I should like to draw the Minister's attention to the great dissatisfaction that is felt against his officials and his Department due to the delays that local authorities are experiencing in getting a reply from his Department. When the Minister was in Cork last April he urged everybody to speed up things as much as they could, since he wanted to go ahead with his work. I believe it was his intention to do so at the time. Since last October, however, there has been a complete slow up in his Department in its relations with the local authorities of which I happen to be a member —the South Cork Board of Assistance, the Cork Joint Sanatorium Committee and the South Infirmary, Cork. On last Saturday four weeks, the Cork Joint Sanatorium Committee held a meeting to consider the provision of accommodation for nurses and maids adjacent to the new chest hospital. If that accommodation was provided the committee would be able to accommodate about 24 extra patients. The Minister was very anxious that we should go ahead with this. As I have said, on Saturday four weeks we sent up a communication to the Department and pointed out that we were holding a special meeting on that day fortnight to consider the Department's reply so that we could go ahead quickly with this project. The meeting was held on Saturday fortnight. Members of the committee attended from all over the County Cork, from Skibbereen, Clonakilty, Boherbee, Buttevant, Mitchelstown and the City of Cork. All these members attended the meeting at considerable expense to the ratepayers, but they discovered when they assembled that there was not even an acknowledgment of their communication of two weeks earlier from the Department. At a meeting of the joint sanatorium committee Deputy McAuliffe presided, and Deputy Seán Keane, Deputy Corry and myself were also present. The meeting unanimously adopted a resolution protesting against the delaying tactics of this Department.
Committee on Finance. - Vote 68—Health (Resumed).
Will the Deputy state under what item in the Supplementary Estimate he is raising this matter?
On sub-head M (4)— Prevention and Treatment of Tuberculosis.
If the Deputy will read the note on the back of the sub-head he will see that it is to provide the additional sum required to pay balances in respect of previous years of grants to local authorities.
Yes, but I want to point out that the Minister is not carrying out what should be carried out.
Quite, but where is the money for it? This is a Supplementary Estimate and not a main Vote.
Am I to take it that I cannot speak on this?
The Deputy is to speak on the items on the Vote. The purposes for which the sums are required are set out on the back.
Can I deal with it under sub-head H?
That deals with grants to health authorities under the Health Act of 1947.
Yes, but if work in respect of which grants are given is not carried out, then I think I am entitled to talk about it. This motion of protest that I am speaking about was proposed and seconded by supporters of the inter-Party Government. A further meeting was held last Saturday in connection with the same thing and even then no acknowledgment had been received from the Department to our communication. There is a waiting list of 55 patients before the joint sanatorium committee.
What was the figure last year?
The Minister went down to Cork, and I am sure he will agree with me in this, that the people in Cork very readily handed over the hospital in Mallow in order to help him in his campaign against tuberculosis. The Minister has agreed to give back that hospital in another four years to the people in North Cork. I am pointing out to him that, if he does not move more quickly, the work will not have been carried out at Mallow Hospital by the time that he will have to hand the hospital back.
I do not think there is any use in dwelling any further on that. Deputy Desmond, Deputy Lynch and myself waited on the Minister last November about another hospital in Cork. We were told that we would be written to. Since then, however, neither the South Infirmary in Cork nor any one of the Deputies on that deputation has heard anything. Last week the South Cork Board of Assistance had to draw attention to the fact that they were not getting any replies from the Department and that matters relating to their hospital were being held up. We were asked to consult with the university authorities about the appointment of a gynæcologist and an obstetrician in the county home. We agreed with them, and when we submitted the result another reply came down about something else, which all tended to delay the scheme as far as possible. We had to appoint another deputation to come and interview the Minister. Last April the Minister came down and spoke about the regional sanatorium at Sarsfield Court, and complained that when he went to his Department a grazing lease was handed to him for his signature for the grazing of Sarsfield Court. He said that was a Fianna Fáil policy and that he would not do that. He waited until the 1st December and then advertised the letting of the grazing.
That is not true.
Another advertisement appeared again for the letting of the grazing from the 1st March. I agree that when the Minister was talking like that he was a very inexperienced man as far as the Department was concerned. I am sure that he has learned that he cannot do all the things that he said he would do. I think he should withdraw some of the things he said about the laxity of his predecessors. I am asking him now to see that local authorities will get replies to their requests, and I think it is his duty to do so.
Deputy MacEntee had a question down to-day asking the Minister for particulars with regard to the increase that is now required. During Question Time I think, Sir, that you indicated that the supplementary questions could be postponed and dealt with under this particular Supplementary Estimate. In answer to the question, the Minister put it to the House that the main reason why this additional amount of money was required was due to the fact that there were 800 additional beds installed within the last year for tuberculous patients. I should like the Minister to tell the House the exact amount of the extra cost.
I corrected Deputy MacEntee on that. Those were only some of the reasons given by me.
I am asking the Minister to tell the House to what extent this particular reason comes into the calculation apart from the other reasons because I know, as Deputies who are members of the Dublin Corporation know, that the biggest number of beds that was provided in last year was provided in Dublin. They were provided in an institution which was taken over and handed to the Dublin Corporation not at a cost to the Department of Health but at a cost to the corporation itself. It has to be paid for over a period of years as a result of a figure being assessed and fixed by the Department of Finance. In addition, the cost of the upkeep of this particular institution falls again on the Dublin Corporation. It is true that the Dublin Corporation will be able to recoup after a period the excess of expenditure on health services over the standard fixed in the year laid down. I am anxious to know, as I think other Deputies are, how much of this additional supplementary amount is actually related to the one item of the many to which the Minister referred. I am very interested to know that because I should like to relate this additional charge to our own experience and costings in the Dublin Corporation.
It is always a matter of difficulty for a Minister to introduce a Supplementary Estimate asking the Dáil to vote an additional sum of money. I should like to take the opportunity afforded by the introduction of this Supplementary Estimate to congratulate the Minister on the operation of his Department and on the manner in which he is discharging his Ministerial functions. The present Minister for Health has brought a drive, energy and enthusiasm to the problems confronting him as Minister and his Department that were never before seen in this country.
On a point of order. The Deputy should be confined to the Supplementary Estimate.
It would be better to deal with the items set out in the Estimate.
The relevancy of my remarks will be apparent in 30 seconds.
Other Deputies might have contrary remarks to make and I consider both irrelevant.
I am surely entitled to put up arguments to the House as to why the moneys required by the Minister under the various sub-heads should be voted by the House. It is to that end I am attempting to direct my remarks. Perhaps I am failing to do so. The question was raised to-day at Question Time by Deputy MacEntee and was again adverted to by Deputy Briscoe, as to the responsibility for the 800 beds referred to by the Minister in respect of the sums included in this Supplementary Estimate. I should like the Minister to let the House know, if I have correctly understood him, on other occasions, that the position in so far as the waiting lists for beds for tuberculous patients west of the Shannon are concerned, is now nonexistent.
This question was not raised by me at all. I asked a simple question—not whether there were adequate or inadequate numbers of beds. How much of the cost of the 800 beds is in this Supplementary Estimate as stated by the Minister to-day as one of the causes of the increase? If we are going to be allowed to discuss this item on this Estimate instead of on the main Estimate I beg leave to rise in the House and speak again.
The debate is confined to the items in this Supplementary Estimate.
I am attempting to confine myself to the items on the back of the paper, particularly item M (4). I understood when this matter was referred to by Deputy MacEntee at Question Time that an opportunity would be given to him and to other Deputies——
On one particular question and that was the cost of the 800 extra beds.
If you get the Minister for Finance to hurry up you can have the main Estimate soon.
I do not know whether it is the attitude of the Party opposite that they wish to prevent the Dáil and the public from knowing the manner in which this money has been spent. I do know this, however, that the manner in which this money has been expended by the Minister's Department has resulted in this position being created, that there are now no tubercular patients waiting for beds west of the Shannon and that the sanatorium in Castlerea, opened by the Minister some months ago, is able to alleviate the position east of the Shannon.
Under what item is there money for Castlerea?
I do not wish to be irrelevant. I merely suggest that for the reasons which I have advanced the House should grant the Minister the additional moneys asked for in this Supplementary Estimate.
I hope the Deputy does not imagine that the Chair wants to preclude him from discussing any item on this Supplementary Estimate?
The Deputy has said all he intended to say.
Deputy Lehane said that all this money is necessary if the Minister is to provide extra beds.
Deputy Lehane did not say anything of the sort.
I should like to know from the Minister what portion of the extra allowance he is asking for under sub-head H has already been paid or will be paid towards providing those extra beds. As I understand it, capital expenditure of such a nature may not rank for recoupment at all. In the matter of new buildings provided through loans no portion will rank for recoupment. Could the Minister inform the House, as regards the 800 beds that he claims to have provided, what portion will rank for recoupment to local authorities? That would be an interesting thing to know. I believe a very small portion will be found to be included in the £1,681,000, if any.
We have a fair idea of the position of local authorities in relation to a big proportion of this increase. Since the Minister took up office, local authorities on several occasions received communications from his Department telling them that he was prepared to sanction increases in different directions. He did not consult the local authorities or the county managers for an expression of their views. He determined in his office what increases should be granted to particular sections of the staffs of local authorities engaged on health services. He also informed local authorities that in his opinion they should have a 96-hour fortnight for their staffs. The local authorities quite naturally did not object to that, but the Minister has not told the House what that may involve. He did not indicate that it has not been found possible up to now in many health institutions to have those staffs employed because of the fact that there is no housing accommodation for them, no nursing quarters. He did not indicate that buildings must be provided before the 96-hour fortnight can be brought into operation in mental hospitals, fever hospitals and sanatoria. I do not know how many public health authorities have put the 96-hour fortnight into operation; I doubt if there are very many, because they have not the accommodation. Some cannot get the extra staff because extra nursing personnel are not available and it will probably be in the year 1951 before the full cost of the 96-hour fortnight and the additional staff required will come on the Estimate of whatever Minister for Health is there.
The main portion of this increase has arisen from the fact that the Minister sanctioned substantial staff increases in different institutions during the year. We are not objecting to that, but the local authorities had no say in the matter. If the sanction comes from the Minister, and he suggests that the staff should get certain remuneration, the local authorities have no option but to pay. If the Minister's Department interferes with regard to the remuneration of staffs down the country the county managers or the local authorities have no say after that.
It is time somebody interfered.
Does Deputy Allen not want to see them paid better?
I am not objecting in the least to that, but before there are increases in the payment of staffs the local authority or the county manager should be consulted. Communications should not come from the Minister's office in the first instance, telling local authorities that such a rate of pay should be made available to their staffs. That is all wrong.
It was merely a recommendation.
What is Deputy Allen objecting to?
I am objecting to such influence coming from the Minister's Department. There is a particular way of determining these things. If that influence is to come from above, and if that practice is to continue, everyone can see what it can lead to.
Mr. Byrne
The Labour Court and labour men.
The Labour Court do not come into it at all. If Ministers set themselves up as labour courts or as the final judges, then there is no reason for local authorities at all. We hear talk about the functions of local authorities being taken from them. It does not matter what functions you give them, if that system is to continue. It may be a good system and it may not. I suggest to the Minister that if, in the future, improvements are to be made in the status of the staffs employed by health authorities, there should be consultation between the Department and the county managers, or those who are directly responsible. In law it is the county manager who should determine the rates payable in any of the services, and not the Minister. I definitely object to that practice. Again, on the matter of these extra beds that the Minister tells us he has provided, I believe that little or no portion of the cost of these extra beds comes within this Estimate.
In view of a possible misunderstanding arising out of a remark of Deputy Lehane's concerning sub-head M (4), I would like the Minister to say if I am correct in interpreting the note on the back of the Estimate as meaning that the whole of the £80,500 therein mentioned is required to pay to local authorities grants at the appropriate rate for approved schemes for the prevention and treatment of tuberculosis which were sanctioned in 1947 and in previous years?
Ba mhaith liom ceist a chur ar an Aire. Sílim go mbeadh sé in ord fé fho-mhír a 4. Baineann mo cheist le foirgneamh mór sa bhFaing i gCo. Luimnigh atá idir lámhaibh ag an Roinn Tionscail agus Tráchtála. Roinnt mí ó shoin, d'iarr Comhairle Chontae Luimnigh ar an Aire Sláinte ospidéal eitinne a dhéanamh den fhoirgneamh sin. Do scrúdaíodh an scéal agus do mhol Oifigeach Sláinte Cho. Luimhnigh don Chomhairle Chontae ná beadh sé oiriúnach mar ospidéal eitinne agus thuit an rud go léir as a chéile.
Ach anois, a Chinn Chomhairle, tuigim go bhfuil an tAire Sláinte ag tathant ar Chomhairle Chontae Chiarraighe an áit seo a thógaint mar ospidéal eitinne do Cho. Chiarraighe. Ba mhaith liom go míneodh an tAire cén fáth go bhfuil séa d'iarraidh an foirgneamh seo a thabhairt do Chomhairle Chontae taobh amuigh de liomatáiste Cho. Luimnigh gan dul i gcomhairle leis an údarás áitiúil i Luimhneach ar aon chor.
I should like to know under what item that arises?
Sin M. 4. atá i gceist.
For previous years.
For 1947 and previous years as I understand it. It has nothing to do with the purchasing of sites now or building.
Tá go maith.
I would like to ask the Minister a question. In regard to the house which was taken over for the purpose of treating tubercular cases in the County Waterford and County Kilkenny — Ardkeen — is there any money voted in this Estimate for the purpose of developing that institution? So far as I can gather nothing has been done up to the present in reference to it.
I would like to explain to the Deputies that the present position has arisen in regard to payments to local authorities and to expenses in which they have become involved because of the fact that we are going through a transition period. The terms of payment and the terms of recoupment will in future be altered. These sums under the health services grant were estimated prior to the completion of the audit of the local authorities. These are grants assessing the amount of money spent in the standard year, 1947-48, upon which all future expenditure will be based. The grants were estimated on that year, and we also have to take into consideration any estimates for the current year. Consequently, there is a number of items included in this Supplementary Estimate which it was not possible to forecast with any great degree of accuracy.
Deputies are concerned with my reply to Deputy MacEntee's question, in which I mentioned the 800 beds for tuberculous patients which have been provided since February last. The House is very anxious to know how much of the total Supplementary Estimate reflects this increase in beds. I am most anxious indeed to supply this information, but I would like it to be known that the information I am giving can be only very rough. If Deputies appreciate that the cost of providing one bed at present is approximately £1,200 to £1,400, it will be obvious that the provision of 800 beds would involve a very much greater capital sum than is mentioned in this Supplementary Estimate. The amount for which these beds are responsible in my Estimate is approximately £166,000. That is a rough figure.
The grants under sub-head H.— Grants to Health Authorities—include the allowances for dependents, which were amended during the year to include a wider range of patients and which, in my opinion, added to the benefits which these allowances confer on tuberculous patients and patients suffering from infectious diseases who come under these allowances. The success of this scheme, I think, is best seen in the fact that in the middle of last year—there were no figures available for February; they were not kept; I got them in July — approximately 1,050 persons were awaiting admission. Since this time last year we have provided approximately 850 beds. If we had a static waiting list, our problem would be a very tiny one indeed to-day; it would have left us a waiting list of approximately 150 patients. But, due largely to the fact that these allowances have enabled men and women to accept early diagnosis and treatment for their disease—a very good thing and a very desirable thing—our present waiting list has grown to approximately 991 patients, that is, 850 beds have been eaten up and we are now left with nearly 1,000 patients awaiting admission. I am not worried about this. I feel quite certain that with a continuance of the very considerable degree of co-operation which we have received throughout the country from all local authorities and from the members of all political Parties, we shall meet this problem in the reasonably near future and completely absorb the present waiting list.
Deputy Allen is anxious to protect the rights of local authorities and he gave expression to his conception of democratic government. I am in wholehearted agreement with him that local authorities must be accorded the fullest degree of independence, and must be in a position to use their own initiative in regard to problems concerning their staff, their organisation and their hospitals. I would point out to him that any notifications which he received from my Department—in view of what Deputy McGrath says, I am glad to hear that he does receive them — are in the form of recommendations, and that, if local authorities feel that I have recommended anything which is in any way inequitable or unjust, it would be wrong of them, as local representatives of the people, to implement any suggestions which they consider wrong or unjust. As a matter of fact, I think I have carried out to a very much fuller degree than previously, this attempt to leave to local authorities as much responsibility as possible. In pursuance of that, in the last few months particularly, I think it right to say that practically every county manager and medical officer of health has been in my Department where we have had most fruitful and useful discussions concerning the whole health problem throughout the country. We in the Department have found these discussions very helpful indeed. We now feel that the local authorities are aware of our problems, and we are beginning to see more fully their difficulties. That is a policy in which I have the strongest and firmest belief. I hope for a continuance of that co-operation from the members of all local authorities, particularly in view of the fact that in the near future it is believed that representatives on local authorities will have restored to them some of these democratic rights which hitherto had been, may I say, rather curtailed.
Rubbish.
We shall see when that comes.
Deputy Lemass referred to sub-head M (4)—Prevention and Treatment of Tuberculosis. The total sum required is in respect to projects on which money was expended prior to 1948. Deputy Little mentioned Ardkeen House. I investigated that problem and decided that Ardkeen House of itself was practically useless so far as meeting the tuberculosis problem in that area was concerned. It was too small and inadequate and subsequently we decided that it was more desirable to make provision for a 250-bedded sanatorium. We decided that Ardkeen House should be the nucleus around which this institution would be provided. Of itself, the house would be too small but it will, however, serve as the nucleus and administration centre for a larger institution. As to the Deputy's complaint that nothing has been done, I am afraid the Deputy has been misinformed. A considerable amount of work has been carried out on the planning of this hospital. We have at present reached a very advanced stage with the planning and hope that it will be possible to start the work in the next few months.
In reply to Deputy Lehane, may I say that the position in the West has reached a stage in which I should like to see the position in the rest of the country? Deputy Briscoe observed that the only major institution provided was in Dublin. That is incorrect. The institution provided in the West, at Castlerea, at present is the biggest and holds the largest number of patients, consequently our problem in Connaught is practically non-existent. There are a few patients here and there. We hope that it will be possible to serve some of the counties in Leinster while we are waiting for additional accommodation at short intervals.
Deputy McGrath raised a number of points in regard to Cork and the difficulties which he experienced in getting replies. All I can say is that there are some problems which take a longer time to consider and to decide than others. I think he should bear in mind that the provision of the Mallow Sanatorium, with its staff and equipment, has been of very great assistance to the solution of the problem in the southern area, and that it was provided with the minimum of delay. Again I should like to thank the members of the local authorities in that area who did appreciate the problem and who assisted me very much in providing that hospital. With regard to the appointment of an obstetrician and gynæcologist, this whole problem is concerned with the position of the maternity hospital, the university and the county home in Cork. The future of our maternity and gynæcological services for the whole southern region must, to a certain extent, be considered in deciding any future appointments in that area.
Obviously, it is a very involved and complicated problem. Nothing would be simpler for me than to say "yes" to letters received, to agree with suggestions made, but I feel that in a matter which so very deeply involves the welfare and health of these women and children, in which the best interests of a university are concerned, and the interests of the whole regional organisation in regard to health are involved, it simply cannot be decided to suit the convenience of anybody by return of post. However, the South Cork Board of Assistance have been invited to send representatives to a conference to discuss this whole position and the Deputy can be quite certain that nobody is more anxious than I am to overcome the considerable arrears which have arisen from the delays over the many years previously in regard to the provision of adequate hospital facilities in Cork. I hope there is no point which I have missed.
I mentioned one point.
Yes, about Foynes. The position regarding Foynes is this: that we are investigating at the moment the desirability of converting the Foynes Hotel into a chest hospital for the south-western area. I have looked into that problem, but there are many difficulties to overcome. The Deputy is aware that the Limerick County Council have shown no enthusiasm to take over the Foynes institution, and I tentatively approached the Kerry County Council to ask them if they would care to consider the proposition. The whole arrangement, however, is completely tentative and nothing definite has been arrived at because we are examining other possibilities. There is nothing final in this.
The Minister will recollect that the Limerick County Council asked to have this taken over as a sanatorium, that it was pronounced as unsuitable by the county medical officer of health and the county council went no further with it.
The position is as the Deputy says — that as a sanatorium it would be unsuitable, but as a chest hospital it has possibilities. The Deputy may not understand the difference. In one case there is a very large percentage of patients completely in bed under operation. In the other there are ambulatory patients walking around and it would not be desirable to have them in that particular area.