, and therapeutic substances, such as Parish's Food, Angier's Emulsion, Scott's Emulsion and castor oil should continue to be available as the stock-in-trade of the general merchant throughout rural Ireland so that he can make an honest profit out of trading in these things— I am not pretending that the general merchant is a disinterested benefactor of the community—and so that the people who live in his neighbourhood, if they find the chemist is charging too much for a 4-ounce bottle of castor oil can go down to the grocer and compare the grocer's price for a 4-ounce bottle of castor oil with that demanded by the chemist, as well as aloes and a variety of other salubrious therapeutic substances of that kind, at which I have no doubt Deputy Dr. Brennan would sometimes be tempted to look down his nose as being somewhat crude. But there are those in rural Ireland who find their constitution better provided for by a pennyworth of rhubarb and a halfpenny worth of aloes than they do by a bottle of Aliphan. They can get one remedy for 1½d.; a bottle of Aliphan will cost about 5/6, and the results are virtually identical. Glauber Salts and Epsom Salts are the stock-in-trade of thousands of shops throughout rural Ireland. I want to ensure that no Orders will be made restricting their sale which are designed to serve the profit-interest of the pharmaceutical chemist and not the protection of ordinary people. Therefore I move this amendment so as to ensure that no restrictions will be put upon the sale of these things with the Minister's approval.
The Minister may ask: "How can they put a restriction on the sale of these things? What power have they to make an order under the existing law?" None whatever. Like many a vested interest they have worked out a most subtle procedure in order to arrogate to themselves the power to make laws with no legal authority to do so. The subtle procedure is this: they go to the wholesale chemist and they say: "There are three therapeutic substances which are virtually interchangeable, the preparation, say, of Eli Lilly and Company, the preparation of Burroughs, Wellcome and Company, the preparation of Parke Davis and Company and the preparation of the United Drug Company. Now you will either undertake to sell only to the pharmaceutical chemist or the pharmaceutical chemist will not take your preparation at all." Suppose they go with that challenge to a toothpaste manufacturer and they say: "There are Colloidal, Euthymol and Gibbs' Dentifrice. Unless you agree to sell your dentifrice only to a pharmaceutical chemist, we will not touch it at all. Therefore, if a person comes into us for toothpaste, we shall sell him Euthymol. If he asks for Gibbs', we will win him away from Gibbs' and persuade him to take one of the two we stock."
Céad fáilte roimh an Teacht annseo, Deputy. I am sure the Deputy from Clonmel who has just come in will confirm the tale I am telling now. The pharmaceutical chemist will then succeed in establishing a monopoly in the sale of these particular commodities and ensure that no, what he would call, unreasonable competition will be set up against him by unskilled shopkeepers who surround him. The justification advanced by the pharmaceutical chemists is this: that the poor ignoramuses, the common shopkeepers, have not undergone the long period of training the pharmaceutical chemist has undergone; that they are ignorant creatures fit to sell flour, meal and domestic commodities of that character, but when it comes to selling tooth paste, on which there is a 50 per cent. profit, when it comes to selling aspirin, on which there is a very comfortable profit; when it comes to selling anything that is to be found in the pharmaceutical chemist's shop, on which there is never less than 30 and, usually, up to 50 and 70 per cent. profit, it requires a highly skilled and trained operative to ensure the safety of the public in its distribution. Where the profit is tuppence in 5/-, or a penny in the £, the common shopkeepers can handle that. Well now, common shopkeepers, of whom I glory to be one, make no claim to act as the custodians of poison goods or other therapeutic substances, which manifestly should be distributed under the direction and control of the Minister for Health. But they do expect their ready recognition of the necessity for that control will entitle them to protection from restrictive practices masquerading as control, but really designed to reserve to the aristocrats of the Pharmaceutical Society the most profitable lines which the general grocer in rural Ireland is in a position to sell. I think that is a reasonable request and it is for that reason I put this amendment down.
I do not think the Pharmaceutical Society ever suggested that the ordinary shopkeeper is an ignoramus. I never heard a pharmaceutical chemist suggest such a thing. The pharmaceutical chemist is merely asking that the sale of certain articles should be reserved to chemists who, undoubtedly, have to go through a long period of training, who have to attend courses of lectures and who have to pass examinations and obtain a certificate before they are entitled to keep open shop for the sale of these goods. If the ordinary shopkeeper wishes to embark on the sale of the goods which Deputy Dillon speaks of, he can form a limited company. The only condition is that he should have as managing director a pharmaceutical chemist. There is no reason in the world why an ordinary shopkeeper cannot enter into the sale of these things, with that particular provision.
The Pharmaceutical Society was founded many years ago. It is a statutory body and it has certain rights and it is in the exercise of these rights that there is, perhaps, something in the nature of a monopoly. But in order to have that, they have to go through a pretty rigorous course of training. I do not think there is anything unreasonable in any craft asking that things pertaining to that craft should be reserved. That is all the pharmaceutical chemists have asked. Up to the present, there is no restriction on the sale of things like Aspirin or Aspro —these are two of the things I heard the Deputy mention. Any shopkeeper in the country can sell them in competition with the chemist.
I am hoping that at some future date a Bill will be introduced which will restrict the sale of medicinal preparations to the people who have been trained to sell them. I must confess I have not studied the amendment the Deputy has been talking to. The only reason I rose is because Deputy Dillon said that the members of the Pharmaceutical Society who are, I think, in general, fairly decent people, are suggesting that ordinary shopkeepers are just the type of people who might be called ignoramuses.
Does it take three years' pharmaceutical training to sell Petrolagar to a constipated citizen—liquid paraffin and agar? I do not think it does, but there is 50 per cent. profit on Petrolagar. Does it take three years' training to permit a man to sell Kepler's Malt Extract to anyone who wants to eat it?
You can sell strychnine for that matter.
Is there any analogy between strychnine and Kepler's Malt Extract? If there is, I would like to hear it. I do not think Deputy Loughman's stomach or mine is large enough to hold that quantity of Kepler's Malt Extract which would put his life or mine in peril. We might feel sick, just as if we ate too many cakes or too much bread, but Kepler's Malt Extract is in no sense a dangerous therapeutic substance. Does it require three years' pharmaceutical training to permit a person to purchase a bottle of Cascara Evacuant? It is the 50 per cent. profit that is worrying the Pharmaceutical Society. Does it take three years' pharmaceutical training to qualify a man to sell a tin of Sister Laura's Food —baby food? If it does, why is he free to sell Neave's Food, Benger's Food, Cow and Gate, and all the other baby foods? Because the Pharmaceutical Society said to Sister Laura: "If you confine it to us, we will push Sister Laura; if you scratch our back, we will scratch yours". Does it take three years' pharmaceutical training to qualify a man to sell Ostermalt?
You can sell real malt without any training.
Does it take three years' pharmaceutical training to qualify a man to sell Antiphlogistin to make a poultice? God be with the days when we sold a quarter stone of linseed and made as good a poultice. But when you put it in a tin and charge four prices for it, no one but a pharmaceutical chemist can sell it and any poor old woman who puts a linseed poultice on her husband is an out-of-date old faggot because she did not get a tin of Antiphlogistin. Does it take three years' pharmaceutical training to qualify a man to sell Peroxide of Hydrogen, prepared by Parke Davis? Does it take three years' pharmaceutical training to qualify a man to sell Harrison's Pomade?
I am surprised to hear a shopkeeper cannot sell that.
You are a mighty good pharmaceutical chemist, but have another think about that. You know what it is for?
And D.D.T. probably enters into its composition. Does it require three years' pharmaceutical training to sell a pennyworth of rhubarb or a ha'porth of jalap or aloes?
There is no restriction on the sale of those things.
Does it take three years' pharmaceutical training to qualify a man to sell Euthymol Toothpaste?
I could explain that, too.
Does it take three years' pharmaceutical training to justify a shopkeeper offering Iodex ointment for sale? I could go on with that list indefinitely. During the emergency the pharmaceutical chemists, apprehensive lest essential supplies might be recklessly distributed without due regard for the interests of the community, succeeded in adding to the list of their monopoly vaseline, Cuticura Soap, Liquid Paraffin, Angier's Emulsion, Scott's Emulsion and Johnson's Baby Powder, not, of course, to secure the profits that accrued from the monopolistic control of these commodities! Such a thought never entered their heads! They are only interested because if the common shopkeepers were permitted to handle these goods they would not be distributed with the solicitous discretion which we may expect the pharmaceutical chemists to exercise, inspired solely by the anxiety to ensure that those who must get a dose of liquid paraffin would get it!
These are not controlled.
Not now, but throughout the emergency they were.
They were always on sale in the shops.
Not during the emergency.
It is a discussion. I am making the case that the sale of these commodities was controlled, and the Deputy intervened to say that certain things were not——
The Deputy may not intervene.
He rose and said that certain things were not controlled. I am reading a list of things that were controlled that manifestly should not have been controlled. They were controlled under regulations and by agreements which were made not for the benefit of the community as a whole, but were made to facilitate the earning of excessive profits by a privileged coterie of persons who, in my submission, were using powers conferred on their executive for the purpose of preventing the promiscuous distribution of poisons and dangerous substances, to draw as grist to their own mill a wide variety of profitable articles of commerce, so that, on the one hand, they would have a monopoly of the sale of them and, on the other, as a result of an elaborate system of agreements between their registered members, there would be no undue competition between them which might be calculated to bring down the price which the consumer was required to pay for the particular commodities which the chemist sought to control.
I find no particular fault with them. They are just another vested interest, subject to the same temptations and yielding to the same temptations as other vested interests. I am happy to think that my representations are made on behalf of a body of persons in this country, too large, too miscellaneous, too varied, ever to become a vested interest—independent, competitive citizens who want no protection, no regulation other than regulations designed to protect the community at large, no subsidy, no privilege, nothing but the opportunity to earn their own living within the law, by legitimate trade procured from their neighbour, as a result of superior service and better value, offered on the hustings in competition with all-comers, on the clear understanding that the more competition there is the better pleased they are. All they want is a fair field. That is why I put down the amendment.
In the first place I should like to correct the statement of Deputy Dillon that the Pharmaceutical Society regulates in any way the profits of members of the society. The Pharmaceutical Society enters in no way into the business transactions of chemists as a whole. There is an association called the Irish Drug Association which operates much in the same way as the Licensed Vintners' Association and which seeks to secure certain advantages for members and representations in regard to business matters are made through that society. I know that quite a number of trade associations arrange that goods can only be supplied to members of that association just as, in the same way, we shall say, as the bicycle people arrange that they will only sell bicycles to members of the Irish Cycle Retailers' Association.
If the pharmaceutical manufacturing firms decide that they will sell goods only through pharmaceutical chemists, I do not think that there is anything unlawful or unjust about that arrangement. Quite a number of the articles which Deputy Dillon read out here this evening are manufactured by firms who have decided in the interests of these firms, perhaps in the interest of the public also, to sell goods which they manufacture through pharmaceutical chemists.
At the suggestion of whom?
Of course that is a very old idea. I have been in business ever since 1910 and I knew of this arrangement when I first started as an apprentice in 1910. It is nothing new, or as Deputy Dillon suggests, something which started during the last war.
No; I agree it is an old story.
The Deputy mentioned some articles including vaseline of which we secured a monopoly during the war. Actually, so far as I can remember, I could not get any vaseline during the war. We did get soft paraffin but for five or six years I did not see any vaseline until the war was over. It is on the market now again. I admit that some of the commodities that he mentioned like Cascara Evacuant, Euthymol, and Hydrogen Peroxide solution are sold through chemists but again it is the firms who manufacture these commodities who decide that they will sell only through chemists. So far as our prices are concerned, the prices are arranged in conjunction with the prices section of the Department of Industry and Commerce. If we get pretty substantial profits, taking into consideration the small turnover of the average chemist's shop, if the shop is to be there at all, it is necessary that these profits should be made. I do not believe that a chemist's shop would be able to exist if it were confined to selling articles within a certain limited range and if it were compelled to sell them at a profit less than chemists are actually trying to secure at present. It is news to me at any rate that the general public, for whom Deputy Dillon thinks he speaks, looks upon chemists as a class of people who are trying to secure an unfair monopoly. I think they look upon chemists much in the same way as they look upon a carpenter who is carrying out his duties in such a manner as to ensure that he will get work that a carpenter should get. In the same way, the chemist seeks to get the type of work which the chemist should get. When I see stuffs that should properly be sold by chemists on sale in shops all over the country, I do not make an objection but I think we are perfectly entitled to fight to see that the sale of these goods should be confined to chemists.
One is constrained to admire the moderation and reasonableness of Deputy Loughman's approach, no matter how deeply I find myself at variance with him. I put it to him, if we restrict to the pharmaceutical chemists the duty of compounding prescriptions, the distribution of poisons, dangerous and scarce therapeutic substances, surely these are that part of his work which is analogous to the craft of the carpenter. I submit that these are to a pharmaceutical chemist what sugar, tea and jam are to a grocer and that there is then a wide variety of cosmetics, soap, and other articles which may with equal propriety be found in the shop of a pharmaceutical chemist, a general merchant, a cosmetician, a hairdresser. The more people who are engaged in the distribution of these innocuous substances, the better it will be for the purchasing community in that the competition which will take place between this wide variety of merchants for the custom of their neighbours, will be calculated to bring down prices, to improve service and to increase the amenities to which the average consumer will have access. That is all.
I am 100 per cent. with Deputy Loughman—I do not think it would be right to allow the grocer to encroach on the specialist trade of the pharmaceutical chemist. The difference that arises between Deputy Loughman and me is where should the line of delimitation be drawn. I want to draw it as narrowly as possible so that, outside that line on the pharmaceutical chemist's side on the one hand and the grocer's on the other hand, there should be free competition for the innocuous substances which either or both of them may offer for sale. It is because I feel that the Drug Association or the Pharmaceutical Society or whatever you may call it——
There is a great distinction.
The Deputy will agree with me that there are distinctions in this troubled world without a difference.
The membership of both associations is strictly confined to chemists. In any case, my sole concern is to ensure that this body, call it what we may, shall not engage in a conspiracy for the restraint of trade in order to enhance the profits earned by its members at the expense of the community under the guise of making regulations analogous to those which would be approved by the Minister for Health primarily designed to protect the community from the irresponsible handling of dangerous poisons or other therapeutic substances.
I believe that is a reasonable request. The Minister has gone out to his tea, as all of us must do, from time to time, and so I am in a dilemma because I cannot expect the Minister for Lands to couch alliance in this highly controversial territory where we are at present moving and, for that reason, Sir, I must ask your leave to withdraw this amendment so that it may be raised again on Report Stage in proper form.
Amendment, by leave, withdrawn.
Question proposed: "That Section 60, as amended, stand part of the Bill."
Deputy Dillon has withdrawn his amendment.
I withdrew the amendment, by leave, to raise it again on Report Stage so that the Minister might have time to consider the merits.
The House has just listened to Deputy Dillon and a Deputy on this side discussing the question as to what sections of the trade should sell particular commodities. If Deputy Dillon had examined his own conscience, as a grocer, having probably an agency for machinery and several other agencies, he will find there are particular lines of business in respect of which nobody else in his town will be given an agency. Is not that true?
There is agricultural machinery, for instance, which occurs to me at the moment. There are certain towns in which there is only one agent for agricultural machinery and no other hardware merchant in the town will get an agency.
I think it is a very bad arrangement.
I think that is true and Deputy Dillon would be the first to defend it.
No. I condemn it absolutely. I believe in competition and free trade.
That is all right so long as it is not too near you.
All I can say is that I believe in free trade. I want it.
Let us hear Deputy Allen.
I am not concerned with the chemists or the hardware merchants or the grocers. I am concerned with the ordinary public and I would suggest to the Minister in the regulations he will make under this section, not to prevent some of the substances that are in everyday use, simple substances, being offered for sale otherwise than through registered chemists because there are many areas that are nine or ten miles from a town where the chemist has his store and it would be to the disadvantage of the public if certain simple remedies that are in everyday use were not allowed to be sold otherwise than through chemists. It would be a bad thing generally and I am sure the Minister will be sensible enough to prevent that and not to give any particular section of trade a monopoly in these simple things that are in everyday use.
Question put and agreed to.
SECTION 61.
I move amendment No. 72:—
In sub-section (1), page 32, to delete paragraph (c).
I am moving to delete paragraph (c) because it is sufficiently covered by the acceptance of certain amendments— Nos. 67 to 70.
Amendment agreed to.
Section 61, as amended, agreed to.
SECTION 62.
I move amendment No. 73:—
Before sub-section (6), page 34, to insert the following new sub-section:—
() A statement by the manufacturer, importer or seller of flock as to its standard of cleanliness, in an invoice or on a label attached to the flock or on the container in which the flock is sold shall be deemed for the purposes of paragraph (a) of sub-section (5) of this section to be a warranty.
This is similar to an amendment already moved with regard to warranty. We are not bound to sue the person selling the article if there is a warranty which would indicate that the offence is higher up.
Amendment agreed to.
Section 62, as amended, agreed to.
Amendment No. 74 not moved.
Section 63 agreed to.
SECTION 64.
Amendments Nos. 75, 77, 79 and 81 might be debated together.
As amendments Nos. 75, 77, 79 and 81 all deal with the same principle and as they are all the same types of amendment, let them stand or fall by the decision given with regard to the first. Therefore, I move amendment No. 75 standing in the name of Deputy Mulcahy:—
In sub-section (5) (a), line 6, after the word "shall" to insert the words "on his signifying his willingness in writing to the health authority."
The position created by these sections of this Bill is rather peculiar and, in my opinion, rather unique. The result of these sections is that a considerable number of officers in the public health service will have their present appointments terminated by a sub-section of this Act and will find themselves, the day after this Bill becomes an active law, in very different appointments carrying much greater responsibility, far more headaches and greatly increased duties. I do not think the matter was fully considered by the Department, at least before they adopted the particular procedure they did adopt, that is, to insert this in a Bill, to bring it before Parliament, to pass it to the newspapers, and then let the officers affected learn about it through that machinery. I think that aspect of the matter was never considered. I do not believe that with any form of agent or servant an employer would decide "We are going to alter that person's title. We are going to alter that person's duties. We are going to give that person much greater responsibility, but we will not even discuss the matter with him and we will not even give him an opportunity of saying ‘yes' or ‘no"'. I do not want to show any pique or anything of that kind but, to begin with, it was a thoroughly discourteous way in which to treat a large number of officers who deserve better.
I do not believe, however, that the Department was fully aware of the gigantic change it was making in the responsibilities of the people we are discussing. I do not believe that they adverted to the fact that without even discussion, without consent, they were changing the whole basis of contract between these particular officers and the various counties to which they had contracted their services. I do not believe, even, that consideration or full consideration was given to the fact that the new officers we are creating here would, in very many cases, require a quite different type of official to carry out efficiently and successfully the new responsibilities which are being forced by law on these particular officers. Let me explain the magnitude of the change made—the change made without consultation, notification, discussion or consent. Each one of these officers referred to in this part of the Bill is a qualified medical practitioner. They specialised in public health—preventive medicine. They went before the Appointments Commission and they received appointments through the Appointments Commission in the various administrative areas whether as county medical officers of health or assistant county medical officers of health. The medical work in every administrative area was, in the past, inside two fields with a high fence between the two fields. The smaller field was the field of public health— preventive medicine. The functions of these men, up to the time this Bill becomes law, and their responsibilities, have been strictly confined within the field of public health. Outside and beyond that there was the other far larger field—poor law institutions. All the work of a multiplicity of dispensary districts and all of the medical institutions in the country was on the poor law side.
In the field of public health the duties and responsibilities were, in the main, confined to preventive medicine, infectious diseases, cleanliness of food, Milk and Dairies Act, slaughterhouses, tuberculosis, the clinical diagnosis and clinical treatment of tuberculosis, plus certain supervisory duties with regard to the notification of births and marriages. Housing also came within the field of public health. I would say that from about 20 to 25 per cent. of the medical work in the county fell into the public health zone. Seventy-five to 80 per cent. fell in the poor law medical zone. By a line in one sub-section of an Act you make all the officers who were responsible purely for the limited field of public health take on responsibility for the whole field of medical work inside their administrative area. Every bit of trouble, every bit of friction, every irregularity, every lack of attention, every complaint made inside any of the poor law medical institutions in a county will become the headache of the county medical officer of the future who used to be the county medical officer of health. You make him by sub-section (1) of Section 64 responsible for advising the health authority generally in relation to health, etc., as well as for all duties assigned and functions of the health authority. Under sub-section (3) you make him the chief medical officer for the county for the purposes of this Bill.
This is not a matter, I think, about which there should be any controversy or disagreement. To a certain extent, we can both appreciate the facts as we are up against them. There should not be any dispute as to whether you are, or are not, altering to an immense extent the position of these officers as well as increasing their responsibilities to an immense extent. The county medical officer of health is an officer on the staff of the county manager, and the latter has responsibility for all work in the county. Let us take it that there is trouble or that there is work to be done, advice to be given or something to be investigated within the field of public health. Up to the date that this Bill becomes law, the county manager's staff officer is the county medical officer of health and his assistant, but if there is any trouble in a medical institution, any adverse report, any complaints from patients, any suggestion of lack of proper supervision or of prompt attention, and if the county manager refers that to the county medical officer of health, he is, and always has been, within his rights in saying: "That is the field of poor law medicine and I cannot encroach on that field". Since the introduction of the managerial system, medical inspectors from the Minister's Department have visited the various districts. They have called the county manager, the secretary for the county and the medical officers together and, in the presence of the county medical officers, they have warned the administrative side that they cannot, and must not, use the services of the county medical officers of health in relation to anything on the poor law side.
That was the position up to the date of the introduction of this Bill. By its introduction, and by knocking out the words "of health" the county medical officer is to be made responsible for all the medical work under this Bill as well as for all the institutions within his administrative area. I think it is beyond argument that you are changing his appointment, that you are vastly increasing his responsibilities. His fitness for the new position is quite another matter. It is purely one of opinion, but I think his right to be consulted before he is pitch-forked into this new office, should be unquestionable. The position that has arisen, and that will arise, is that all those people who are affected are going to find themselves faced with very much greater responsibilities than they ever had to carry before, with very many more headaches and more worries, doing a type of work that will, and must, if it is to be conscientiously carried out, lead to conflict between themselves and their medical colleagues within their administrative area. The suggestion in the amendment is that that should only be done after they have signified their willingness, in writing, to take on these new duties. The amendment, as it were, merely raises the whole question. I do not think that, if the amendment were carried it would be the wisest course, because if nine or ten officers did not signify their willingness to take on the new duties imposed on them I do not know what the position would be. It would mean that this Health Bill and the new services would break down completely, in their particular areas. I do not think that, if such an amendment were inserted and if a person did not signify his willingness to take on the new duties, there would be any justification for dismissing him. What would happen is that he would be paralysing the machine in his particular administrative area. That would be an entirely unthinkable attitude and, as far as I know, would not be adopted by any of them.
The alternative is to discuss with the officers in question their new responsibilities, their new functions and their greatly increased duties in order to induce them to face those new responsibilities with the same enthusiasm and willingness with which they faced their old duties. I have heard it argued that no change is being made in the position of these men, and that we are not increasing their responsibilities or their duties. That is one leg of the argument, but anybody who knows anything about medicine in the various administrative areas under the Department of Local Government knows that there is no foundation whatever for that particular argument. The other leg of the argument is that it is a bad principle, one that could not be accepted, to increase the remuneration of a whole-time officer because of increased duties and responsibilities. That argument is equally untenable. It is an argument that would blast sky-high the Civil Service, the Army and all State services if you were to apply it to them. The civil servant when he joins as a junior is a whole-time civil servant. When the efficient man gets promotion, he gets increased responsibilities and against that he gets increased remuneration, but he is a whole-time State officer all the time. Where does the principle apply? The principle of increased remuneration, with promotion, with increased responsibilities, with added duties and with added worries, is the soundest principle in the world and is one that makes for bringing out the best, one that makes for keenness, one that gives a person an ambition to succeed and the determination to get on. But for the first time, as far as I know, in the legislation of this or any other country, the Minister and Parliament by law abolish the office held by a number of people, by law put them into a new office, without even informing them, without even consulting them, pile on immense new responsibilities and make no provision whatever for any compensation for the vastly increased duties.
That is the principle contained in all these sections that I read out. It is the same principle applied to different officers. The amendment which is down here for the first is similar in form in all the other cases. I would like to hear from the Minister some statements to the effect (1) that there was no intentional discourtesy, and (2) that it would not be the policy of his Department when dealing with the medical man, the civil servant, the engineer or the wage earner, to change his job, increase his responsibilities and increase his work without consulting him and, further, without any suggestion as to how it is proposed to remunerate or compensate him.
First of all, I am afraid I will have to disagree with Deputy Dr. O'Higgins in his interpretation of the section. Sub-section (1) is very little different—in fact, there may be some difference in words, but I think there is no difference in meaning—from Section 21 (6) of the Local Government Act, 1925. In that Act it was laid down that a county medical officer of health will advise the council on any matter where expert advice is required on matters affecting the health of his county or district.
There was not any difference in the meaning and it was not intended that there should be. This section was brought in to codify what had gone before. Changing the name does not make any material difference, as I am sure the Deputy will admit. In regard to county medical officers of health, there is, first of all, a change of title. As far as the other provisions in this section are concerned, they are merely consolidating and do not go further than that. I do not think it can be contended that in this Bill the duties or responsibilities are increased. It is a matter to be decided whether they will get extra duties or not.
I certainly meant no discourtesy to the medical officers of health. When this section was put before me—as it stands now; I do not think I suggested any amendment—the note I got with it was that it was merely a consolidatory section and made no change in the present law except in regard to change in title. I can assure the Deputy that there was no intention of any discourtesy. What is more, I do not think I ever subscribed to the principle that, in the case of a medical officer, increased duties or responsibilities should not be accompanied in any circumstances by increased remuneration.
I did not even mean to suggest that the Minister did.
That is a matter which should be considered. I would make this appeal to the Deputy—this is not, perhaps, the place or the time to discuss this matter fully and we might only do harm if we were to argue the matter out in every detail here. The intention in this Bill is that the county medical officer of health would take over the health services of the county. He will be responsible for these, as he was in the past.
No, he was not in the past.
Public health services. As I pointed out on the Second Reading, whereas he had to do a good deal of the work in regard to inspection in the past, that will be done by district medical officers in the future and he will have the supervision. It is a matter to be decided whether the duties and responsibilites are increased or not. As regards institutions and so on, that is again a matter to be discussed and decided, whether the medical officer of health would be responsible for those institutions or not. These matters will come up for discussion when we get down to working out in detail the regulations under the Bill.
To go back to the White Paper, when it comes to be put into its final form, some of these matters may come up for discussion with regard to the exact part the county medical officer of health will take in the county and what part will be played by the other medical men of the various grades and classes. I do not think the Deputy is right in assuming that we have so far made any change. If I am convinced by the medical officers of health that they are in fact getting more work to do, more duties to perform, more responsibility and so on, I would be quite willing to listen to the case for remuneration to suit the new duties and new responsibilities. But we will have to wait until we see what those duties and responsibilities are going to be. I do not think we can discuss that very minutely at this stage.
I agree with the Minister in that. I feel acutely uncomfortable in discussing this here and think it would be much better discussed elsewhere. It is rather unfortunate that these discussions, and many of them, did not take place before the people concerned were faced with the sections we have before us. I have been for practically 20 years a medical officer of health and have been watching the poor law administration alongside me and I can read, although not always understand, an Act of Parliament; and I know the meaning of simple English words. Taking those things together, I see sub-section (3) here:—
The county medical officer for a county shall be the chief medical officer for the county for the purposes of this Act.
Managers are not medical men and are not specialists, and the people we are talking about are staff officers of the manager. Medical worries are coming before them every day; institutional worries are coming before them every day, and complaints are coming before them, although not every day. There are matters to be investigated in many institutions and many dispensary districts. The very minute this section goes through, what will any manager who knows his job do? He will utilise his staff officer—I think that ought to be obvious to everybody—and the mere utilisation of his staff officer for the purposes of the Act means very increased worries and increased responsibilities on that staff officer or those staff officers—the kind of worry and responsibility that may lead to strained relations between himself and his professional colleagues under circumstances which may arise in any district at any time. We can leave it at that.
I should like to make clear to the Deputy that there is nothing in the Bill to say that the county medical officer of health will be responsible for the institutions.
The county medical officer for health is responsible for the medical work under this Bill.
Under this Bill, certainly.
And treatment is under this Bill.
That does not say he must do the treatment, or even be responsible.
He is responsible for the supervision.
That remains to be decided.
Amendment, by leave, withdrawn.
Amendments Nos. 76 to 82, inclusive, not moved.
Sections 64 to 67, inclusive, agreed to.
SECTION 68.
Question proposed: "That Section 68 stand part of the Bill."
I take it the Minister would reply on similar lines with regard to the position of dispensary doctors?
Yes. If duties and responsibilities are increased, we must necessarily consider the question of remuneration.
Question put and agreed to.
SECTION 69.
Question proposed: "That Section 69 stand part of the Bill."
I am very interested in the appointment of bacteriologists to county hospitals. The Minister will agree that county surgeons and physicians are working under great disadvantages by reason of the fact that they have not got bacteriologists. I quite appreciate that it would be too expensive to have a bacteriologist for each county, but I was wondering if it would be possible to have one appointed for three counties combined such as Sligo, Leitrim and Roscommon. As I say, physicians and surgeons are working under great disadvantages and I should like the Minister to indicate what he proposes to do in this connection.
One matter we are considering is a regional organisation for certain services, one of which will be bacteriology and I think it will be practically in line with what the Deputy suggests. Three, four or five counties, according to their size and the work to be expected in them, would be made into a region for certain services, including bacteriology.
Question put and agreed to.
Section 70 agreed to.
SECTION 71.
I move amendment No. 83:—
Before Section 71, but in Part VII, to insert the following section:—
(1) Where an enactment repealed by this Act (in this section called "the repealed enactment") conferred powers and duties on a sanitary authority and corresponding powers and duties are conferred by this Act on a health authority, the following provisions shall have effect:—
(a) every person who, immediately before the repeal of the repealed enactment, is the holder in a permanent capacity of an office under a sanitary authority the duties of which relate solely to the powers and duties conferred on such sanitary authority by such repealed enactment, shall become and be the holder of the same office under the health authority in whose functional area the district of such sanitary authority is situated,
(b) the said office under a sanitary authority shall, for the purposes of any enactment relating to superannuation, be deemed not to have been abolished.
(c) if any question arises as to whether the duties of a particular office under a sanitary authority relate solely to powers and duties conferred on such sanitary authority by the repealed enactment, such question shall be referred to the Minister whose decision shall be final.
(2) The following provisions shall apply in relation to every person who, immediately before the commencement of this section, held, in a permanent capacity, an office under the title of sanitary sub-officer under a sanitary authority:—
(a) such person shall become and be the holder of an office under the same title under the health authority whose functional area includes the functional area of the sanitary authority,
(b) the said office under the sanitary authority shall, for the purposes of any enactment relating to superannuation, be deemed not to have been abolished,
(c) the holder of the office of sanitary sub-officer under a health authority shall (in addition to performing duties in relation to the functions of the health authority) perform such duties as may be assigned to him in relation to the functions of any sanitary authority in the functional area of such health authority and for that purpose the provisions of paragraph (b) of sub-section (1) of Section 10, and of Section 20 of the Act of 1941 relating to the duties of officers and of sub-section (2) of the said Section 10 relating to appeals by officers shall apply in relation to the said office as if it were also an office under the sanitary authority of every sanitary district in the functional area of such health authority.
Holders of certain offices, including that of sanitary sub-officer, under sanitary authorities, will be transferred to similar offices under the health authorities. Sanitary sub-officers are concerned and nurses engaged on maternity and child welfare work, which is at present run by the sanitary authority. So far as their status, duties and so on are concerned, they will come over with exactly the same status and duties.
Amendment agreed to.
Section 71 agreed to.
SECTION 72.
I move amendment No. 84:—
In page 39, line 44, before the word "acquire" to insert the words "under this Act".
This is a drafting amendment.
Amendment agreed to.
Section 72, as amended, agreed to.
Sections 73 to 82, inclusive, agreed to.
SECTION 83.
I move amendment No. 85:—
To insert at the end of the section a new sub-section as follows:—
(4) Section 83 of the Local Government Act, 1946 (No. 24 of 1946) (which relates to the disposal of land not required by a local authority) shall apply to the disposal (not being by demise for a term not exceeding one year) of land under this section and for this purpose references to the Minister for Local Government in the said Section 83 shall be construed as references to the Minister.
This amendment is to apply and adopt Section 83 of the Local Government Act, 1946, relating to the disposal of land. It is the section which governs the procedure to be followed.
Amendment agreed to.
Section 83, as amended, agreed to.
Sections 84 to 87, inclusive agreed to.
SECTION 88.
I move amendment No. 86:—
To delete sub-section (6) and substitute the following sub-section:—
(6) In this section, the word "premises" includes temporary dwellings and aircraft.
This amendment follows the third amendment moved to the definition section.
Amendment agreed to.
Section 88, as amended, agreed to.
Section 89 agreed to.
SECTION 90.
I move amendment No. 87:—
In paragraph (b) of sub-section (2), page 46, lines 40 and 41, to delete the words "when in uniform".
Sub-section (4) prohibits a member of the Garda from exercising his powers, unless he is in uniform or produces on request his official identification card. The words "when in uniform" in sub-section (2) (b) are, therefore unnecessary.
Amendment agreed to.
I move amendment No. 88:—
In paragraph (c) of sub-section (2), lines 43 and 44, page 46, to delete the words "Commissioner of the Garda Síochána" and substitute therefor the words "Minister for Justice".
It is the Minister for Justice who should be referred to, instead of the Commissioner of the Garda Síochána, because all fines accrue to the Minister for Justice.
Amendment agreed to.
Section 90, as amended, agreed to.
Section 91 agreed to.
SECTION 92.
I move amendment No. 89:
In sub-section (1), to delete the word "may" in line 17, and substitute therefor the word "shall".
The sub-section reads at present:—
"The Minister may by Order establish a council to be called ‘The National Health Council' to give to the Minister when so required by him advice on matters affecting or incidental to the health of the people."
The provision is mixed up with a general kind of suggestion that the Minister may, at any time he requires special advice, establish a special consultative council to give him advice or assistance on any particular matter. In the first place, I think these two ideas should be separated entirely in the Bill. I think that the idea of a National Health Council, whether set up with statutory powers or merely for the purpose of being an advisory council to the Minister, should be completely separated from the general power that the Minister may wish to have to set up special consultative councils for some ad hoc purpose or some special idea. I think that it degrades and minimises the idea of a National Health Council, even as an advisory council, to simply make it part of a section that gives additional and other powers.
There are two amendments in my name. The one which I am moving now is to make it obligatory on the Minister to have a National Health Council to advise him on certain matters. The second amendment goes further. It provides that the National Health Council will have constitutional powers, functions and duties established by law. The Minister indicated that his view of a National Health Council is that they would be just an advisory body. He would call them together and, from time to time, there would be matters that he would refer to them for their consideration and opinion; and from time to time perhaps they might assemble themselves and make representations to the Minister with regard to certain matters that they considered advisable to do or to consider. The Minister has not given any indication as to what his final idea is with regard to either the constitution of the National Health Council or their powers, functions and duties. He simply says that, as far as the powers, functions and duties are concerned, he will only regard them as an advisory body. He has not indicated that they will be a body that can assemble on their own initiative and consider matters and, even though having no power of any kind, will still be in a position to advise the Minister or to make representations to him on any matter that they might decide on.
I want the Bill amended in such a way that it shall be obligatory on the Minister to have a National Health Council. The Minister may say that, except the council is to have some power, making it obligatory on the Minister to have a council would serve no particular purpose, because, if he did not want to be bothered with a genuine council he could assemble a bogus one, the members of which would give him a guarantee that they would not worry him in any way or say anything to him on any subject he did not ask them to consider. I do not think that would be a sound argument to put up. I think that if we laid down in our legislation that the Minister should have a National Health Council, no Minister could appoint a National Health Council that would not be truly and equitably representative of the profession in its various branches. Therefore, I press on the House that, even if the Minister is only to regard the National Health Council as an advisory body, the section ought to make it obligatory that such a council will be set up. I should like a decision on that point by itself. We can then discuss the matter further on amendment No. 90.
I do not object to that at all. As I have no other intention than to set up this National Health Council, I do not see why I should not bind myself here and now to do it by using the word "shall". I agree with the first amendment. On the second amendment——
We will come to that on the next amendment.
Amendment 89 agreed to.
I move amendment No. 90:—
To delete all words after the word "council" in line 18 and substitute therefor a new sub-section as follows:—
() The constitution, powers, functions and duties of the National Health Council shall be as by law established.
I am afraid I will have to insist that the council will be advisory, and therefore bringing in a Bill and so on would do very little more than what is stated here in the first sub-section. As well as that, I am sure Deputies are aware of the congestion in connection with legislation in general and it might be a few years before we would arrive at such a Bill. I think we ought to carry on for the present anyway.
I appreciate that it might not be very easy to decide straightaway what powers, functions and duties we should give the National Health Council and to define them so precisely that we would be prepared to put them into a piece of legislation. I appreciate that we are advancing in the matter when the Minister agrees to make it a statutory requirement on him to have a National Health Council. Having gone so far, I think it is desirable that we should discuss the matter a little more and try to see what exactly the Minister's outlook is on the matter and get as clear an idea from him as we can how it will be constituted and the kind of duties that he expects to give it.
I think it is desirable in discussing the matter that we should refer to the recommendation made by the Commission on Vocational Organisation which was invited by the Government to review the whole of the social and economic organisations in the country and to suggest in what way the various vocations and the various sections of the community with specialist functions could give of their best to the work of the country as a whole. It approached the examination in that particular way and it made certain recommendations as to how the professions could, in an organic way, develop their organisation so as to make them, in so far as their own sphere was concerned, self-governing to such an extent that they could give the best from their own experience to the nation.
The commission approached this matter on the lines that that could and would be done, without reference to any particular kind of political organisation or society here. In relation to the Council of Health, they gave general ideas as to how that council ought to be set up from the point of view of representation and from the point of view of function. In paragraph 543, the commission recommended unanimously that a Council of Health be established and constituted more or less as follows:—
"I. Representatives of central and local authorities:
One from Department of Local Government and Public Health.
One from Department of Industry and Commerce.
One from the General Council of County Councils.
One from the Association of Municipal Authorities of Ireland.
II. Representatives of medical profession, to be appointed by the Medical Professional Board:
One from the Medical Research Council.
One from the teaching bodies.
One from the voluntary hospitals.
One county medical officer of health.
One dispensary doctor.
One general medical practitioner in private practice.
III. Representatives of other professions, to be appointed by their respective professional boards:
One dentist.
One veterinary surgeon.
One nurse.
One engineer or architect.
One chemist.
One pharmacist.
IV. Representatives of other organisations:
One from the National Health Insurance Society.
One from the voluntary bodies, e.g., the Red Cross Society.
One from the Council of Education.
One from the National Conference of Agriculture."
That gives an idea of the scope of the representation that the commission considered was necessary on a Council of Health. They then went on to discuss what the function of the council ought to be, and the report says:—
"The function of the council should be to advise, to co-ordinate and to plan.
It should serve first of all as a consultative body, possessed of specialised knowledge, information and experience, to which the Minister could look for technical advice on public health problems. It should examine and report to the Oireachtas on proposed public health legislation. It should ensure that in housing schemes the requirements of public health in regard to drainage, sewerage, sanitation and hygiene are met.
Its second function should be to co-ordinate the work of the many isolated and independent agencies interested in public health, to eliminate overlapping and to secure unified effort for agreed objectives. It should be the organ to stimulate public interest and co-operation in health services and should be a sensitive interpreter of the needs and complaints of the public. Thirdly, it should act as a planning body to draw up a long-term programme for the development of health services, stressing preventive rather than remedial measures. It should encourage research in public health with a view towards constant improvement and progress along the latest scientific lines. A positive constructive policy is most desirable in regard to dietetics and pure food, domestic and public hygiene, physical training and fitness. Obviously, its plans must be practical in relation to the taxable capacity of the country, and our available resources.
Among its more immediate tasks the council might make a survey of the present state of public health, the causes of death and the incidence of diseases; it might review the present ‘red ticket' service and dispensary system and consider how far adequate medical, dental, hospital and maternity services are provided at reasonable cost for persons of small or moderate means.
Such a council would need a standing executive committee and a permanent secretariat and should have power to appoint its own full-time director who should not be a civil servant. The amount and importance of its work would involve a number of meetings in each year and the appointment of sub-committees for special problems. It should issue an annual report to be sent to the Oireachtas. The expenses of the council should be borne by the State by means of a grant-in-aid."
I think it well at this stage to call attention to the nature and scope of the recommendations made by the Commission on Vocational Organisation. The Minister, I admit, is taking a step which will, I am sure, have its effect in helping on the organic growth of a council of this kind, representative of the various bodies that are mentioned here. But I would like to ask him whether he has considered the implications of the recommendations that are made here with regard to the unique position of the professional organisations connected with medicine and the fact that they have a unique and a specialised type of advice to give and I suggest that they ought not to be coerced into particular lines of policy that would not evolve naturally from their own lines of thought and that they ought not to be subjected to mere Departmental control either in dealing with matters that they consider should be dealt with, or restricting their views or their consideration of the problems that require to be considered.
I think it is particularly important, while the Minister is taking the step that he is taking, that he would make it clear that the council of health that he is appointing will have power of initiative, will have initiative of its own in considering matters that affect either the public health or the general education and outlook of the people on their own health problems. Perhaps the Minister could tell us what his attitude is to that type of initiative.
The approach of the Vocational Organisation Commission is very interesting and exhaustive. We can follow it to a great extent, and will naturally do so. I suppose any persons thinking over these problems would be inclined to think in the same direction in looking for advice. First of all, regarding the constitution of the organisation, I think many of the bodies suggested there would be asked to give us help. Maybe I might be inclined to weight some of them more than others. On the other hand, I do not think I would approve of having a representative from what is referred to there as the Department of Local Government and Public Health—I would not agree with that. I think the council should be composed of people outside the Department entirely.
As regards their work, when the Vocational Organisation Commission were considering this view they had in mind the building up of a vocational body from the bottom upwards, and they must have had in mind people who would be practically whole-time. I have in mind men who are very busy —good men are usually very busy—in their own professions. I do not think I could expect that they would give more than ten or 12 days in the year. That would mean a meeting every month. In fact, they may think it hard to give that much time and, therefore, it will be largely a matter of advice.
It says here that the consultative body shall be composed of people with specialised knowledge, information and experience. I agree with that, but unless we take them over completely, in what way can we avail of their services? We must remember that these people with knowledge and experience will have to make a living and, therefore, they can give only part of their time. I do not think they would have very much more time than to examine the proposals and regulations that we put before them for an expression of their views.
If you go on to the second function, to eliminate overlapping and secure unified effort for agreed objectives, we could not possibly ask that council to take the initiative in that respect. I think it would be only fair that they would say: "Well, let the Department provide a plan, put it before us and we will tell them what we think of it." Again, the commission say: "It should act as a planning body to draw up a long-term programme for the development of health services." You could not expect these people to do that. The Department will have to do that but that is the type of thing that would be put before the consultative council for their views when it is drawn up. Again, they say: "The council might make a survey of the present state of public health." Let the Department make the survey and let them see the result of that. I think that what will happen naturally will be, that the Department will do the investigation and the reporting and put its reports before the Health Council and get the Health Council's mind on it.
It is true, of course, that the Vocational Organisation Commission suggests that they should have their own staff. I would not agree with that. I think that would only lead to confusion—that they should have a staff to make these investigations and reports which would be going at the same time into the Department of Health. I think that on the whole if they are appointed as an advisory body—and I am quite sure they will give good advice—that we shall be going as far as we can at the moment. I do not know how things may turn out in a few years' time; perhaps then we may look at it in a different way and be inclined to look further in the direction suggested by the Commission on Vocational Organisation.
An Leas-Cheann Comhairle took the Chair.
The Minister has not quite met the point I put. That is, will the National Health Council be so constituted that the members of it can be brought together on their own initiative to discuss problems?
The second question is: will they be provided with some element of a secretariat? There is financial provision for travelling expenses and for subsistence allowances of the members but there is no provision for a secretary to the chairman or to the council as a whole. There is no provision to give the council as a whole a small nucleus, at any rate, of a secretariat.
I certainly would encourage members of the council to put down matters for discussion if they wish to do so. Any member may send in a matter for the agenda and that will come up for discussion after the usual notice. Some arrangement will also be made that if two or three members want to have a meeting, that meeting will be called. As regards a secretariat, there will be an officer of the Department who will carry out the secretarial work at the meetings and he will be available, naturally, to send out any reports or any documents they may need. If the chairman wants to send a special letter to the members, suggesting that a special meeting might be called for instance, of course that officer will be available for that purpose. I do not see what further secretariat would be required. A secretary would be only required in connection with the meetings.
Amendment, by leave, withdrawn.
Section 92, as amended, agreed to.
SECTION 93.
Question proposed: "That Section 93 stand part of the Bill."
I should like to know if the Minister has any policy conceived in regard to this matter at all.
Yes. I think that we shall have to try to convey to the public what it is necessary to do in the way of precautions against certain diseases. Let us take, say, influenza, which comes along occasionally. We should try to convey information to the public, giving them certain advice as to how they can avoid it, or any other epidemic that may arise. I hope to get moving in that line as soon as we have time to settle down.
I take it that in these matters the National Health Council will have power to give advice?
Question put and agreed to.
Sections 94 and 95 agreed to.
SECTION 96.
I move Amendment No. 91:—
Before Section 96 to insert the following section:—
A health authority may, with the consent of the Minister, make arrangements for the provision of a nurse or nurses to give to any person requiring the same, advice and assistance on matters relating to health and to assist sick persons.
This section would enable the health authority to employ nurses to attend people in their own houses and to disseminate information with regard to health matters. It will be possible under the section to use the voluntary associations that are there at the moment.
Are we to understand that it is the intention of the Minister to encourage the continuance of the voluntary nursing organisations?
I should not like to answer that question at the moment. I think we shall certainly require their services for some time, but what the future policy will be in regard to voluntary organisations I could not say at the moment.
The financial part of the White Paper might throw some light on that.
The financial part is attractive enough.
Amendment agreed to.
Section 96 agreed to.
SECTION 97.
I move amendment No. 92:—
Before Section 97, to insert the following section:—
(1) A health authority may make arrangements for providing ambulances or other means of transport for the conveyance of patients from places in their functional area to places in or outside such area or from places outside their functional area to places in such area.
(2) Where a person makes use of an ambulance provided under this section, a health authority may, at their discretion but subject to any relevant regulations under Section 27 of this Act:—
(a) make a charge for such use in accordance with regulations made by them, or
(b) make no charge therefor.
(3) A charge under sub-section (2) of this section for the use of an ambulance by any person may be recovered as a simple contract debt in any court of competent jurisdiction from:—
(a) such person, or, in case such person has died, his legal personal representative, or
(b) any other person liable to maintain such person for the purposes of the Public Assistance Act, 1939 (No. 27 of 1939), by virtue of Section 27 of that Act or, in case such other person has died, his legal personal representative.
I was afraid on reconsideration that the section as it stood was hardly wide enough. We suggest the new section instead because it is possible that it might be held that ambulances could only be used for the work of the health authority in connection with its own institutions. It might be necessary for the health authority to send an ambulance to a voluntary hospital in some cases. We are providing for a contingency of that kind in the amendment.
I want to suggest that the Minister might make a provision to enable local authorities to hire an ambulance. It might be that there were ambulances for hire in a district and the local authority might not have a sufficient number of ambulances of its own, available on every occasion.
It reads—"a health authority may make arrangements for providing an ambulance". "Providing" means having or hiring. It includes hiring.
Amendment agreed to.
Deletion of Section 97 agreed to.
Section 98 agreed to.
SECTION 99.
I move amendment No. 93:—
In sub-section (1), line 18, page 49, before the word "may" to insert the words "after consultation with the Minister for Local Government".
This was inadvertently left out in the drafting of the Bill. The Minister for Local Government is responsible for the constitution and removal from office of all local authorities and it would be necessary, therefore, for the Minister for Health to consult him before anything like this could be done.
Amendment agreed to.
Section 99, as amended, agreed to.
SECTION 100.
I move amendment No. 94:—
In sub-section (1), page 49, line 44, to delete the words "this Act" and to substitute therefor the words "any of the provisions of this Act except Part VIII".
This is a drafting amendment.
Amendment agreed to.
Section 100, as amended, agreed to.
FIRST SCHEDULE.
I move amendment No. 95:—
To delete the entry relating to the Public Health (Ireland) Act, 1878, and to insert the following:—
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41 & 42 Vic., c. 52
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Public Health (Ireland) Act, 1878.
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Section 11, paragraph (3) of section 91, section 95, paragraph (3) of section 97, paragraph (6) of section 100, sections 132 to 156 and sections 158 and 258.
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We are adding to the list of repeals here. Paragraph (3) of Section 97 is being added. That imposes a penalty on a keeper of a common lodging house who fails to notify a case of infectious disease. Section 158 is also being added which provides that a justice may order the removal to a mortuary of the body of a person who dies from an infectious disease. That is already provided in the Act. Section 258 is also being repealed. It provides that every officer of a sanitary authority shall attend and assist in any prosecution instituted by such authority on receipt of an order from such authority so to attend, provided always that if a medical officer of the sanitary authority shall so attend and assist, he shall be entitled to remuneration from the sanitary authority.... These are being added to that Schedule.
Amendment agreed to.
I move amendment No. 96:—
In the entry relating to the Local Government Act, 1925, to insert the word "and" between the figures "19" and "21" in the third column.
This is merely a drafting amendment.
Amendment agreed to.
Question proposed: "That the First Schedule be the First Schedule to the Bill."
When discussing the striking case Deputy Dr. O'Higgins was making with regard to vaccination, I understood the Minister to say that with regard to vaccination he was prepared to be advised by medical opinion here and that if in consultation with organised medical opinion here he could be persuaded that it was necessary to retain the Vaccination Acts or any part if them, he was prepared to do it. I would like to ask the Minister whether it is his intention to have such consultations before the final passing of this Act with organised medical opinion in this country and whether he is on the other hand proposing to repeal the four Vaccination (Amendment) Acts here and whether he is going to wait for some time to consult medical opinion on the matter.
My idea is to proceed with the abolition of the Vaccination Acts and then, if medical opinion—which I believe it is—is in favour of the continuation of vaccination against smallpox, to include it in this Act, to make it the law under this Act.
That is, that the Minister can then, by reason of its being made an infectious disease under this Act, make the necessary regulations under this Act that will in fact do the work of the Vaccination Acts in the past or whatever part of them he considers necessary.
Yes. The Acts will not be repealed until the new regulations are made. The regulations will be made by the time we are repealing these other Acts. Under the immunisation section it can come in as an infectious disease.
Question put and agreed to.
SECOND SCHEDULE
I move amendment No. 97:—
In paragraph 7 to delete the words "by district medical officers" in the first line.
It was too restrictive as it stood. It may be necessary, for instance, to give powers under this paragraph to the medical officers of health and their assistants. So by leaving out these words we can give the power to whoever may require it.
Amendment agreed to.
I move amendment No. 98:—
To delete paragraph (8).
Paragraph (8) is really not necessary. Paragraph (1) provides for notification of diseases by medical practitioners and other persons.
Amendment agreed to.
I move amendment No. 99:—
In paragraph (9) to delete the words "on the requisition of district medical officers" in the first line.
This is consequential.
Amendment agreed to
Question proposed: "That the Second Schedule, as amended, be the Second Schedule to the Bill."
In paragraph (5) provision may be made for the requiring of adult persons to remain away from specified places or the parents of children to keep the children away from specified places. I assume the intention of that paragraph is to empower the Minister to make regulations prohibiting children who are suffering from infectious disease from going to school or church and to prohibit adults from going to any specified place to which the public have access. I agree that in certain cases of very grave infectious disease it is right that this power should be in the Bill but it is necessary that in making the regulations steps should be taken to ensure that they are so framed that they will not prevent an adult person or child from attending Divine Service in case of infectious disease which is not very grave. There are various forms of infectious disease, some grave and others not so grave. Steps should be taken to ensure that this prohibition on persons attending Divine Service does not apply to minor forms of infectious disease.
There is another provision in the Schedule. Paragraph (14) mentions the safe disposal or destruction of infected or dirty articles. I raised that matter on another section and was told that it was covered by the Schedule. I am anxious to know if this particular paragraph gives power to ensure that all second-hand clothing offered for sale to the public is subjected to inspection or disinfection or disinfestation. It is appalling to see second-hand clothing being hawked from one town to another and offered for sale when, as far as I know, there is no guarantee or assurance that any steps have been taken to disinfect or disinfest it. That is a serious matter which would require to be dealt with under this or some similar regulation.
The first question the Deputy raised was in connection with paragraph (5) of the Schedule with regard to people suffering from infectious disease being prohibited from going into any public place. That, of course, again, is a rehash of a power already there under the Public Health Act, 1878. I could not give any undertaking, of course, how that will be worked in any particular instance. It may be necessary in certain cases to prohibit persons even going to church but I do not think medical officers of health will be restrictive unless they find it absolutely necessary. We have power, as regards second-hand clothes, to disinfect and inspect, etc. Generally speaking the regulations can be enlarged. If anything is left out we can come along and make it right. The Schedule only gives an indication.
Second Schedule, as amended, agreed to.
Title agreed to.
Bill reported with amendments.
Fourth Stage ordered for Tuesday. 24th June, 1947.
I would ask the Minister to let us have his amendments a week before the actual date of discussion. When could the Minister have his amendments circulated?
We will try to have them as soon as we can. I promise that we will give Deputies on the other side of the House a few days to come along with other amendments if they wish.
We would like to facilitate the Minister in having the Report Stage at the earliest possible moment but we would like three or four days.
Yes, that will be all right.
