I move:—
That it is expedient to authorise such payments out of moneys provided by the Oireachtas as are necessary to give effect to any Act of the present session to amend and extend the Health Act. 1947, and certain other enactments.
Committee on Finance. - Health Bill, 1952—Money Resolution.
This Money Resolution, in effect, asks the Dáil to give the Minister a blank cheque to discharge the commitments which will come in course of payment if this Bill ever becomes law. We oppose it, not because the estimate of the cost of the scheme embodied in this Bill which the Minister himself gave during the course of the Second Reading debate is indefinite, indeterminable and unnecessary, not because the cost which he may have honestly estimated as being the cost of the scheme if it ever comes into operation is heavy, or anything of that kind, but because we have very fundamental objections to the general scope and purpose of the scheme embodied in this Bill. It is because of these objections that we must oppose any expenditure that will be involved in the passage of the Bill. We oppose this Resolution because we are opposed to the scheme in the Bill and to the expenditure of money on such a scheme. We have, as our reasons for opposing this Resolution and the spending of money on this scheme, very fundamental objections in principle.
The Minister was unable to tell us during the course of the Second Reading debate on the Bill what, even approximately, might be the cost to the community, whether the taxpayer or the ratepayer, if this Bill were put into operation. We do not base our objection so much upon the fact that we do not know what this Bill will cost. We do not base it upon the fact that the Minister, when he was introducing the Second Reading of the Bill, at column 1911, stated that he could not say with any degree of accuracy what the additional cost would be. We appreciate that it would be difficult for the Minister to give any accurate estimation whatever of the cost. We know that other people who have addressed their minds to this problem of the cost of the proposals embodied in this Bill believe that when the Bill is in full operation, if it ever comes into full operation, and certainly if the people who are supposed to be benefited by the provisions of the Bill do take advantage of the provisions of the Bill, the cost may run anything up to £8,000,000, £9,000,000, or even £10,000,000. Even if we were faced with an expenditure of that magnitude we would not hesitate to support an expenditure of that kind or of that magnitude if we were satisfied that there would be an adequate return either to the recipients of the benefits in the Bill or to the community at large or to the health of the community as a whole.
We are profoundly dissatisfied with the provisions of this Bill. We believe that, so far from even the modest estimate of cost given by the Minister at £1,800,000 being justified, there will be no adequate return whatever for that very heavy expenditure either to the community or to the recipients of the benefits under the Bill. We believe that the Bill merely adds to the costs of the health services of this country without any proper return for the expenditure of the money.
We are opposed to this Resolution and the expenditure of the money for which it asks also because the Bill, or perhaps I should say the propagandaby means of which the Bill has been endeavoured to be, if I may use the current phrase, sold to the public, seems to offer or is put forward as offering a number of benefits to the recipients which in fact it does not contain.
We are opposed to this Bill and the provisions of the Bill and the expenditure of the money required to carry out the provisions of the Bill because the scheme, if it can be called a scheme, embodied in the Bill is unjust to the middle classes.
We are opposed to this Bill because of its conception and design. It bears on its face the marks of official conception, design and execution and every internal evidence that no experienced professional mind was brought to bear upon the consideration or construction of the scheme embodied in the Bill or the problems with which the Dáil should be faced and should be discussing in connection with the proposals in a Bill of this kind.
We are against the proposals in the Bill and the expenditure of money on those proposals because the principle of the Bill, in so far as there is any principle at all in the Bill, is merely an extension of the dispensary services, merely an extension of the public assistance services to a greater number of people and different classes and because, based as they are upon that dispensary system, which is the product of an alien administration in this country, the proposals in the Bill are an enlargement of State control and the forerunner of socialist medicine in this country.
We are profoundly against the Bill and the expenditure of money upon the Bill also because of the proposals with reference to the contribution of £1 to entitle people who are not within the classes named in the Bill as being entitled to benefits under the Bill, because that £1 contribution, masquerading as it is as something in the nature of an actuarial calculation or an insurance contribution, is merely a fraudulent subterfuge to get over a moral objection which was put forward to the free-for-all scheme which wasadumbrated by the Minister in the White Paper published by his Government some time last year.
We are against the Bill because it is unworkable and we believe it is intended never to be worked. It is unworkable because those people to whom the people of the country and the community as a whole must look to work the Bill have been insulted, derided and their services refused with contumely and contempt, because the medical profession has not been consulted in connection with the health problems which everybody in this House desires to consider for the purpose of finding a proper remedy and because, without their co-operation, without their advice, without their assistance and without their experience, it will not be possible either to work this Bill or to conceive and design a scheme proper and adequate to the needs of the community at the present time. Nor will it be possible without their assistance to design such a scheme as would do what is necessary-provide, not for particular sections of the community but for all sections of the community, adequate health services at the lowest possible cost to the taxpayer and to the community.
Speaking generally, we condemn this Bill and refuse to give the money for it to mark and underline our dissatisfaction with the principles of this Bill and with the method which the Minister has adopted in connection with the framing, designing and construction of the proposals, because we believe that, taken as a whole, the Bill, in so far as it purports to have any scheme at all embodied in it, is contrary to the best interests of the community and contrary to the best interests even of those whom it is alleged and designed to benefit.
I do not know whether it would be possible in a discussion of this kind to get some agreement on fundamentals. Could we consider that at least two propositions of principle could be agreed upon in our discussions? Is it not plain and obvious now that everybody in the community has realised at last—many realised it before buteverybody realises it now—that it is nothing but fraudulent pretence to suggest that there is any such thing as a free service for any section of the community? Is it not remarkable that the only widespread public interest that manifested itself in connection with this Bill or even the White Paper that preceded it last year, the only general interest that was displayed by the public, was evoked when the Minister went around the country explaining to the representatives of the ratepayers that the heavy cost of this Bill was going to be shared by and very largely imposed upon the ratepayers of the several counties whose health authorities were to implement the Bill? It was then that people began to wake up and take an interest in the Bill.
Outside a small section of the community whose interests perhaps were gravely affected by the provisions of any Health Bill that might be introduced in this House, outside certain social groups, outside even only a few constituencies in the City of Dublin, I think I am right in saying that there was no real interest whatever displayed in connection with the health proposals. But public opinion became clamant and vocal when the Minister announced he was going to put a very heavy burden on the ratepayers of each county in order to defray the cost of this scheme, such as it is. Then that public opinion became vocal and emphatic, that they were not going to have it under any circumstances. It was not going to be a question of the community getting free services or that certain sections of the community were going to get something for nothing: it was a question of seeing that the ratepayers were not going to be saddled with the heavy cost of the proposals embodied in this Bill, the cost of which we are now asked to defray in part at least out of taxation, by this proposal which we have before us at the present moment. That is a significant fact which must bear the Minister's consideration and that of his colleagues, in connection with this matter.
Could we have agreement on this basic principle also? Could we have it recognised frankly and honestly that every section of this House and everyParty in this House and every Deputy in this House stands for the principle that no citizen of this State is going to be deprived of all necessary medical, surgical and nursing appliances and attention, merely because of lack of means? Could we, having accepted those two principles, approach with some degree of calmness the solution of the health problems of this country? Recognising that there is scope and room for wide divergences of opinion on the methods to be adopted for the solution of our undoubted problems in health matters, recognising that there are sources of informed opinion and wide experience from which anybody. endeavouring to solve those health problems may get useful information and advice, could we at least endeavour, by resorting to every possible source of advice and experience, to get for the people of this country and every section of the community, and not merely particular sections of it, the most effective methods that will produce for us the best health scheme that will be workable and acceptable and that will bring both physical benefit to the community and social and moral improvement?
I am fully aware and realise that the particular stand that we take here to-day on this Resolution will be misrepresented by our political opponents. The Fine Gael Party and other Parties who may support us in the stand that we are making on principle and in the interests of the community and of all sections of the public whose health is endangered and whose health requirements are not being provided for in this Bill will be represented as a Party or Parties that refused to give to the Government moneys that were required to give additional benefits to particular sections of the public or for the extension of health services to the community. I know that we will be misrepresented in that respect and that political capital will be made out of it. Equally I know that I do not care on principle whether that misrepresentation is made or not; but I think I am entitled here and now to make it clear that we have always stood—certainly so long as I have had anything to do with the councils ofthis Party or with the policy of the inter-Party Government or of the Party to which I have belonged since the change of Government—for a proper health service and for a proper approach to problems of health.
Perhaps I may be pardoned if I give a short extract to show that approach, the approach that we had as a Government shortly before the change of Government, when we made it clear that the expenditure of money was not the primary consideration, nor was economy a matter that affected us, in our approach to health problems. I spoke in my own constituency on the 7th May, 1951, and dealt with the policy then of the inter-Party Government in that matter. The principles I then enunciated, both social and financial, and the principles for which we then stood—and for which we have since stood—were given in a very short summary I made at that time. I gave a more detailed exposition of those principles in a speech I made at Kilkenny on 16th December, 1951, after the change of Government and after we went into opposition.
Speaking at the inception of the general election campaign in my own constituency on 7th May, 1951, I said:—
"The principle of improved health services has been accepted by all responsible moral and social institutions in this country. Within the past few weeks representatives of the Department of Health and the medical profession have been meeting to review all present health services and to suggest plans for their improvement and schemes to safeguard the health of all sections of the community. It is the aim of my Government, first, to see that the best possible medical services, including provision of the highest specialised services, is given to every member of the community and that no person be denied this service because he is unable to pay for it.
The mother and child service naturally has been given primary and urgent consideration. Considerable progress has already been achievedin a short period, in arriving at agreement on the broad principles of a scheme dealing with matters in the pre-natal, confinement and post-natal periods and the practical details are now being worked out. The service of the infant is being thoroughly examined, with the assistance of experts in each particular field. It is hoped that within a short time there will be in the City of Dublin a scheme for maternity services which will be comparable with any scheme at present in operation in any part of the world. The Government fully appreciates the desirability and necessity of securing the advice of labour and middle-class and women's organisations, local authorities, nursing and dental organisations and others concerned. It is clear from even my early examination that the whole health structure of the country requires a thorough overhaul. The odious legacy of an alien poor law administration—the dispensary system—is in special need of improvement and this Government is determined to make it. Accordingly, consideration is also being given to the establishment of a full comprehensive service to cover the needs of all members of the community. A system of contributory insurance may provide the solution."
That was the policy, financial and social, which we had for our health problems. Compare that policy with the niggardly provision made in the present Bill. Compare the cost which will be involved to the taxpayers and the ratepayers by this niggardly service which is being provided in the present Bill with the cost which that comprehensive scheme envisaged in the policy which I enunciated at that time would have involved the public.
It was our aim to review all the present health services and to safeguard the health of all sections of the community and that no person should be denied medical services if he was not able to pay for them. We gave the mother and child service primary consideration. We stated that we would take advice not merely from all sections of informed opinion in the medical profession, but from labourorganisations, middle-class organisations, women's organisations, local authorities, nursing and dental organisations and others concerned and we were determined to get rid of the odious legacy of alien administration, the poor law dispensary system, or at least to improve it and to bring it up to date in accordance with our own requirements. If there is any principle at all in this Bill, it is founded upon the continuation and extension of that odious legacy of alien administration, the poor law dispensary system. In so far as it has any principle at all in it, this Bill is based upon a continuation of that odious system and we are asked by this Resolution to give the Minister a blank cheque for a continuance of that odious system of poor law administration.
I have emphasised the words that I used in that speech for the purpose of meeting in advance the misrepresentation and detraction that will be probably wide-spread by the Minister and his colleagues against me and my colleagues in connection with our opposition to this Money Resolution. I want to emphasise again that no person was to be denied any medical service because he was unable to pay for it. That was the fundamental principle—that no person was to be denied any health service because he was unable to provide for it. We were determined to improve and, if possible, get rid of the odious legacy of an alien Government—the poor law administration. We oppose this Resolution to-day because the Bill is a continuance of that odious legacy of alien administration. We do not want to give either the taxpayers' money, which we would be doing if this Resolution was passed, or the ratepayers' money, which would be a consequence of our passing this Resolution to-day, for the continuance of any such system or any such odious legacy of alien administration.
That was the policy which I stated was the policy of the inter-Party Government and was to have been their policy had there not been a change of Government. I stated that policy and it is still our policy and will remain our policy in spite of the provisions of this Bill, and in spite of thefact that this Bill may become law. I do not know whether it will or not— I doubt it. But we feel so strongly on this matter that we will not vote one farthing either of the taxpayers' money or ratepayers' money to help to carry out the services proposed in this Bill. We feel so strongly upon it that we have put down no amendments to the Bill because we believe it is so fundamentally unsound in principle that it could not be amended. When we have the opportunity we will bring in our own scheme to deal with the health problem of the country in our own way in accordance with the principles I enunciated on the 7th May, 1951, and that I reiterated and expanded in Kilkenny on the 16th December, 1951.
In order to anticipate the misrepresentation and the propaganda which will be levelled against us, that we would not vote for the extension of health services, I want to repeat a few of the phrases in the speech I made at Kilkenny. I referred to the fact that social and health problems would probably occupy parliamentary attention for months ahead and I said:—
"The health needs of the community were part of the justification for those human improvement projects comprised in the capital investment programme. The principle of improved health services has been accepted by all responsible moral and social institutions in the country. Church and State, the various political Parties, and the medical profession are agreed on the principle, and the aim, therefore, must be the working out of details which will conflict neither with moral principles nor with the just social requirements of the community."
I want to emphasise the next passage:—
"We believe that no consideration of mere conservatism can justify the maintenance for a moment longer than is necessary of suffering to which any human alleviation can be brought."
I said that if the problems are not merely left us by the past, but are left to us by a non-Irish Government of the past, we must be careful not to turn for a solution of them to the verycountry whose previous principles and practice had led to their nurture. I developed the matter further, but I do not intend to repeat it now. I just want to refer to one passage in conclusion:—
"While the existing health system must be changed if the people are to be given the service they are entitled to get in so far as the means are available, it is well to reflect what may be involved in this necessary overhaul. It is not merely the services which it is possible for private practitioners to give the people having regard to the facilities they possess; it is not merely the system of remuneration, and the basic finance of medicine which require to be recast if justice is to be done. The whole system of State medicine which has grown up haphazardly as an outcrop of the British poor law administration, and which was crowned by the Public Health Act of 1947, must be recast according to right principles. That principle is that the essential liberty of the subject involved the control of the growth of bureaucratic power. This power cannot be resisted if it is centralised."
We intended and we intend, if we get the chance, as I believe we will have the chance, to recast the whole system of State medicine which has grown up haphazardly as an outcrop of British poor law administration. The dispensary system here and the poor law administration imposed upon us by the British Government was the forerunner of socialised medicine. On that foundation of socialised medicine and the dispensary system the scheme under this Bill has been erected and socialised medicine will be maintained at increased and increasing cost to the community without any adequate return for the money involved.
I object to this Bill because it is unjust to the middle classes. It is also unjust to those classes which were the recipients of the benefits given under the system of British poor law administration and which are described in this Bill as the low incomes group. That group will get practically nothing under this Bill. Little, if any, benefit willaccrue under this Bill to those sections of the community covered in that all embracing phrase "the lower income group". The people in that group will continue to have a ticket, but a white ticket instead of a red ticket. Instead of looking to the nearest dispensary doctor or midwife for maternity services they may possibly look across the border of the dispensary district to another doctor and another midwife, both of whom will be essentially the same types as their own dispensary doctor and their own local midwife, They will still get, or lack, the same kind of attention which they get, or lack, under the present system.
Under the present system a woman in the lower income group is attended by the midwife. Only in certain circumstances is she attended by the doctor. Only when complications arise is the doctor called in. I am informed that the average birth rate in each rural dispensary district is about 17 or 18 per annum. Only in perhaps five out of that 17 or 18 births is the doctor called in at any stage.
The Minister has tried to sell this scheme to the public by saying that the public will have a choice of doctors. He made an utterly reprehensible reference in his Second Reading speech to what he described as the bucket-shop methods of the medical profession. Those utterances pale into insignificance when compared with the methods employed to delude the people by this Bill. Under this Bill there is not a choice of doctor, of hospital, of maternity service or of anything else. In theory, there is a choice of doctor. Neither in theory nor in practice is there a choice of hospital. The women in the lower income groups, those in other sections of the community now brought within the scope of this Bill, whether they be in the middle income group or in that group which can bring itself in by the payment of this fraudulent £1 per annum, will get in future exactly the same service as they are getting at the present time.
They are supposed to have a choice of doctors. Where in the rural areas in this country are doctors to be found in private practice? Doctors practiseprivately in the cities and in the towns. What will the choice be in the rural areas? If there are two dispensary doctors there will be a choice of one or the other. In how many rural dispensaries are there two dispensary doctors? In very, very few. It is alleged that a patient can go across the border into the next dispensary district and ask the doctor there to attend her. The dispensary doctor in his own particular district is bound by law and in accordance with his contract to attend his patients. The doctor in the neighbouring dispensary district is not bound by law or by his contract to attend a patient from another district. He is under no obligation whatsoever to do that. Theoretically a patient may ask a neighbouring dispensary doctor to attend her. He can refuse to do so. He can tell her to go to her own doctor.
In the cities and towns where there are maternity hospitals, mostly of a voluntary character, all sections of the community, whether they be in the lower income group, the middle income group or any other group, have a choice of doctor and hospital and they can, by selecting their hospital, get the benefit of the most expert gynaecologists in this country. That situation will not be changed by this Bill and, therefore, there is no further benefit given by this Bill.
In connection with the so-called facilities as regards institutional treatment or medical services under this Bill, either for the lower or middle income groups there is no choice of hospital. What will happen is that the queue waiting for beds or for treatment will become larger and larger. Somebody will be pushed out inevitably and that somebody will probably be the poorer people in the lower income group. That is the Bill for which we are now being asked to pass this Money Resolution in order to give the Minister a blank cheque for its implementation.
The Bill is unjust to the middle classes. It was our desire and aim and object and policy to ensure that all sections of the community were cateredfor to the fullest extent possible and in the most beneficial way at a minimum of expense to the community as a whole. I have always taken the view that those sections of the community which appear to have less money than other sections are more deserving of attention in matters of health than are the better-off sections. These are the people whom I describe as the white collar workers or the salaried middle classes who do their best to meet any misfortune that overtakes them in the ordinary hazards of life in so far as hospital and medical care are concerned. In recent years important discoveries have been made in medical and surgical science but the new drugs are beyond the pockets of even fairly well-to-do sections of the community. No provision has been made in this Bill to meet that situation.
The Bill provides that a person with a capital investment of £12,000 in the Minister for Finance's last loan bringing in an income of something less than £600 per year at the current rate on the stock exchange will come within the provisions of this Bill. The bus driver living with his unmarried son, a bus conductor, out in Crumlin, will be outside the provisions of the Bill. The farmer with a valuation of £50 and a deposit receipt in the bank will be inside the provisions of the Bill but the wage-earner with over £600 per year, and that £600 is computed out of his own earnings and those of his sons and daughters, will be outside the provisions of the Bill. The farmer with a valuation of £50 can go in his Chrysler car to avail himself of the provisions of this Bill while the bus driver living in a corporation house in Crumlin will derive no benefit under it. The bank clerk, the commercial traveller and all those who come within the category of the middle classes earning over £600 per annum are not provided for in this Bill.
The Bill bears on its face all the marks of officialdom. It has all the internal indications of having been designed by officials without the advice or assistance of any professional person. The easy, facile course was taken of saying "Here we have a system in existence, a poor law system.We will build on that. It is easy to administer. It is easy to carry on." That appears to have been the primary consideration, ease of administration, and they take as the basis of this new scheme the odious legacy of an alien administration, the dispensary and the poor law system, and they endeavour to bring everybody into that. They take the step of levelling down instead of bringing up. Instead of giving better facilities to the lower income groups all they do is to bring in what are described as the middle income groups into the poor law system, and they bring in, too, all those who are willing to pay £1 per year to get over the objection to the moral law. They are brought down to the level of the public assistance class —of those people who are described in the Bill as people who cannot by their own industry or other lawful means provide for their own medical attention or care. That is the method adopted—the facile method, easy of administration. It is not a question of what is best for the patient or the section of the community.
This Bill does not deal with all sections of the community, as we had hoped. It deals only with certain sections of the community and brings them all down to the one level. Further, it brings hardship to the people who are not brought within its scope. What justification is given in respect of the expense on the taxpayer and the ratepayer? There is free medical attention and surgical attention in this Bill for a person with a capital of, say, £12,000 but what about the bus driver and his son?
Suppose the bus driver and his son were in the Bill under Section 14?
Mr. O'Higgins
Read the Bill.
The middle classes are being dealt with unjustly under this Bill. The reason for that, again, is that it was facile for officialdom to say: "We have a system; we will keep that system and enlarge on it. It will be easy to work it. It would be too much trouble to go on to some other scheme." The departmental officialswould have nothing to do with policy but the Minister would. It might be bad policy. He might not have the votes in this House if he had some other scheme or consulted the medical profession. They said they would work on the existing scheme and extend it. They asked themselves: "Whom will we put out and whom will we bring in?" And, again, there was the facile method—£50 valuation for the farmers and £600 a year. £601 put you out. But, in order that there might be a division point, the Minister puts in a clause to the effect that anybody who can prove to the satisfaction of the county manager that it would be undue hardship for him to pay for himself will graciously be allowed to join the queue of people in the lower income group who are trying to get facilities under the Bill. He has to prove that not merely by saying: "I have only £601 or £610," but by giving particulars of his family circumstances. The county manager might say: "Give up cigarettes or the pictures and you will be able to pay it." That is the scheme of the Bill so far as the middle classes are concerned—so far even as the working classes are concerned also.
I want to touch shortly on the provision with reference to £1 a year— shortly, because I think it is the most disreputable thing in the whole Bill. The Minister, as everybody knows, was faced with the obvious proposition that the scheme which he said in the White Paper he was going to carry out— free for all without any means test— free services up to a particular age for children—was contrary to the moral law. Then he said: "We will charge them £1 a year and cock a snook at the moral law"—and £1 a year will do it under the fraudulent and the bucket-shop methods that are adopted by pretending that that £1 a year has some actuarial basis, or is it, as the Minister said on one occasion, a kind of insurance? £1 a year will not go anywhere towards paying the preliminary expenses of this maternity scheme.
As I understand it, in order to carry out this maternity service that is supposed to be provided under this Bill, the doctors who say they will participate in it will get a capitation figureof about £4 or perhaps £3 or perhaps £5. Whatever the sum may be, it does not affect the argument. That £1 towards the £4 or £5 capitation grant is all that will be contributed by these people to the scheme. On top of that, there will be the other expenses. It is a fraudulent pretence to say that the £1 has anything to do either with actuarial matters or with any insurance. It is a subterfuge of a fraudulent character in order to get around the moral law.
I have referred to the fact that when we left office a group of experts were considering the type of scheme that would be desirable in the interests of the community, that would be most economical and that would benefit all sections of the community. The Minister was hardly in office when, for reasons referable to the division lists in this House, he summarily dismissed the people who were giving their time to the service of the community and the country as a whole. I have advocated the medical profession in office and out of office. I do not advocate the cause of the medical profession merely as the advocate of a professional clique who are looking after their own pecuniary or personal interests, or their professional privileges. I do so in the public interest and because I am most firmly convinced that the health problems of this country cannot be solved in the way that the Minister has endeavoured to solve them, namely, by setting aside with contumely and contempt a vocational organisation, a profession which is essential not merely to the life of the community but to the life of the individual members of the community. I had that principle that I referred to in the speech at Ringsend, which I have quoted here, namely, that I would consult not merely the doctors but women's organisations, labour organisations and health organisations of every kind and class and character.
I took the view which I thought then and still think to be the common-sense view, namely, that if there is a problem to be solved the best way to solve it is to get different minds to consider that problem and its solution, bringing to bear upon it their knowledge andexperience and putting that at the service of a Government. Is it suggested at this stage of the world's history that a health scheme can be put into operation without the advice and collaboration and co-operation of those persons who have spent a lifetime in learning matters connected with health, medicine and surgery? Is it not merely common sense to invite their assistance, to ask them in the public interest to give the Government the benefit of their experience and their knowledge and what they suggest should be the solution of the problem? Having got advice from various other people and having got all the advice sifted by the professional people in the Department of Health and then again by the lay officials of the Department of Health, the Minister then has the responsibility in the course of his public duty, of utilising whatever talent and experience he may have, to formulate policy upon all that information gleaned, in the manner I have stated, for his benefit and for the benefit of the public, to select what is best from all that and to make up his own mind, not at the dictation of any one particular section of the community who have been asked and freely give their advice, but to say: "There is the solution and these are the facts. There is the advice upon it by a group of specialists, by a group of general practitioners, by a group of nurses, by a group of labour organisations, by a group of women's organisations and consumers' organisations, in the interests of the public." As the representative of the public in health matters, the Minister then makes up his own mind on that mass of information which he has gleaned in that way and he is in a better position then to formulate policy for the benefit of the public and not for the benefit of a political Party, for the retention of seats or of ministerial posts by individual members of a political Party.
That was the principle underlying the scheme we had when we asked the doctors to give us the benefit of their specialist experience and the benefit of their knowledge to the public. Now we are faced with a situation where we are asked to give millions of money for something in reference to which thedoctors had not been consulted before it was framed, conceived or designed. It bears upon its face the marks of officialdom without any informed opinion from any professional source. With that set of facts, where a vocational organisation, a professional body of men who have spent their lives in the pursuit of the cure of human ills are set aside with contumely and contempt, we are asked to give millions of money to work a scheme that is in itself unworkable and that has not yet got and will not get, as we are informed in the public Press, the co-operation of the medical profession.
We object to that procedure. We think it is contrary to the public interest. No matter what anyone may say about me here or elsewhere, when I speak on health matters or advocate the point of view that is put forward by the doctors or the medical profession as a whole, I speak from my conviction of what is good and beneficial for the public interest and not of what may benefit professional privilege or give pecuniary advantage to any particular section of the medical profession. For that profession I have the profoundest admiration. For the experience and knowledge of Irish doctors I have profound admiration. But that admiration and my knowledge of them individually and collectively does not mislead me into advocating what they say merely because they say it as doctors or as a profession. I say it because I want to know what these people, who have experience in health matters and who have spent their lifetime in dealing with the ills of human nature and with public health problems, have to say about the problems, what their suggestions are and how the scheme is going to be worked. I would not say I would necessarily accept all or even any of their suggestions. Before I, as a member of a Government, would put my hand to any document embodying health policy I would deem it public duty to say that these people were consulted and their co-operation secured.
I have no doubt that that co-operation could easily have been obtained.The fact that it has not is a gross insult not merely to the profession but to the public as a whole. It is a great damage not to the profession but to the public interest and the health interest of the country. This Health Bill brings within its scope or purports to bring within its scope large sections of the community built as it is upon a system which was the forerunner of socialist medicine. I will oppose it as vigorously and with every possible means lawfully and constitutionally within my power and at my disposal. We would not amend it because it is incapable of amendment. It is fundamentally wrong in principle not because the doctors will not have it, not because their co-operation or collaboration has not been accepted or sought but because the profession which is concerned with the health of the community and which is necessary to the working of any health scheme has been set aside with such contumely and contempt, because the public interest and the health of the community as a whole has been endangered and jeopardised and a proper health scheme has not been conceived or designed. In consequence we object to this Bill and to the provision of money for this Bill and we will vote against it on every possible occasion.
Might I make a suggestion before the Minister gets in? This debate is likely to run until 10.30 p.m. and a number of Deputies will want to speak. Could we get the agreement of the House to adjourn for an hour for tea?
We will stick it out. We will not need any tea this evening.
The Minister.
The Minister is not concluding?
That happened before when we were in Committee.
I just want to make a few observations on Deputy Costello's speech. I will do my best not to misrepresent him. I am sure I will have the sympathy of the Dáil in myendeavours not to misrepresent him because I seldom heard a more heated speech and more determined opposition in this House against any measure; yet when the Second Reading was taken a few weeks ago Deputy Costello and his colleagues sat like dummies and never voted against it.
You are wrong in that. We did vote against it.
You did not vote against it.
The records say we did.
You voted to postpone it.
We voted against it. Look up the records.
You did not.
We did. We did not have a division but we voted against it. There was a very good reason.
I see. In future when the Opposition are very much against a thing they will say politely: "No", but they will not vote against it.
For a very good reason.
I know, and I am going to tell you the reason. You were waiting to see how the cat would jump and you made up your minds as Fine Gael always makes up their minds—according to political expediency. You were just waiting to see how the cat would jump. As a matter of fact, the Deputy who spoke from the Fine Gael Benches, Deputy Dr. O'Higgins, did not oppose the Bill very much. He asked for postponement and reconsideration because he thought that we did not give sufficient consideration to the views of the medical profession, but he did not oppose the Bill in principle at all. He just asked for that reconsideration and there was a division taken on that. The Opposition were beaten on that and when the question was put possibly they said in a very mild way: "No", but they did not vote against it.
Is the cat jumping?
The cat is out of the bag now.
They evidently had a meeting of their Party before the Second Reading and they decided not to vote against it, that it would be the best policy for Fine Gael.
We did not.
They put down what they called a reasoned amendment asking the House to postpone the Second Reading of the Bill until it had been given due consideration and so that they might have a little time to go to the country. That amendment was put to the House and they were beaten on it. Then when the Ceann Comhairle put the motion for Second Reading there were a few faint "Noes" but there was no division. They did not know then how the cat was going to jump. Since that time, as Deputy Costello has indicated, they have seen a certain amount of opposition growing to the Bill in the country and they want to cash in on that opposition. Deputy Costello gets up here, thumps the bench and makes the most vigorous speech in opposition to any measure that I ever heard discussed in this House. The few good things that were in the Bill, according to him, would not work while, he said, other things that we claim were in it were not there at all.
I never heard a more unreasonable speech or a more vigorous speech against any measure introduced in this House but yet they did not vote against the Second Reading—perhaps I had better be careful and say that they did not divide against it—because they were not sure how things were going to go in the country. Again we have political expediency as the guiding force in Fine Gael. They have now made up their minds to oppose the Bill and at a Party meeting they briefed their leader to come in here and oppose it tooth and nail, in every clause and at every opportunity. I never saw such a change of front by any Party as thatwhich has marked the attitude of Fine Gael on this Bill. It would be interesting to know what were the considerations, apart from this political expediency, that induced Deputy Costello to come in here and make that speech.
A Deputy
Two candidates in Wicklow, possibly.
Deputy Costello gave us his reasons. As I say, I do not like to misrepresent him, but it is not very easy not to misrepresent him.
Mr. O'Higgins
Not for the Minister.
First of all, he told us that the cost did not matter even if it ran up to £10,000,000 or £12,000,000. When I visited the local authorities in connection with this scheme—and I went round to all of them except one— I ascertained that the unanimous opinion, even of all the Fine Gael members, at these meetings was that this was a good scheme but that it was costing too much. That was the unanimous opinion everywhere. As a matter of fact they said to me that if the central authority would pay for it, it would be a grand scheme and they would be all delighted to have it, if it were not for the cost. Now, apparently, there is a different policy in Fine Gael. They do not like to say to the people: "The health services are all right as they are." They want to be able to say to the people: "You want better health services but, in fact, you are not getting them in this Bill. If we were there, we would provide them for you." They say that neither for the middle income group nor for the lower income group is there enough in this Bill. That is the new policy of Fine Gael as expounded by Deputy Costello because the Fine Gael members seem to approve of his speech.
The Fine Gael policy is that there is not half enough in this Bill, not to mind about the cost, that we are not providing half enough for the middle income group or the lower income group. They say that we are following the dispensary system, the old socialistic system of some British Tory Government of 100 years ago. DeputyCostello objects to the socialism that somebody like Lansdowne introduced about 100 years ago and he says that we are following that system and following socialism. He says that we should cut away from that and get on to some other principle which he has in mind but which he did not adumbrate very clearly. When he comes back he is going to operate that principle and he does not mind if it costs as much as £8,000,000 or £10,000,000. I would advise other Parties, whom Deputy Costello might expect to co-operate with him, that they will need to be very careful; they do not know what expense he might run them into. £8,000,000 or £10,000,000 apparently is nothing to him now when speaking over there as leader of the Opposition.
First of all, I should say that there are only two things of importance in this Bill. One is a better scheme of service for women in maternity and for the infant for some time afterwards. Of course I need not remind the House that that provision was enthusiastically approved of, in fact a little better was approved of by Deputy Costello as Taoiseach away back in 1948 or 1949. It was enthusiastically approved of by Fine Gael Ministers. They were all in favour of it and they all voted a certain amount of money to publicise it. They were all in favour of the mother and child scheme, but we know what happened afterwards when they ran away from it. They definitely and enthusiastically approved of it at one time. Seeing that they approved of it at that time I take it that they do not propose to oppose that part of the scheme at the present time.
The only other thing of importance in the Bill is the proposal to help the middle income group in the provision of hospital or specialist services. I do not think anybody can object to that very strongly. I could quite understand members of the Labour Party or other Parties putting in amendments to try and improve these services. At least I would imagine that the attitude of a responsible leader of a Party who was not interested in political expediency would be: "We will let the Bill go on and we will try to improve itsprovisions as it goes on. So far as it goes it is an improvement." That would not do Fine Gael. They believe that they are going to get some political kudos by opposing this Bill. Of course having burned their boats, having let the Bill through on Second Reading without very much opposition the only thing left to them to do is what Deputy Costello did—come out vigorously against the Bill now, thump the desk and say: "I will oppose it in every single clause" and threaten that when he comes into office he will do away with this Bill and bring in a better one.
Is there any Deputy on the Fine Gael Benches—perhaps they did not read the Bill—who objects to local authorities helping people in the middle income group to get hospital or specialist treatment if they are not able to afford it? The principles underlying this Bill are those that Deputy Costello himself laid down, that nobody must be deprived of medical services simply because he cannot afford to pay for them. That is the principle we worked on and in order to work that principle we took the lower income group and gave them everything because they cannot afford to pay for anything. We then took the middle income group and said that presumably they could pay the family doctor but they might not be able to pay for the hospital or specialist's services if the family doctor suggests that such services are necessary and we decided that we must help that group to that extent. That is the big principle enshrined in this Bill, to help the middle income group.
The members of the Fine Gael Party are now trying to deprive the middle income group of the benefits laid down in this Bill and they are going to say to that group: "If you cannot afford hospital treatment then do without it. If you cannot afford specialist treatment then do without it. Wait until Deputy Costello gets into power when we will bring in a Bill to help you." In the meantime men may die but Deputy Costello is not very much concerned about that. Would it not be better if you are thinking only of the people's health and not thinking of the political support you might get from certaindiscontented elements in the country, to let the middle income group have this benefit until Deputy Costello comes into power and improves this Bill? Why not let them have it in the meantime? I do not propose to misrepresent Fine Gael, but I propose to say—and it is no misrepresentation— that if they vote against the Bill, they are definitely depriving people of the middle income group of hospital and specialist treatment where they cannot afford to pay for it, and that may occur in many cases. I cannot see how anybody who has the interests of these people at heart can oppose the Bill and say: "Let them wait until we come in and we will give them a much better Bill than the one that is there."
Deputy Costello poured great ridicule on the provision for a choice of doctor. What will he do in his measure? Will he say: "I want to give a choice of doctor"? I am quite sure that if he were framing in his own mind a good measure of medical benefits, that is one thing he would think of—that the people should have a choice of doctor— but he ridicules it because it is in this Bill. We all admit that in certain rural areas a choice of doctor is difficult, but I do not think that would apply to more than 20 per cent. of the population. At least 80 per cent. of the people are within reach of a town, a village or a city where a choice is available. Why not let us have a choice of doctor and why not let us say, even though it may be a bitter pill for Deputy Costello to swallow: "That provision at least is good and we could support it, if nothing else"?
Is it not absurd for a man like Deputy Costello to get up here and condemn the Bill so unjustly that he condemns everything in it, even though his condemnation goes beyond the boundary of truth? Is it not obvious that he was under some sort of severe obligation to reverse engines? He tried to give the impression that Fine Gael from the beginning were against the Bill but had not had an opportunity of expressing their opinion on the Second Reading for some reason unknown to us. He wants to give the impression, by the vigorous condemnation he makes now, that they wereagainst the Bill all the time and not that they had made up their minds since the Second Reading that on that occasion they had taken a wrong turning and had to reverse engines and come out in total condemnation of it. Deputy Costello will have to explain that more fully. He will have to explain what is responsible for his change of attitude and the change of attitude by his Party.
He will also have to explain to the middle income group whether it is that he considers it just and right that they should be deprived for some years or some time to come of hospital and specialist benefits because they cannot afford to pay for them now; because he is so determined to rake in whatever political kudos there is in opposing the Bill he is determined to sacrifice them in the interests of political expediency. There is a choice of doctor in the Bill—a choice given for the first time. As every Deputy knows, up to this the woman in a dispensary district had to go to the dispensary doctor—she had no choice. Whether that woman was living in a country place or in a town it was all the same except in the case of the City of Dublin, where maternity hospitals were available.
Deputy Costello has raised the same old argument put up by those opposing the Bill, that the hospitals will be full of people and I notice that the people who oppose the Bill always add: "It is the poor people who will be kept out." Why should the poor people be kept out? Deputy Costello puts up that hackneyed argument which is put up by people opposed to the Bill who want to find any argument they can against it. If a person in the middle income group should go to hospital and if he is sent to hospital when the Bill comes into operation, is it not proof in itself that the Bill is necessary and that he cannot go to hospital now because he cannot pay? If it is not a proof of that, then the other is true, that, under the Bill, the doctors will be sending people to hospital who should not be sent to hospital at all. I do not believe that will happen because peopledo not go to hospital unless they need to go, so that the argument that the hospitals will be full of people is an argument in favour of the Bill, in favour of the necessity for the Bill, because it shows that Deputy Costello and those like him believe that there are many people who should get hospital treatment but who cannot afford it, and that, when the Bill comes into law, it can be done and the hospitals will be overcrowded. My only answer is that we are providing more hospital accommodation as we go along.
The Deputy talked about the £600 limit and again he overshot himself in the examples he gave, because his examples are not correct. He says that a person with £12,000 in National Loan would be assessed on an income of £600. He would not—he would be assessed on an income of £850 or £900. If the Deputy will look at the Social Welfare Act in which these regulations are laid down with regard to assessment of income, he will see that is the case; but the Deputy had not the time to look up these things. He was in rather a hurry to make this volte faceat the request of his Party, and he came in here and made a speech condemning the Bill although he was not very sure whether his condemnation was based on fact or not.
Put the amount at £10,000.
If the Deputy wants to mend his hand now, he may do so, but I am not here to help him in that way. I am dealing only with what he said. One would imagine that, when he proposed to condemn a Bill such as this, he would have sat down a week or so before the Second Reading and would have made up his mind about what he intended to do. There was plenty of time for him to make his condemnatory speech and for him to look around to see whether his arguments were based on the truth or not. He did not do so because Fine Gael had decided at the time that they would not oppose the Bill, that they would try one of these delaying actions to see how things would go and when they were up against this meeting, theyneeded more time to think; but Fine Gael came up from the country and said: "We think the country is going against the Bill," and when Deputy Costello heard that, he said he would come in and condemn it, as he has done, and he nearly broke the desk in front of him in his condemnation. He had not had time to think of all the arguments and he was not sure whether he was basing his arguments on truth or not.
When talking about the sum of £1, he said that it was put in as a fraudulent method of getting around a moral principle. I never heard of anybody getting around a moral principle by fraud. It is an entirely new conception to me and I feel that if people thought they could get around a moral principle by fraud, many of them would try it, but I do not think it can be done. Perhaps Deputy Costello will tell us it can be done, but I have never heard of it being done before. Deputy Costello has a mind which is capable of anything and he might be able to explain to us how it can be done. The £1, as Deputy Costello says, will not nearly meet the expenses. He says we are going to give the doctor £4 or £5. Indeed, I would give him more than that, but let us take £4 of £5 for the job. Statistics show—and the Deputy will find them in the Abstract of Statistics—that there are in this country 242,000 women under 44 years of age.
There are 65,000 births annually so that, on the average, the married woman of child bearing age has a child every four years. After all, in dealing with statistics one must take averages. One must assume, whether it will work out that way or not, that every woman will ensure under this scheme and pay her £1 per year and if she does there will be no cost upon the State. The £ will pay for the whole lot but Deputy Costello knows that an argument was given to him when he came into the Dáil to denounce the £. Accordingly, his arguments were hurried against the measure. He could not have had time to think over the matter. I am telling him now that if he looks up the Abstract of Statistics he will find that the married woman during her childbearingyears has a child on the average every four years. If the women come in under this scheme they will pay £4 for every child born and if we get the doctors, as Deputy Costello thinks, for £4 or £5 I think it will be a very good proposition. We will collect the money and pay it out again. There is no fraud about that. It is a good proposition. Deputy Costello took the matter in a hurried way and was willing to grasp at any argument for the time being.
I think Deputy Costello inferred that this scheme was brought in in an attempt to hold certain support in the Dáil. I am very glad to hold all the support I can and I would have been delighted to have the support of Deputy Costello too. There is no doubt but that he would be a vigorous advocate to have on your side.
In 1947, when I was Minister for Health, the 1947 Health Act was passed and a White Paper produced. The White Paper produced by the Fianna Fáil Government in 1947 differs very little from the White Paper produced in 1952. Again, the Bill differs little from the White Paper produced in 1952. There is the history so far as I am concerned. What puzzles me more than anything else is why Fine Gael changed their minds. Perhaps they will tell us the reason why. I do not know. They may be able to do so. I am sure the people will be interested in that. When they go down to their own followers they will try to convince them that they did not change their minds at all and, perhaps, the people down the country will believe it, because they must believe queer things to believe Fine Gael at all. I want the Fine Gael members behind Deputy Costello to realise that if they vote to throw this measure out—I hope they will not succeed—they will be voting to deprive the man in the middle income group who says: "I require an operation very badly but I cannot afford to pay for it" of the necessary treatment. Probably the Fine Gael T.D.s will say to such a man: "You know the sort of Government you have and you know what to expect," but they will not say: "If Deputy Costello had his way hewould not allow you to have your operation until he comes in." I would advise the members of the Fine Gael Party to be careful about following Deputy Costello's footsteps in connection with this motion.
What about the medical doctors? Will they change their minds?
Does Deputy O'Leary stand up for the doctors?
As a doctor, the Minister should do so.
I would like to give the Minister a chance of correcting some misconceptions on my part. The Minister has, on many occasions, told us that when he came to deal with the Second Reading he would discuss the costs of this measure. Beyond telling us that it would cost £1,800,000 when operating in full and that half of that would be paid by the State and half by the local authorities, he gave us no information of any kind in regard to the costs. He suggested that he would be glad to do it only that he would have to disclose what he has in mind for certain services which will be subject to negotiation by persons and bodies concerned.
We are presented now with this measure. We are presented with it in spite of the fact that the profession whose work and services he proposes to arrange have declared that they have not been adequately consulted in the matter, that they are not going to co-operate if the measure is passed and that they have given reasons both general and particular for their attitude. In face of that the Minister comes to the House with a complicated measure which will have very definite and important reactions not only on the lives of the people but also on their character and general well-being. It will also have an impact on the organisation of our institutions here. He merely tells us it is going to cost £1,800,000.
The Minister has seen many estimates as to what the cost of this measure is likely to be but he has madeno attempt to challenge the cost of these things. His reply to Deputy Costello's speech on the matter is just a little bit of political ranting which comes rather peculiarly when he stresses the urgency of the matters. When the Minister talks about the urgency, it comes rather peculiarly from him since he emphasised in dealing with the matter here that some time must elapse before the proposals in the Bill, if the Bill is passed, will be put into operation and that it is not his intention to push local authorities unduly to implement the provision of the Bill.
On this Financial Resolution, I think the Minister should address himself to these costs. The White Paper which the Minister says is not very much changed in the terms of the Bill gives on page 12, paragraph 19, certain headings as follows:—
"The Government proposes that the following new or extended services should be provided:—
(a) Hospital and specialist services."
Has any estimate been made of what will be the cost of the new and extended services under the heading of hospital and specialist services in a year, two years' or three years' time when the scheme is in full operation? In regard to the heading under (b) has any estimate been made as to what the additional cost will be for the medical care for mothers and infants? Has any estimate been made as to what the additional cost will be under (c) maternity cash grants, under (d) child welfare service, (e) school medical service, (f) nursing service, (g) dental and ophthalmic services and (h) medicines and nutrients?
We are dealing with a measure radically reorganising the health services of the country and we are doing that at a time when the people who will carry it out say they cannot co-operate in view of the nature of the proposals and the lack of discussion and consideration as between them and the Minister. Surely this House is entitled to know whether any detailed consideration has been given to the additional cost that will arise under these headings. The Minister, or at any rate his Department,must have examined in rather considerable detail how these additional and extended services are going to be organised and applied. Some estimate, however round the figure may be, must have been made. To get away with the excuse that he cannot give us any information about these matters because he would have to disclose what he has in his mind for certain services which would be subject to negotiations with the persons and bodies concerned, is trifling completely with the Dáil which is asked to deal with a very important matter affecting the lives of our people generally.
I would like to say, in view of the position that has arisen between the Department and the doctors—whoever is responsible—that, if pressed on this House, it is going to put this House in a very difficult position, because if the position is that the Minister is being unjust, and is blindly going ahead in a brutal and dictatorial way with his scheme, and is riding rough-shod over one of the primary peices of functional and professional organisation in the country, then he is tending to injure not only the dignity and prestige but the authority of this House. We must all, in the transaction of our business here, be careful to see that we do it in such a way that we can maintain the prestige and dignity of Parliament and thereby maintain our authority.
The Minister, from the point of view of putting the full cost of the scheme before the House, should again examine the cost and present some statement of his estimate of what the increased costs will be. At the tailend of the White Paper, pages 15 and 16, we find the various services that are going to be provided for the lower income group, the middle income group and for persons outside the lower income and middle income groups. I would ask the Minister to look at the headings under which information is given to us. Paragraph 40 says:—
"When the Government's proposals are fully implemented (see paragraph 38) the health services which will be available, without charge to the recipients except where otherwise stated, for different classesmay be summarised broadly as follows:—"
I will now give the headings which the Minister has stated are not very different from those that are in the Bill. I give them as they are in the White Paper because they are in a convenient and in a clear way. The lower income group will be the recipients of the following services:—
(a) General medical practitioner service.
(b) Hospital and specialist services.
(c) Medical and nursing care for mothers and infants (with choice of doctor).
(d) Maternity cash grants.
(e) Medicines and essential nutrients.
(f) Child welfare and school medical services (including appropriate nursing services).
(g) Dental and ophthalmic services.
(h) Infectious diseases service.
(i) Infectious diseases maintenance allowances.
Now, under each of these headings there is, I take it, expenditure at the present time in respect of the lower income group. The Minister, therefore, either anticipates increased expenditure under these headings or he does not. I submit that he estimates that there will be increased expenditure. What is the objection to giving that information to the House under each of these headings. If the Minister thinks it prudent, for any reason, to give it otherwise, what is the objection to giving, under a group of headings, what the present day expenditure is for each of the last three years and information as to what will be the increased expenditure in the first year, the second year, the third year and the ultimate year in which these new services will be in operation. Can the Minister give any answer as to why he does not provide us with that information?
As regards the middle income group,the services that they may be the recipients of are as follows:—
(a) Hospital and specialist services.
(b) Medical and nursing care for mothers and infants (with choice of doctor).
(c) Child welfare and school medical services (including appropriate nursing services).
(d) Dental and ophthalmic services (a charge not normally exceeding half the cost may be made except in the case of the child welfare and school medical services).
(e) Infectious diseases service.
On some of these services there is perhaps, expenditure at the moment. At any rate, the Minister has to consider what the total cost is likely to be when each of these services is put into operation for what he calls the middle income group. What objection has the Minister to giving us that information? How can the Minister possibly ask the House, in view of the circumstances in which this Bill is put before us, to pass it without getting any information as to the cost of providing these additional services for the middle income group?
I come now to the third class, that is, persons outside the lower income and middle income groups. Under the following heads they may be the recipients of the following services:—
(a) Hospital and specialist services for—
(i) Women in respect of motherhood and for infants up to six weeks of age.
(ii) Persons whose family income exceeds £600 a year, who would suffer severe hardship if not regarded as eligible (see paragraph 24 (f)).
(iii) All pupils of national schools in respect of defects discovered at school medical examinations.
(b) Medical and nursing care for mothers and infants (with choice of doctor).
(c) Child welfare and school medicalservices (including appropriate nursing services).
(d) Dental and ophthalmic services for children attending child welfare clinics and for pupils of national schools in respect of defects discovered at child welfare clinics and at school medical examinations.
(e) Infectious diseases service.
Under some of these headings, such as (d) and (e), there may be some small expenditure at the present time, but surely the Minister has made some kind of an estimate of what the ultimate cost is likely to be under each heading.
I would, again, ask any person accepting responsibility for taking decisions in this matter, on the cost side alone, whether there can be any excuse for the Minister coming in here and saying that this whole thing is going to cost £1,800,000 while at the same time giving us no information of any kind in respect of services which are so clearly defined and of groups which he himself has very clearly defined. I suggest that the Minister is withholding from the House information that he must have. In doing so, he is not only treating the House with discourtesy and contempt but is undermining the authority of this Dáil as a national institution where the people's interests are supposed to be fully and adequately discussed and fully and adequately guarded and provided for.
I say that the Minister, in treating the House in this particular manner, is undermining the authority of the House. I do not think that any section of the House can allow the authority of the House to be ignored or to be weakened in the country. The Minister, in one of his recent comments on the health situation—I do not know whether it was on the Bill or on the Health Estimate—held up the doctors as a group that, in declaring they were not going to co-operate in this Bill, were almost acting subversively towards the State. He suggested that there are countries to-day where, if a group of men did a thing like that, that soon very much more would not be heard of them. I say that it is the Minister primarily, particularly on this point alone of the question of the costof this measure, who is acting subversively towards this House, and is undermining the authority of this House.
The Minister says £1,800,000. Certain estimates have been made. The last report for the Department of Health— 1950-51—at page 79 gives the estimated cost of local health services for the years 1947 to 1951, the amount met by local authorities and the amount met by the State. The total estimated cost of local health services for the year 1947-48 was £5,671,000; for the year 1950-51 it was £8,084,000. For the public assistance services which, in so far as the main amount is concerned, would seem to include the services covered by the types of services that we are concerned with in this Bill, that is as new and extended services, the cost in 1947-48 was £2,452,000, and in 1950-51, £3,045,000. An answer given by the Minister in the Dáil to a question put to him in the matter would seem to indicate that for the year 1951-52 it was £3,175,000. At any rate, the figure in the report for 1950-51 is £3,045,000. To my mind—I am open to correction by the Minister —the figures given under public assistance services would appear to be the total cost of the general type of services that are provided for here for the lower income group.
In an article in Studiesof March, 1953, on the new Health Bill, Father E. J. Coyne deals with this matter of estimate of cost. Dealing with the lower income group and the free services, he says:—
"The only yardstick of comparison which we have is the British cost. There it costs about £2 5s. per head to give everyone much the same ‘general practitioner services' (including pharmaceutical, dental and ophthalmic) as are outlined in the Bill. Hence the free services of this nature for 1,000,000 persons (‘onethird of the population') would cost about £2,250,000. The British cost per head of free institutional and specialist services is over £6. Hence our cost would be about £6,000,000: a total for the two sets of free services of £8,250,000 per annum."
That is for the lower income group.
A comparison by way of estimate can be seen on page 13 of Father Coyne's article where, dealing with some general matters, he says:—
"The community should ascertain what it costs per head to give the Bill's full services to the lower income group, who get them free, both the general practitioner and the hospital and specialist services. These are unlikely to cost less than £3 10s. or £4 per head: and are more likely to cost £5 10s. or £6."
Is the Minister not in a position to tell us what the lower income group general services cost at the present time, and is he not in a position to give us a figure showing what he expects the increase in costs to be because, on the figures indicated there, there would appear to be a substantially increased cost, more than the cost of which he has given an estimate?
The figures are there plain enough. The estimate made by Father Coyne, after full examination of the whole thing, is given plainly there. My recollection of it is that it would cost an additional, say, £2,000,000 to give the services that are indicated there, substantially more than the Minister has indicated as the whole of the increased cost.
For the middle income group, Father Coyne has taken something like 680,000 as the number of people who are paying national health insurance. The Minister, I think, has given another figure—something nearer 500,000. At any rate, taking the number of people with an income of £600 a year, the number of farmers and their dependents with a valuation of £50 and under, you are providing the middle income group with the hospital and the general services, everything except general practitioner services, that are being provided for the lower income group, and you are providing them free. If that is anything like the cost of these institutional services to the lower income group, there is something like £4,000,000 or £5,000,000 to be provided for there. If we are wrong in these calculations, it is up to the Minister to make us clear in the matter.
As to the school medical services,there is full information as to the number of children who are getting school medical services. There is full information as to the number of school children. The Minister is providing in an amendment that secondary school children and vocational school children will get the same medical services as the national school children. It is not yet clear whether the bill for the provision of these services will be given to the school authorities as far as secondary schools are concerned or to the local authorities as far as vocational schools are concerned, but the Minister ought to be able to tell us what is the cost of the school medical service for primary school children at the present time. The total number of primary school children who got free medical attention in the last year quoted in the Department's report is about 145,000 out of an average enrolment of 381,000 and an average daily attendance of 332,000, so that about one-third of the children in the national schools are examined annually. The child is examined every three years. Does the Minister intend under the new scheme that the child will be examined every year? Does he intend that the authorities of secondary and vocational schools will have to have an annual examination for their children, or are we going to require a particular standard of examination for the national schools and a higher one for the secondary and vocational schools? There must be some kind of an answer in the ministerial or departmental mind to that question. There must be some figure of cost as to the amount spent on school medical attendance at the present time: and it should be possible to give an estimate of the increased cost.
These are matters, on the question of mere cost, in which I think the Minister is behaving in an astounding way in not giving information to the Dáil. In the general circumstances in which the Minister is pressing and hurrying this Bill, and in view of the position into which he has got himself with the medical profession, this is a very disruptive and destructive attitude for him to take up.
The Minister questions DeputyCostello's picture as to the extent to which the services that are promised in this Bill are actually going to be availed of either for the lower income groups or for the middle income groups; but the Minister has only to look at the figures that he has quoted for the beds throughout the country. He has only to look at the conditions that face any county medical or surgical hospital in the country, to realise how false a picture is being created for our people. It is particularly disastrous on the mother and child side, because increasingly throughout the country women are desiring to go to hospitals for delivery and the Minister knows that there have been cases where doctors wanting to get a patient into a local hospital have found shocking conditions facing them when they brought the patient there. They found the accommodation limited to a certain number of beds but filled to beds twice that amount. The Minister might very well say that all these services cannot be provided immediately, but if that is so why cannot he pause now and see where he is going, in the circumstances that have been created between himself and the Department and the medical profession?
The Minister complained here some time ago that the medical profession had quarrelled with Dr. Ward, had quarrelled with Dr. Browne and had quarrelled with himself and he could not understand that there could be any rhyme or reason or intelligence or honesty or any desire to serve on the part of a group of people that would so quarrel. My recollection is that, after we had opposed the 1945 Bill, dealing with only two-thirds of about 600 amendments in Committee for 15 days and then leaving any further discussion of the matter because of the attitude of the Minister, a month after our vigorous fight against the compulsive clauses of that Bill, the journal of the Medical Association wrote that there had been a certain amount of acrimonious discussion in the Dáil on the terms of the Bill but, speaking for the profession, the editor of the Irish Medical Association journal at that time considered that the profession were in favour of the Bill. Much as the Parliamentary Secretary at that timewas trampling on their judgement in certain matters, it was we here who were standing up against the compulsive clauses of that Bill and standing up for the liberty and the dignity of our medical services.
Seven years have passed since that time. The Minister is in a great hurry now to point out that Deputy Costello is asking people in great difficulty to wait for another while, until he has an opportunity of providing a service for them. Yet the Minister is telling them that there must be still further delay. If there is to be still further delay in seeing that these very important and necessary services are provided, I ask the Minister to do what he was asked to do by the amendment moved by Deputy O'Higgins on the Second Reading, that is, go either to his own Medical Health Council or to the organised representatives of the medical profession and have further discussion and consultation with them.
I agree fully and completely with the aspect of the matter that Deputy Larkin put in the forefront of his statement on the 26th February, when he said that personally he felt that "in many ways the doctor gives greater service to the community than a member of any other profession" and when he continued that it appeared to him that "we fail to give the proper respect and credit to doctors to which they are entitled". Deputy Larkin also said that "if we are dealing with such a question as health, we must have not merely a philosophical approach but also a social approach".
The Minister cannot think that the health services and all that they imply —study and research and devotion to a very difficult and very exacting work— can be carried on by anybody but the doctor. We are talking of free medical services. We can see the Minister's outlook on what is likely to happen to the voluntary hospitals, in spite of his declared desire not to interfere with them in any way. He definitely has stated that, if the voluntary hospitals do not co-operate in a scheme such as this, for him, they will pass out of existence, that they will get into very grave difficulties and that he sees noother ending and no other cure for that.
The only free medical services that are provided in this country are those given by individual doctors in the voluntary hospitals and in a very widespread way throughout the whole of the country where doctors are giving the benefit of their professional skill to people for nothing. They do that because they have a concern for the condition of those people. That is the only free medical service, the only medical service that is not paid for in some way or another either by personal payment or by rates or taxes. It seems to me that that is the one free medical service of a high class that exists in this country at the present moment. These are the services that are going to be cleared out. It is quite true for Deputy Costello when he says that under this Bill there is likely to be no free medical services in the country.
The doctors have issued a statement which I quote from the journal of the Irish Medical Association for April:—
"The following resolutions were passed unanimously at the meeting which had been convened to decide on the association's attitude to the Health Bill, 1952:—
(1) That we, the members of the Irish Medical Association, desire to inform the heads of all Churches that we unanimously reject the proposals contained in the Health Bill, 1952, and refuse to co-operate should the Bill become law, on the following grounds:—
(i) This Bill signifies in its essence the State control of the medical profession;
(ii) Under this scheme the State must enter unduly and very intimately into the life of patients and doctors;
(iii) In order to implement this Bill, the State must levy a heavy tax, by direct or indirect methods, on the whole community, independently of the desire or necessity of the citizens who will make use of the facilities that may be provided;
(iv) In implementing this Bill by taxation, direct or indirect, the State will, in practice, morally compel its citizens to avail of its services;
(v) In implementing this particular scheme, the State must have recourse, in great part, to ministerial regulations, as distinct from enactments of the Oireachtas.
(2) Resolved, that a Defence Committee be set up, which shall be representative of all branches of the profession, to devise ways and means to defeat this Bill.
(3) Resolved, that authority be granted to branches and groups of the association to have published in the local newspapers advertisements and/or articles setting forth the views of this association on the Health Bill."
That is the position to which the organised medical profession has been reduced. We cannot but take cognisance of that and we cannot but appeal to the Minister not to go ahead with that situation as it is. We are prepared to examine the difficulties that the Minister has, or thinks he has, on any aspect of health policy between himself and the doctors. But we ought to have it plainly stated and we ought to be able to discuss the pros and cons here without being told that the cat was jumping in the country and that we were taking good stock of it. I do not know how many cats were jumping in the country in 1945 or 1946 when we were dealing with the Fianna Fáil proposals for health organisation then. I know that eight people went into the Lobby on the Second Reading division. Even if this Bill does go through its Committee Stage, I doubt that it will last as long as the two-thirds committee did on that other Bill. The Bill broke, although the organised Irish Medical Association indicated that the profession were rather in favour of it. There were not many cats jumping then. We are not bothering about cats jumping. We are bothering about what we can do through the instrument of this Parliament for people who have limitedresources and can only make use of these when every section of the people is working in a harmonious way to make the best of it.
I ask the Minister to realise that the whole approach of his Government to administration and development and politics in this country is a totalitarian approach. The whole approach of the Department of Local Government to local authorities through the county managers has been part of an attempt to introduce more and more State control. One aspect of this which is seen in the ministerial offices is that since the Fianna Fáil Government got settled into office the technical advisers in any Department were no longer the heads of their department.
That is travelling very far from the Money Resolution.
It bears on the attitude of the Department of Health and the Minister for Health to the medical profession.
I know that the debate has been wrested very far from the Money Resolution, but I suggest that the Deputy should again return to the relevant method he employed at the outset of the Resolution.
I want to say that in dealing with health in the Department of Local Government and Public Health long ago the head of the medical inspectors was the man who was looked to to discuss, to formulate and to control medical policy generally, subject to the Minister. Now the technical people have not access to the Minister except through the machinery of control which grips from the Minister down through the technical service, down through the manager, over the technical service. Finally, I want to put it that the attitude that any sensible person ought to take on this Bill and on this Resolution is to ask the Minister to realise that he cannot, and that any other person, whether the manager or the county council or anybody else, cannot improve the structure of the health services or carry them on. That can only be done by the trained and experienced medicalprofession. It will be disastrous for the health services and for this Parliament as an institution to force a machinery of health services and the cost of them on the country which the organised medical fraternity do not think is right. It is a complete travesty of our function as a Parliament. There are certain elements of compulsion in this Bill, but it is not worth talking about them when compared with the main thing, that there must be reconciliation and co-operation between the Ministry and the medical fraternity.
On the question of costs, I want to emphasise that the Minister is simply destroying the position and the influence of this House if he does not make an attempt to explain to the House what he thinks the cost of this measure is likely to be. I have indicated figures which show that the additional cost of this Bill will run into millions more than he has estimated. Half of these millions, according to the Bill, would fall on the State and half would fall on the local authorities and the local ratepayers. In order to show the necessity for examining the discrepancy between the estimate which the Minister makes and the estimate which others have made, I should like to point out that in Great Britain it was estimated that their health services as remodelled would cost £170,000,000 a year. They are now not only costing £400,000,000 a year but they are costing that £400,000,000 plus the charges that now have to be met by the recipients of these services, charges they were not expected to pay and from which they were excused when the proposals were first introduced.
Deputy Costello said the cost did not matter.
I will not accept Deputy Dr. Browne's paraphrasing of Deputy Costello's remarks. Whether the cost matters or whether it does not we should be told by the Minister what it is expected the cost will be. I am sure that Deputy Dr. Browne in his desire for proper health services would like to have a common-sense approach in relation to what we will ask the people to pay for the services that arebeing provided. We are proposing to give certain health services to people under this Bill, to people from whom we have taken infinitely more money by the removal of the food subsidies than we contemplate spending on them under this Bill, although I myself believe that the Bill will ultimately cost more than the food subsidies ever did and it is the people who will have to foot the bill.
The Minister is trifling with the House, with its prestige and with its authority in the way in which he has dealt with this matter of cost. He goes further in trifling with the authority and prestige of the House and the interests of the people when he asks us to spend time here discussing these health measures, the principles of which have not been agreed between him and the members of the medical profession. It is the members of that profession who will ultimately do the work. We may talk the faces off ourselves here and we may print Bills to fill the square outside but that will bring no comfort to our hearts so long as the organised medical profession do not believe that they should implement those measures. One might as well try to build houses while ignoring the carpenters and the plasterers and the bricklayers. One might as well try importing and exporting goods and commodities by ignoring the dockers who do the work.
Deputy Costello raised a number of extraordinary points which must be resolved before we proceed with consideration of our future health policy, particularly in relation to Fine Gael's attitude on that matter. Listening to Deputy Costello and to Deputy Mulcahy I could not help recalling a remark of Adlai Stevenson during the presidential election campaign in which he said that the Democratic Party had had to drag, kicking and screaming, the Republican Party into the 20th century.
My attitude to this Bill was tending to be slightly critical because of certain obvious objections that I had to it. Having listened now to the Fine Gael Front Bench speakers I am beginning to understand, to some extent,the tremendous triumph the 1947 Act must have been in those relatively unenlightened days. To have got that measure through the House in face of the opposition of Fine Gael was a magnificent achievement indeed.
My objection to this Bill is a limited one. I have seen a particular principle in relation to our health services brought one step forward. That is that they should be fundamentally egalitarian. Every man, woman or child, in other words, shall be sick in the best possible hospital and with the best possible medical attention that the State and the community can provide. To a limited extent we have our toe in the door. In time we will kick the door wide open and establish here proper health services. We may have to wait. I am prepared to wait.
I can afford to back this Bill now because that tiny moiety of that principle is retained in relation to the mother and infant aspect of the scheme. I was a little amused, and somewhat confused, at the remarkable volte faceon the part of the ex-Taoiseach, Deputy Costello. There was complete silence on the Second Reading. Now we know that he was nursing deep in his heart the most profound objections to any and every section of the Bill. All the time this most eloquent senior counsel has sat silently except to say in his mild way “níl” as a signal that he objected in the most profound and fundamental way to the Bill. To-day he discloses the fact that all the time he sat there silently, with his colleagues on either side of him, stemming this torrent of objectionable imputations on the Minister and his predecessor and waiting to pour it over our heads to-day. For some inexplicable reason he remained silent on the Second Reading. To-day he made some remarks which must be replied to because they go beyond the bounds of what one is apt to expect from a colleague in this House.
I do not wish to be disrespectful to the ex-Taoiseach, but I must say that I felt that his speech was a terribly tedious dissertation on a policy in relation to health matters. Throughout,a couple of phrases kept bobbing up—"odious legacy of an alien Administration" and something about, "contumely to his professional medical colleagues". In themselves, these two phrases convey nothing to anybody. I was particularly interested in the fact that, throughout that speech, we did not succeed in discovering from Deputy Costello, the Leader of the Fine Gael Party in this House, what Fine Gael policy is in relation to health matters. He talked about fundamental principles. Most certainly, fundamental principles are involved—but he did not mention a fundamental principle which concerns Fine Gael for the future. He was very discreetly silent, and I wonder why. I wonder if Deputy Costello is slightly worried due to the fact that, if he is too forthcoming in regard to the conservative, reactionary, Tory, Fine Gael health policy or social policy he might alienate his former associates, particularly in the Labour Party, who are committed to a more progressive line than I honestly believe would be followed by Fine Gael if they were free. Is that why this extremely able ex-Taoiseach spent all his time this evening weaving fanciful mirages and pictures about health services without bothering to come down to bedrock and say how he stood on the only important principle of health services as far as I am concerned and, indeed, as far as many people are concerned——
A free-for-all?
——and that is whether there shall be or shall not be a means test in relation to health services? Deputy Costello said—and I hope I do not mosquito him—"That was the policy which we had and we have always stood for a proper health service." He also spoke of "ridding ourselves of an odious legacy of alien administration". I think Deputy Costello was rather unfair. There was a time when Deputy Costello had a good policy in relation to health services: There was a time when Deputy Costello did not divide the people of Ireland into the "haves" and the "have-nots"—and the "have-nots" could take what remained when the"haves" were finished. There was a time, as the Minister pointed out, when Deputy Costello was in favour of a no-means-test health service generally. In fact he, with his colleagues, directed me to bring in no other service. He directed me to strike out an enabling clause—a clause which would have enabled the Minister for Health to bring in a means test. He asked me to strike it out for fear any means test would be included. That is the important consideration, in my view, in our health services. I can accept the present Bill largely because I believe that democracy orders that we should creep before we walk, and walk before we run.
That is a very big change in the Deputy's attitude.
The Deputy has always been a democrat and has always accepted the ruling of the majority.
Oh, oh!
Faith, you did not.
Order, order!
The Deputy is in favour of a no means test. Did Deputy MacBride subscribe to the decision to have a no means test mother and child scheme, and then did he run like a rabbit with his other colleagues——
Did the Deputy not refuse to abide by the majority ruling of his own Party?
I have a letter here about Deputy MacBride. I think it is relevant——
To the Money Resolution?
——to his views on health policy. We must understand that if this Bill is rejected this Government goes out and another Government will take office, and then we shall have the new Government's policy under consideration.
That is the trouble.
Very definitely, that is one of the troubles.
You are afraid that the Government will go out of office.
Deputy Costello was allowed to shout for over an hour, and similarly Deputy Mulcahy, without any interruption. Might not Deputy Dr. Browne be allowed to speak now without interruption?
Except your own interruption.
My interruption was a point of correction.
Let us deal with Deputy MacBride's policy. Presumably he will be part of another inter-Party set-up. I quote now from a Clann na Poblachta document, dated 10th January, 1951:—
".... The mother and child scheme, which Noel Browne intends to introduce in the very near future, will make available a completely free health service, without any means test, to every mother and to every child up to the age of 16 years.
Are not these achievements of which we should be proud?"
That used to be Deputy MacBride's policy.
The House is not dealing with Deputy MacBride's policy. We are dealing with the Money Resolution.
The House could not deal with Deputy MacBride's policy.
I agree. We are dealing with what Deputy Costello said. He said here this evening "We have always stood for a proper health service". I am suggesting that the policy of Deputy Costello and of the people who supported him was quite a different policy up to the time that they decided that the will of this House, as established by the Minister for Health in 1947, that there should be no means test, should be set aside at the behest of a handful of doctors sitting in Fitzwilliam Square—a pressure group of vested interests—with no rights to the people whatsoever. We representthe people of Ireland, whatever they may say about us and whatever we may say about one another. It was decided then that the rights of the people should be set aside. It was decided that the welfare and future of the 3,000,000 men, women and children of this country should be set aside for a couple of thousand doctors who felt that they might lose some money as a result of the extension of good health services to every person in the State. Everybody knows that they are a vested interest fighting just like R.G.D.A.T.A., the publicans and so forth.
Were there only the doctors at that time?
Do not answer that.
You would be too cute to answer that.
I am going to quote from declarations by Deputy Costello. They are to be found in documents which are available to anyone who wishes to read them. I took the precaution of seeing that they would be available because I knew that it would be my word against theirs. Fine Gael then decided—as I suggested in my resignation speech—that they would side with the medical association. The magnificent opportunity arose that they were given to understand that that scheme, on which they were agreed, was contrary to the moral law in certain regards. As reported in column 760 of the Official Report of the 12th April, 1951, Deputy Costello wrote to me as follows:—
"I can assure you that immediate steps will be taken to dispose of any financial matters which may be outstanding in regard to the proposed service on the understanding that the objections raised by the Hierarchy have been resolved."
I quote this further sentence for Deputy Mulcahy's benefit as it concerns the financial implications. Deputy Costello, the then Taoiseach, continued in the same letter to me:—
"Indeed, I may say that to my mind the financial questions whichmay remain outstanding are altogether insignificant..."
That is what Deputy Costello said at that time. Then we have this interesting situation. There were objections apparently put forward by the Hierarchy at that time on some grounds. Deputy Costello is quoted here as saying: "Clear up these grounds and you can go ahead. The money does not matter." Now we have the most extraordinary situation developing in which this politician comes into the House and attacks the Minister for having produced a solution, this device of a pound. Deputy Dillon was equally offensive about it. To a certain extent, I can hardly blame him, but Deputy Costello goes further and he calls it a fraudulent pretence, masquerading, as it is, to get over a moral objection. Surely that is a most offensive remark to make, not to Deputy Dr. Ryan who is well able to take it and to defend himself but surely it is a most offensive reflection on the members of the Hierarchy.
Are you defending them now?
Yes. Surely it is an offensive remark to make in relation to the Hierarchy: the Hierarchy are a party to this fraud, this hoax, as Deputy Costello has described it. Surely, in consequence, Deputy Costello has been particularly indiscreet for a member of a major Party of this House and of the safe, expedient Fine Gael Party to make such a charge that the Hierarchy and Dr. Ryan would get together secretly, behind closed doors, and contrive this fraud, this hoax, as he has described it, on the public in order to keep himself in office for a few months.
Deputy Costello I believe, has done considerable damage in his handling of this whole matter. On the 12th December, 1950, he is quoted in a circular of the Irish Medical Association as saying as his considered opinion that:—
"Neither the Dáil nor the Seanad would approve any amendment of the Act or regulations which would envisage the omission of a means test in connection with this scheme."
We have Deputy Dillon, of course, saying: "I am 100 per cent. in favour of the mother and child scheme." We have Deputy MacBride and the whole inter-Party Government in favour of a scheme which would have given good health services and would have been running well at this stage. Then they decided it would suit their game well to back the moral law. I put it crudely like that because I believe that is crudely what they did in their anxiety to further the interests of a handful of doctors at the expense of the health of the people of this country. Then I was directed to do what they knew to be at that time the impossible in order to put the Hierarchy at rest in regard to these difficulties. Having achieved their objective and having given me an assurance at that time that immediate steps would be taken to dispose of any financial matters if the objections raised by the Hierarchy were removed, they now tell us that because the objections by the Hierarchy are removed, the Minister is a fraud and is perpetrating a hoax with the Hierarchy in order to keep himself in power. The Hierarchy's objections are removed.
The Hierarchy are quite well able, as we all know, to speak for themselves and defend themselves when the occasion arises. This scheme has been publicised and propagandised throughout the country. There has not been a single syllable from any of the Hierarchy in condemnation of the scheme. Surely we must accept that this scheme is acceptable whatever we thought about the other, however similar it is or however identical it appears to me to be; it does not matter now. There apparently is no objection in relation to the moral law as regards this scheme. Still we have the Fine Gael Party now deciding that they will vote against this whole Bill, every single syllable, every single section and every enabling Act. The reason, now that the Hierarchy is not there and the moral law can no longer shelter it, is 2,000 doctors. Are they worth it?
If the Deputy pours out any more venom we will need a few doctors to clear away the poison he is spreading.
The Fine Gael attitude to vested interests is as always: publicans to-day, grocers to-morrow, doctors the day after and the people come last. The Fine Gael policy as always: what is bred in the bone comes out in the flesh.
Someone was talking about offensive remarks.
Are not the publicans entitled to live? Do they not carry on an honest trade?
An "honest" trade is the operative word.
They are entitled to live.
What is really irritating Deputy Costello is the fact that his friends were kicked out of the Custom House. And why not? What right had they to be there? It is our property. It is the property of the people of this country. We nominate men whether it is on this side or that side to go into the Custom House and we give them powers derived from the people through our position. If the Medical Association has a pauperish poor law policy differentiating between the rich and the poor, setting out different treatment in different beds, and if they can persuade Fine Gael to put it across in public let them come out on the hustings and compete against us. Let them put that policy before the people and if they are returned to the Dáil let them go into the Ministry. Then they can operate whatever services the people give them the authority to operate. But we cannot stand by and see a Minister of this House abrogate his rights, his authority and powers for a few doctors who happen to have a particular position in our society.
The Medical Association cannot bring in the scheme and I hope will not be permitted to bring in the scheme which they would wish. Deputy Costello gave the doctors carte blanche to bring in whatever scheme is acceptable to the Medical Association. That is quite true. I happen to know that was part of the deliberations, that "there must be no publicity given to thescheme until it has been passed by the Irish Medical Association". What an absolutely fabulous proposition. I asked Deputy J. A. Costello, as I asked Deputy Declan Costello recently, would he accept that we should ask Deputy Walsh to go out of Agriculture and allow a federation of rural workers to go in there and formulate our agricultural policy, or Deputy Larkin and the trade unions to take over Industry and Commerce.
Why should these people hold a privileged position in our society? Why should they be permitted to do what the ordinary man or woman is not able to do, unless he or she can fight his or her way into this House and on to the Front Benches? Why should they expect to be treated differently from anyone else? How have they earned that privilege? I believe it is imperative that we should be particularly careful of the tremendous privileges which are given to us here, primarily as politicians. I know, as a doctor, I owe no allegiance whatever to the medical profession once I cross the threshold of this House. To me it seems that when the members of that profession come forward as trade unionists, fighting for good conditions for their workers, their claims must get mature consideration just the same as those of anybody else—no less and certainly no more. But when they presume to come in here to take over certain duties, in particular the executive functions of a Minister of State, then I must insist that we draw the line.
Deputy Mulcahy went as close as he could, particularly after Deputy Costello's performance, to the cost of the scheme. I am sure many of us who are not Tories or Conservatives got a certain ironical amusement out of reading the efforts of the Conservative Government in Great Britain in their recent Budget, because I have no doubt before the extension of the magnificent health scheme and the magnificent social services over there, the Tories, in their time, prophesied all sorts of appalling disasters and financial upsets for the people tofollow the introduction of better social services for the people.
Now the Tory Minister is able, in spite of the expense of these benefits and in spite of the burdens imposed on the people during the Ministry of Sir Stafford Cripps, their greatest Chancellor, to continue these benefits for the people and at the same time have reasonable taxation. I believe that for our health services the perfect pattern and the correct pattern to be followed is one which is already established. It is nothing new, nothing revolutionary, nothing like that suggested by the ten misguided physicians in the Independent.It is not a form of Communism or of fellow-travellerism. It is a standard service which we have already here in relation to tuberculosis and infectious diseases. The pattern in that service is that when a man is sick the doors of the hospital are open to him until he is well. Until then he is not a poor man or a rich man, but a sick man. I believe that is the pattern which all our health services will ultimately take. So long as I am in the Dáil, that is the pattern on which, no doubt, I shall have to fight Fine Gael to the death because it is quite obvious, listening to them here, that, like the Republican Party in America, they can only be dragged, kicking and squealing, into the 20th century.
Any kicking or squealing that was done in the interParty Government, we know by whom it was done.
We know who did the kicking.
And who did the squealing.
The Minister has stated that there was a great change about the attitude of Fine Gael since the Second Reading of this Bill, and I am sure we all agree with him. Later than the Second Reading, in the debate on the Central Fund Bill on the 20th March, as reported in column 958 of Volume 137, Deputy McGilligan, in interrupting a speech of mine and some observations I made in regard to what he said about the Health Bill, made the following statement:—
"I did not speak against the Health Bill."
The report then goes on:
"An Leas-Cheann Comhairle: Deputy McGrath is entitled to be heard.
Mr. McGilligan: Is he entitled completely to misrepresent? I did not say anything against the Health Bill."
Later on the report continues:
"Mr. McGrath: If Deputy McGilligan was honest in his opposition to the Health Bill, will he tell us why he did not come in and vote against it?
Mr. McGilligan: I am not against it.
Mr. McGrath: Would the Deputy tell us why only 21 members could be got to vote against it?
General Mulcahy: It was not against the Bill they voted but in favour of an amendment introduced by Deputy Dr. O'Higgins."
I think that makes it pretty clear that Fine Gael were not against the Health Bill when it passed its Second Reading here but to-night Deputy Costello said the Health Bill was so bad that they would not submit any amendment to it.
What has happened to cause this change since the Second Reading of the Bill? Is it not clear from Deputy Mulcahy's speech when he said that the doctors would not work it anyway and that it could not be worked without the doctors, that no health scheme could be worked unless the doctors were prepared to work it? No house can be built without workers, no clothes can be made without tailors. Doctors cannot be fed without bakers and the doctors should remember that they are not in authority in this country. If this Assembly passes an Act I think that the Attorney-General should consider the attitude of people who say that they will not work that Act. I am one of those who believe that the passing of this Bill will ultimately mean a reduction in our health costs. Knowing the amount of good that the Act of 1947 did for the treatment of T.B. and that we have had alower death rate for T.B. since I feel that in a very short space of years the cost of T.B. services will be considerably reduced and, with the help of God, ultimately wiped out.
I feel the same about this Health Bill—there are many diseases which could be considerably reduced if we had proper health services. Anybody with any contact with the people must know very well the dread a breadwinner has of going into a hospital and the fear he has of doctors' and hospital bills. I am sure that every public representative must be approached week after week to get hospital bills reduced, and we all know, too, that there is many a breadwinner postpones treatment too long to get an effective cure because of this dread.
There is no use in anyone telling me that the doctors in the voluntary hospitals work free. I agree that certain doctors do a lot of free work, and I appreciate that very much, but I am aware of cases of people being pressed pretty hard to pay money to doctors, even in voluntary hospitals, where they act only in an honorary capacity. Everybody in this country is entitled to the best medical service available, no matter what his means. Will some Deputy tell me what chance a specialist has of getting into any of the voluntary hospitals at present, without a tremendous lot of pull? Are we not aware that the families of doctors control different hospitals and will oppose by every means in their power the admission of any of these high-class specialists into any of these hospitals? We have a thoracic surgeon and an orthopaedic surgeon in Cork. Will anybody tell me that they could operate in any other place except the local authority institution or sanatoria? They would have no chance whatever of getting in, and it is as well for us to face facts in this regard. I have some very good friends who are doctors, and I know they do a lot of good, and a lot of free work, as I have said, but I am also aware of people who are squeezed for the last penny to pay these doctors' bills.
We talk about the facilities available at present. For the past four or fiveyears, in Cork City, we have been trying to obtain some kind of night service, a skeleton service, from doctors. The corporation sent a deputation to meet the medical men and this week we got a reply from the Irish Medical Association saying that there were 298 doctors in Cork and that we ought to be able to get doctors at night. I know for a fact that on many occasions people have not been able to get doctors at night and there were complaints by the workers' council and by the corporation members of people failing to get medical attention at night in the city.
Deputy Costello said that we were doing away with the red ticket but getting a white one. It is true that we are substituting a white card for the red card, but everybody knows that at present a person has to go with a red ticket every time he wants a doctor. If a white card is provided, it will last for 12 months for that man and his family and he will not have to be running to the doctor every time somebody in the house gets sick and trying to find a doctor, who cannot always be at home, either. There is no use in saying that it is the same thing.
The whole of the opposition to this Bill is based on the threats of the doctors that they will not work the Bill. If we were to bow to every section of the community in that way and take notice of their threats, there could be no Government in any country. Every other organised body in the country will be entitled to act similarly, if the doctors are allowed to do it, and there are organised bodies in the country who are suffering more than the doctors.
We have a system in the voluntary hospitals whereby subscribers who pay a guinea can vote to elect trustees, and this year in Cork we had numbers of doctors' families rushing in to subscribe their guineas and then coming up and getting control of the trustee. They can elect 15 trustees and they can then elect 12 members of the board of management. Fortunately, the doctors forgot that Deputies are ex officiotrustees and we were able to tell them how many representatives they would have on the committee. I very plainlytold them at the meeting that, if they controlled the committee, I would insist on putting up in every ward a notice to the effect that the doctors were there in an honorary capacity and that no patient need pay them. That is a fact and it is as well that the public should know that fact—that doctors in a voluntary hospital are in an honorary capacity——
What part of the Money Resolution does this come under?
——and are not entitled to collect any payment. Not alone was that an attempt to be a worker in the ward but it was an attempt to be the employer as well. I should be very sorry to brand all doctors in this way, but, as an organisation, the Irish Medical Association has adopted an attitude of a type which, if the Government bows to it, will mean that there will no longer be any democratic Government in the country.
We have a minority now.
Deputy Browne has dealt fairly well with what Deputy Costello said about the fraudulent pretence of the £1. I think that was a scurrilous remark. This Bill is very badly needed and I believe that, if given a fair chance, it will do as much good as was done by the 1947 Act in relation to the T.B. scheme, if not more good. It deals with a class to whom no consideration was given before— people suffering from paralysis and other diseases who are not entitled to any benefit at present. There will be schemes of rehabilitation, of treatment and of maintenance benefit under the Bill for these people. I was talking to a sufferer from polio who was speaking in Cork last week and he told me he was a Fine Gael man but that this was one of the best Bills ever introduced. He said great good was being done in these sections alone. He said they were doing a tremendous amount of good. I am sure that every Fine Gael Deputy in the Dublin area knows the man I am talking about. He said a great deal of good was being done in thesethree sections and, moreover, that it was a great Bill for the people, that Dr. Ryan and his predecessor, Dr. Browne, had undoubtedly the welfare of the people of the country at heart and were acting in a humane manner in putting these services at the disposal of the people.
I hope this Bill goes through quickly because it is certainly very badly needed among the working and middle classes in this country.
If this Bill means anything, it means the nationalisation of health.
It is the improvement of health.
We have already seen the nationalisation of transport. Instead of bringing service, efficiency and the results that were expected it has brought confusion and expense on the community. We will have the same position here. We will have a position where the doctor, in fact, will not be responsible for his patient, but it will be the Administration that will be responsible for the patient in his stead.
This Bill proposes that finance should be provided from the Central Fund and also provided by the ratepayers of the country. No limit has been indicated, and if this Bill goes through the ratepayers who will be called upon will be forced to pay a heavy charge on their rates with no chance of regulating the manner in which these services will be applied. Even at the present time, the portion of the rates which provides for health services is almost the largest one. Possibly the roads portion of the rates is the largest, but health would be a good second, and in many cases it is in front of the road charges on the rates.
This Bill proposes that a further burden should be imposed upon the people. In many cases the ratepayers who will put up the greater part of the cost will not, in fact, qualify for any kind of medical treatment under this Health Bill. The Government has no mandate from the people to put through a Bill which is such a drastic departure from existing conditions. If the powers were not made available bythe 1947 Health Act, which had a very broad net, it is obvious that the 1952 Health Bill, this proposed Health Act, recognises the fact that this is going to be a very great departure from the existing health legislation. We have already seen that the 1947 Health Act was responsible for increasing the rates and taxation very considerably by reason of its broad application and this Bill proposes to impose a further burden. In fact, we can say that the effect of the 1947 Health Act has been to put many voluntary hospitals into the financial difficulties we know to-day.
We are now in the position where this Bill may bring further difficulties so far as these hospitals are concerned. Instead of facing the difficulties with which these hospitals and local authorities are confronted in order to provide the finance, we are bringing in a Bill which is going to impose a greater strain and a heavier burden upon those sections.
Then we have no guarantee that if the Bill becomes law the health of the people will be improved. To-night we had Deputy Dr. Browne biting the Fine Gael hand that fed him.
How did they feed him? Stop that nonsense.
He is well fed on a Fine Gael pension now.
He has no Fine Gael pension.
He has to be sure.
The Deputy should get away from personalities and address himself to the resolution.
I want to submit that the last Government was not a Fine Gael Government but an inter-Party Government.
It was not a Cowan Government.
There would not have been Fine Gael Ministers there were it not for Deputy Dr. Browne and others.
Yes, I agree with that.
Deputy Rooney on the Money Resolution.
It was Deputy Dr. Browne who forgot that we had an inter-Party Government instead of a Fine Gael Government the last time.
The Deputy should come to the Resolution which is the only issue before the House.
The contribution by Deputies McGrath and Dr. Browne was much to the effect that this Bill was going through now with the approval of the authorities who were actively interested in the mother and child scheme previously proposed by Deputy Dr. Browne. I do not think that that can be accepted. We have read in the newspapers a tirade of abuse that passed between the Minister and his critics on several occasions. It cannot be said that there were no objections to the proposed Bill and it is not from only one quarter alone that opposition to this Bill is coming. I heard Deputy Dr. Browne snapping his fingers here and suggesting, of course, that the moral law can be disregarded on a matter of this nature.
He did not say any such thing.
He did not say any such thing. He said Deputy Costello suggested it.
No such thing. I am satisfied that is what the Deputy said and if Deputy Cowan reads the debate in a few days he will find I am right.
You, Sir, heard yourself what Deputy Dr. Browne said in this House and to say that he alleged the moral law could be disregarded or fingers snapped at it is an allegation against Deputy Dr. Browne that I will not permit in this House.
Whether it is permitted or not it is a fact. I heard it said.
It is not a fact.
I took a note of it and the official record will prove it.
It is a foul slander.
The Deputy should address himself to the Money Resolution.
It is a filthy, foul slander.
The Deputy is entitled to interpret what another Deputy said without Deputy Cowan or anybody else advising him.
He is not entitled to use this House for foul slander.
He is entitled to interpret what the Deputy says.
Nobody will slander Deputy Dr. Browne in this House while I am in it.
It is a great blessing that you are here, but it will not be for much longer.
I heard Deputy Dr. Browne say that there was a change on the part of the present British Government in relation to the health scheme there compared to previous years. He omitted, however, to tell the House that there had been a drastic pruning of the health scheme that has been operated in Great Britain since the present Government came into office. In consequence of the number of abuses which became apparent from the broad application of the health scheme which had been operated in England there has been considerable pruning, while some parts of it have been discarded. The result has been a considerable saving in costs in Great Britain.
Where has there been pruning? Deputy Mulcahy said that the cost there has gone up from £127,000,000 to £400,000,000. Is that pruning? If the cost has gone up by almost £300,000,000 that is a queer way of pruning.
Under the previous Government——
The Labour Government.
That is the previous Government.
Deputy Rooney should be allowed to make his speech without interruption.
They are not going to stop me. Do not worry about that. I want to correct Deputy Cowan on that. Deputy Mulcahy made a statement that was quite correct. What he said makes a very good case for what we were speaking about to-night. We are told that the cost of this scheme will be borne by the ratepayers and the taxpayers. We had an optimistic figure given by the Minister in regard to cost—something about 1/6 in the £. Possibly, one can compare that optimistic figure with the £100,000,000 which the British Government started their scheme on.
£127,000,000.
But in a couple of years that figure had gone up to £400,000,000. The position became such that it was necessary for the Government in control at the time to make an investigation and to prune that figure as well as put an end to certain sections of the health scheme where abuses were found to exist. The result of that has been that the health scheme in England at the present time is not costing as much as it cost in previous years.
It is costing £400,000,000.
I have not the figures here. If I had. I would quote them. The fact, however, remains that it was necessary to carry out certain adjustments to the scheme in Great Britain.
Will you take your eyes off Great Britain some time or other and put them on Ireland?
After all, we have to follow Deputy MacEntee and Deputy Lemass who crossed over to see Mr. Butler last year.
You are always talking about England.
When they came back they read out a British Budget in
Ireland. That was a great change for the great Republicans or pseudo-Republicans, as they turned out to be.
They were not '49 ones, anyway.
The public are greatly concerned about this Bill. They are being led to believe by false propaganda put forward, no doubt, by the Fianna Fáil Party——
And the Labour Party.
I am not going to say the Labour Party. Deputy Larkin explained the reason why he is supporting the Bill. He said that he was not satisfied with it, and gave his reasons.
And the Minister is not satisfied with it, but it is the best he can do.
Are you satisfied with the Bill?
No.
You were never satisfied with anybody or anything.
I am more satisfied with it than Fine Gael seem to be.
We have already indicated that we are opposed to it and are taking a stand on it.
How can you stand on it when you allowed the Second Reading to go through?
We are opposed to it because we see that it is not going to improve the health of the community in a way that would be commensurate with the burden which it will place on it. We are satisfied that, under the existing health regulations and the powers which the various health Acts give the authorities, if improved services are to be provided they can be provided by existing legislation.
Deputy McGrath has already admitted that this only changes the colour of the ticket from red to white. It is obvious that this Bill is the price whichFianna Fáil Party had to pay Deputy Dr. Browne, Deputy Cowan and the others.
That does not arise on the Money Resolution.
I wish it were so.
It is the price which they are paying for their support, but in the long run it is the community that will have to pay for this piece of political tangling.
The basis of the Bill has been there since 1947.
The 1947 Bill was bad enough. Can the Deputy not leave it there? We have here a Government which does not represent the majority of the people. It was put in by three capricious Deputies.
The Deputy cannot discuss the formation of the Government on this Money Resolution.
My complaint is that the Government has not a mandate to put this Bill through.
The Government puts through nothing. It is the Dáil which does that.
It has not a mandate to put through a Bill of this nature. Therefore, I feel that this is a matter which should be put to the people to decide. We are ready to face that issue at any time, and are entitled to get a decision from the people on it. The people should be told clearly the issues that are involved in this. Let the people decide. The people did not know that they were going to have a Fianna Fáil Government in 1951 when the 14th Dáil assembled.
In many cases, this Health Bill is going to bring hardship on people who are in need of treatment. I say that because the more deserving people, the poor people, will find that other people who are more comfortably circumstanced will have equal claimswith them on the service of physicians and in the use of existing medical equipment. At the present time, the poorer sections of the community have priority in a matter of bed accommodation and medical treatment. The position under this Bill will be that the better-off classes in the community will have an equal claim on the limited services and the limited accomodation at present available to the poorer people.
The Deputy read the Bill upside down.
I would like to hear from the Minister, when concluding, what plan he has in relation to the financing of our hospitals.
Which hospitals? The voluntary hospitals or the others?
Many of the hospitals at the present time are showing heavy deficits. If this Bill becomes law it is probable that obligations will be imposed upon them which will cause further losses. Before those burdens are placed upon both classes of hospitals we ought to hear from the Minister what he proposes to do about the existing difficulties confronting most of them.
I hope to be able to say what I have to say in two or three minutes. First of all, I oppose this motion to give a blank cheque to the Minister, but I want to make it quite clear that my attitude in this is different from the attitude adopted by Deputy Costello. I do not agree with one of the reasons Deputy Costello gave for opposing the motion. The reason he gave was that the farmer with a valuation of £50 and under, travelling around in a Chrysler car, would benefit under this scheme, while the unfortunate worker living in a corporation house with an income of over £600 would not benefit from it.
My objection to this Resolution is, first of all, to giving a blank cheque to the Minister. I also object to the Minister coming in here and speaking about political expediency and to Deputy Mulcahy on the other side speaking about political expediencywhen it is quite clear that both the major Parties in this House are trying to pretend to the people that they are giving them something for nothing when they have nothing to give except what they take from the people and what they charge the people for taking from them and charge them for giving back. I do not believe that that is an honest thing to do. I believe that there is political expediency on both sides of this House. The whole attitude is dishonest. We should tell the people that the Minister for Health has no private fund from which he can give the people something for nothing, that neither has Deputy Costello, that neither has Deputy Mulcahy. It is for that reason that I oppose this Resolution.
My opposition to this Money Resolution springs from one source only. A great deal of lip service has been paid to the question of rising expenditure. In recent speeches from Government Benches reference has been made to the fact that the limit of taxation has been reached. The problem that besets the minds of Deputies who represent rural constituencies is what will be the ultimate cost of the health scheme?
My opposition to the Money Resolution is based purely on my belief that, in the circumstances of the time, if the Government is talking about overexpenditure, the limit of taxation being reached, its incapacity to discharge certain, obligations that seem to have arisen, we as a rational Parliament cannot approach the Health Bill on any basis other than our capacity to pay.
I say perfectly honestly that I do not oppose health schemes as such in any circumstances. I feel that the people are entitled, to the extent of our capacity, to all the services that we can give them. On this particular issue I want from the Minister a real, factual, practical estimate of the cost so that we can analyse whether it is within our immediate capacity to pay.
I am not a lover of any system that may be referred to as a pauper system. I have no particular appreciation of any merit in any English health scheme. We are quite capable of designing, conceiving and putting intooperation schemes that would be infinitely more suitable and more practical for our people than schemes taken from other nations.
I want to ask the question that is activating the minds of people: when will we stop conceiving in Parliament schemes of expenditure without analysing the practical issue as to whether, having regard to revenue yield and present State difficulties they are within our capacity to pay?
I should not like my opposition to this Bill to be misconstrued. I intend to put on record what my approach to it is. There is no doubt that certain elements in this community need attention and a good deal of assistance in securing for them the particular type of attention needed. We have made extraordinary progress in tackling the problem of T.B. I sincerely hope that there will be an equal impetus in tackling the problem of cancer. Nobody in this House would deny people the right to the best possible medical services the State can afford but, in the light of the present financial situation, as revealed, the question at issue is, is the Bill within the capacity of the people to pay?
Central taxation is already too heavy. A further increase in rates will have disastrous consequences. Every member of the House realises that. The county that I have the honour to represent has been in the forefront in the development of health services for the people. I do not think County Cork takes second place to any other county in the provision of various mobile units for the detection of T.B. or in the efforts it has made to accommodate T.B. patients. What will we suffer for that? The Minister knows full well the consequences of our industrious effort to come abreast of that problem. The impact on the rates in Cork County will be infinitely heavier more quickly than in other counties because of the expenditure we have already embarked upon.
Health services, unfortunately, with many other social benefits that have become a feature of our legislation have, in the political sense, been used out of context as so many sops. When the Government want to cut food subsidiesthey say: "We make it up in social services." When they want to do something else that is unpleasant there is talk about making it up in the provision of amenities under the health scheme or social services.
Some day we must come down to rock bottom and ask ourselves whether we are conceiving schemes for a financial empire, an empire that we have not got, or schemes that are practical and within the capacity of the people to pay. Whatever the reason is, I say seriously that the impact of rates on the people in the cities and throughout the country has become extraordinary. We have had evidence in the public Press and in actions of various types that have had to be taken, that for the first time in a long time there is serious difficulty amongst responsible, hardworking members of the community in meeting commitments for their rates. If this Health Bill puts an additional impact on them of 2/6 or 3/—and that is a conservative estimate where my county is concerned—I wonder will it be within their capacity to pay. Take Cork County generally—and take, in particular, my own end of it, West Cork. We have a scattered population rapidly emigrating. Now we have an enlarged health scheme envisaged for people who, in the main, will not be there to enjoy it. There are more practical things that could be done at the moment than this particular type of expansion. People can maintain health best of all when, within their own earning capacity, they can maintain themselves reasonably well and avoid the ill-effects of malnutrition.
It is easy for people to twist opposition to a Bill in a political arena, but I appeal to this Dáil to get into a rational mood on this matter. We all appreciate the necessity for improved health schemes, for better and improved hospitals, for the development of research in certain phases of medicine ; but we have to ask ourselves rationally whether we can do it all now. If the Minister can satisfy me and satisfy the country that we can adequately afford what is now envisaged, I do not think there would be much opposition to the development.
Can we place a money value on health?
One has to place this value on it—if the Deputy wants an answer—one has to place a value on the capacity of the community itself to pay for the benefits it gives. There is no good in having a healthy community if the ultimate financial policy of a Government leads to the creation of unemployment, further and rising uncertainty and if, in the ultimate analysis, it leaves people, who were maintaining a reasonable standard of health, prone to all the dangers that come from lowering that standard. Nobody can put a value on health—we know that—but we as a Dáil here dealing with the taxpayers' money, dealing with the capacity of the Irish community to pay for the benefits that it is to get, must have a realistic approach to it and must relate cost to capacity to pay. I firmly believe that most of the real opposition and agitation in the country arises from the fact that we have a Government talking about "the limit of taxation being reached" and about "expenditure having gone beyond all bounds". In the light of that situation, we are entitled as responsible Deputies to ask the Minister to give us concrete and substantiated figures as to what the cost will be and his opinion as to the capacity of the community to bear it.
It is easy to say that half of it is going on the rates. We must remember that the rates are as invidious a tax on people at present as direct taxation for the Central Fund. In the light of certain decisions taken by the Government, that it cannot afford £250,000 for this or some other amount for that, can we take the view, without proper direction, that this health scheme is within the capacity of the people to pay? If it were, I would not see any real opposition to it—except that, unlike Deputy Dr. Browne, who is critical of his colleagues——
Ex-colleagues.
I am talking about doctors now. Deputy Dr. Browne could not make a speech here without being critical of his ex-colleagues in theCabinet, but that is understandable in the warp that can come in a person's nature by virtue of a political twist.
That is the warp we are hearing now.
With respect, I am not entering into this debate in any contentious way, but only to try to get for my constituents—who have pressed me to get it—the real cost of this scheme. To go back to the point I was about to make, when people began to mix Deputy Dr. Browne's professional colleagues with his former political colleagues, I say to the Minister, in all earnestness, that I do not suggest all is right either on the medical profession side or on the ministerial side, but I know you can spend all the money in the world, all that this House can vote, yet if you have not the co-operation of doctors to work a health scheme you cannot work it. It is not blacksmiths or carpenters that run a health scheme. "Is buan gach duine in a dhuthaigh féin," mar a deirimíd i nGaodhluinn. In this particular case, whatever the merits on either side, there is no merit in trying to implement a health scheme in which the very people who are vital and essential to its implementation are starting off on an antagonistic basis. Deputy Dr. Browne quotes with glib banality some Americanese of Steven-son in the recent campaign, about "Republicans being dragged like screaming children into the 20th century"; but remember that a health scheme without the co-operation of doctors can be dragged nowhere with effect except into the lives of the people of the country to the detriment of their health.
They did it in England and did it very well, in spite of the opposition.
The gallant captain was very critical a moment ago of what they did in England. Now, like the devil, he quotes Scripture for his purpose.
The evidence is there.
I do not give a fiddle-de-dee about what they did in England. We have in this country not only good doctors, but doctors who can hold their place and their capacity for their jobs in any part of the world. These people can give a real service to the State and to a health scheme on the basis of understanding and co-operation. We cannot have two opposing forces standing on little dykes and bawling at each other.
The State and the doctors.
That is only making a pawn of the real people it should be our concern to help, those who are in need of help.
The State and the doctors.
If the Deputy will stop yapping, I will not keep the House very long. Then he can make his own speech. Let us get back to the reality of the situation and ask what the real question is that is upsetting people. We have a Government which is very voluble on rising expenditure. We have a Book of Estimates and a budgetary situation which have to be faced in the light of ever-rising expenditure. We have the Taoiseach and his merry band talking about the limit of taxation having been reached. Is it not germane to the issue on this Money Resolution to ask ourselves are we conceiving something that is not within the capacity of the community to bear? If we are, it is our duty as an Opposition to expose that.
I want to see expanded as rapidly as possible to every person in need of them for any illness whatever all the services we can rationally and reasonably afford to pay for. In extreme circumstances, I think we should err on the basis of making money available even in difficult circumstances for certain types of research which are necessary. I want to put on record in this House that my opposition to this Bill does not spring from any petty political basis or any bias. If we are in earnest in talking about the limit of taxation being reached and a ceiling being put to expenditure in some way,we should really face the real question at issue, whether the conception in this Bill and the scheme that it envisages, between the impact on the ratepayers and the impact on the taxpayers is within their capacity to pay.
Let me end on this note. I feel that we would be infinitely better off in this State to-day if we concentrated more on ensuring decent employment for people with a standard of wages and an earning capacity to sustain themselves in life on a nutritional basis which could combat ill-health. If we had reached that stage, we would not be talking of ever-rising expenditure. In facing the question of people in need of certain services and of certain research aids, we would be facing it in a far stronger financial position and we would be able to do justice to all sections of the people.
I feel happy this evening because the thing which I have been watching and waiting for and hoping to happen has happened at last. We now know where we stand in this House. At last the Fine Gael Party have thrown off the shackles. At last they have made it clear to the Labour Party that there is no hope there. It is a good thing for the country that we should have had so soon this realisation of what is in fact involved, in the constitution of this House. Deputy Rooney—I admit he is not very responsible, but he hears things in the Party rooms—says that the present health service is good enough for us and that the 1947 Act was a rotten Act anyway.
I did not say that.
Any improvement we have had in our health position, any hospitals that we built, any improvement we have made in regard to T.B., and the success of our attacks on disease, all these are due to the Act which Deputy Rooney says is not a very good Act anyway. I am surprised, but I should not be surprised, at Deputy Collins who has for so many years pretended that he was of the advanced element of Fine Gael, thathe did not believe in the old conservative people in the Party. He has nailed his flag this evening to the worst conservatism I have heard expressed in this House since I came into it. I have never heard reactionary ideas expressed in this House as I have heard them expressed this evening by Deputy Costello, Deputy Mulcahy, Deputy Rooney and Deputy Collins. The people are not to get anything unless we are satisfied first that we can pay for it. Was not that the old idea? Let them die on the roadside if it is considered that it should not be paid for.
Who is going to pay for it then?
I am happy because when I voted for a change of Government I specifically said that I was doing it for the purpose of enabling the Labour Party to regain its soul.
Leave the Labour Party out of it. Mind your own business.
You are not the Labour Party. You do not represent the Labour Party.
Will the Deputy please address the Chair?
I am not standing for interruption from Deputy Keyes, bitter and all as he is against me for the simple reason that I deprived him of office before he was long enough in it to qualify for a pension.
That is a dirty attack and it is typical of Deputy Cowan to make it. It is untrue.
Deputy Cowan must withdraw that statement in respect of a member of this House, ascribing motives to him unworthy of any Deputy.
Will the Chair tell me what I said?
The Deputy knows what he said. He ascribed a motive to Deputy Keyes and that must be withdrawn.
If you say so, I withdraw it.
You changed the Government because you were bought over with a promise that you would get a district justiceship.
If Deputy Murphy cannot restrain himself he will have to leave the House. He should understand that when the occupant of the Chair has risen he should not interrupt. I ask him to remember that.
I withdraw what I said about Deputy Keyes. I should not have said it. I hope I will not be interrupted during the rest of my speech.
Deputy Rooney should withdraw his reference to Deputy Dr. Browne also.
It was a different reference.
Deputy Cowan on the Money Resolution, I hope.
I said I was very happy that I brought about a position which will be very clear to every worker in this country. I am glad that a couple of years ago I took a step which enables me to say that I am standing with progress against reaction. There are many people who read what we say here. There are many people who understand what we say here and who understand what is happening here. The people to whom we are responsible ultimately understand what is happening here this evening and they will take their decision accordingly. I have never heard such reactionary sentiments expressed here as those expressed here this evening. No Deputy in the last five years has ever heard such reactionary sentiments expressed in the House.
We have many things to do in relation to the health of our people. We have to build houses for our people. Our bill in Dublin for houses alone in the next seven or eight years will be in the region of £30,000,000. Will we have the Deputy Rooneys, the Deputy Collinses, the Deputy Mulcahys and the Deputy Costellos telling us we cannot afford to spend that money on houses?
You have already stopped the building of houses.
Are we not to spend that money? Will it be said that we cannot afford it?
You have already stopped the building of houses, and there are 13,000 builders' labourers unemployed because of that.
I will deal with interrupters myself if I am not called upon to withdraw by the Chair.
You have interrupted me often enough.
Every Deputy is entitled to speak without interruption. I understand Deputy Rooney has already spoken.
And I was interrupted.
That does not justify the Deputy in interrupting now. He should not follow a bad example.
Does the Fine Gael Party want us to go back to the old idea held by them in 1928, when they would not build houses? Does the Fine Gael Party want us to go back to the old ideas prior to 1932, when the Government of the day would not provide social services? Does the Fine Gael Party want us to go back to those ideas? Nothing can be read into the Fine Gael speeches made here this evening but that we are to go back to the bad old revolutionary days when we measured what we would do for the people by what we thought the people could afford. I want to know exactly where we stand and if it is made quite clear that that is the Fine Gael mentality and their ideas we will know clearly where we are.
I noticed a reversion to type this evening, a reversion to the old idea that we should not spend anything if it is maintained that the people cannot afford it. It is no use Deputy Costello saying that he welcomes millions more being expended on health, or Deputy Collins saying he would welcome a good health scheme if we could afford it. What we have to do is to examine the scheme before us and seeif it is a good one. Is it a necessary scheme? Is it a desirable scheme? Can we pay for it? I have heard a good deal of humbug to-day as to what the scheme will cost. One of the last things we did before we took our short holiday was to pass the Minister's Estimate for the current year, but Deputies have spoken here this evening as if they were not aware of that fact.
And the Health Bill was accepted on the Second Reading.
I will deal with that later. It is significant that we have had these speeches to-day because they indicate quite clearly that Fine Gael has decided to cut the painter as far as the Labour Party are concerned, and they are showing Labour that they do not care two hoots about them now.
The relations between Fine Gael and the Labour Party are not relevant on this Money Resolution.
Fine Gael feels that it can express these sentiments to-day and snap their fingers contemptuously at their former allies. Why? Because they think it will be good politics so far as they are concerned. I think they have made a mistake. I think they will discover it is bad policy. I think they will discover, as they should have discovered years ago, that this country, like every other country, wants progress in relation to housing and in relation to health. Any Party that will endeavour to stop social services, to stop improved health services, to stop development or building will not, in my view, ever rule in this country again.
Deputy Mulcahy says he objects to the cost of this scheme even though he maintains the cost is not clear. That is not a modern attitude. We have had that attitude in every social welfare scheme ever advanced here or in the British Parliament. Compulsory free primary education was opposed on the ground that the people could not see what the cost would be. The Government of the day could notsatisfy the reactionaries as to what the ultimate cost would be, but the measure was enacted in spite of them, and to-day we have free primary education. When a progressive Minister brought in a Bill to abolish child labour in the mines the typical Conservative reactionaries opposed that measure because they said that it would affect their profits. The Minister at the time could not tell them how much would be involved then or ultimately, but the Bill was passed. When Lloyd George introduced his scheme for old age pensions he was opposed by the Conservative element and an element here refused to accept old age pensions for quite a long time.
That ignorant conservative mentality has shown itself in many countries. It has been in existence here and in Great Britain for many years and it has taken progressive Parties and progressive Ministers to beat it down. They have beaten it down just as the present opposition to this Bill will be beaten down. When unemployment insurance was introduced we had all the talk about the dole, what a rotten thing it was to give a dole to a man because he was unemployed. We had the same objections to the widows' and orphans' pensions scheme.
When the health services were introduced in the British Parliament by the last Government there they were opposed again by the reactionaries and the Conservatives. They were opposed by the doctors as violently as they are being opposed here. A good strong British Labour Minister, however, made the doctors toe the line and they have toed the line ever since and they are rendering good service to-day. I want to tell those doctors here who think they can start a rebellion against the interests of the country that they will not be permitted to do so and the sooner they realise that the better it will be. The members of the Irish Medical Association who are engaging in propaganda—some of it foul propaganda—against this Bill do not represent the doctors in this country. I have no doubt the doctors will co-operate with the Minister and the Government. I have no doubt they will co-operate with the people in giving effect to thescheme outlined in this Bill. Deputy Costello spoke for quite a long time to-night. I do not know why Deputy Costello cannot get his facts right. The Minister has referred to some of them. One would imagine that the Leader of the Fine Gael Party, speaking on a motion of this importance, would have felt it necessary to check on his facts. He made the astonishing statement here that a bus driver in Crumlin who had a conductor son would not get services provided in this Bill because, between the two of them, they had over £600 a year—whereas, it is provided as clearly as can be in the Bill that any person, both the driver and his conductor—any person insured under the Social Welfare Act, 1952 will benefit by the provisions of this Bill. This is a very simple thing but when you have the leader of a Party, an ex-Taoiseach, making such a profoundly wrong statement as that one will have a certain sympathy for the Deputy Rooneys when they come to make their statements.
I will be able to stand up in Fairview—not like you—the next time. You will not be seen the next time. Make sure of that.
He will lie down in it.
Order!
I am glad the Chair heard the interruption.
Keep writing letters to the papers.
All interruptions are disorderly.
What do Deputy Costello, Deputy Mulcahy, Deputy Rooney want? They want to provide that the mother and infant scheme that is in this Bill will not be put into operation. That is what they want to stop. They want to stop the provision for the people of the specialist and hospital skill that should go to curing people under this scheme. They want to deny to the farmer—and I want to mention that specifically because,apparently, they are appealing to the farmer in the line they have taken up— whose rateable valuation is less than £50 the specialist and hospital benefit that is provided in this Bill. They want to prevent his wife and infant from receiving the treatment that is provided in this Bill.
Because he has a Chrysler car.
I challenge them to go to the country on this issue alone as to whether or not the farmers under £50 valuation want this. As I understand it, the farmers of under £50 valuation comprise the majority of the farmers of this country.
Surely going to the country rests with you.
Their rates will pay it.
Order!
The Chrysler cars.
It is a very strange thing. In Dublin we have one of the finest health services in the country. We provide a free mother and child scheme and we have been providing it for a long time and nobody knowing anything about it. But it is just happening in Dublin. We are providing every health service that could possibly be provided under present legislation and the total contributed to the rates of Dublin by the ratepapers of Dublin City is only 48 per cent. of the total money spent by the city council. I think that if Deputies will examine how much in a country is contributed by the ratepayers and how much is spent by the local authorities they will find that perhaps the percentage is somewhat about the same. That is something that can be examined. I have not gone into it for every county but at least I know it for my own city.
We have had quite a considerable lot of criticism of the Government and criticism of the members of this House who have voted for this Bill. Our action has been criticised outside the House by men who call themselves or who are publicised as eminent doctors. I readin the Irish Independentof the 9th instant a report of a speech made on this Bill at Limerick by Surgeon T. C. J. O'Connell in which he stated:
"This Bill represented a further and serious stage in the attack upon the middle classes and particularly upon the free professions. The attack had been stimulated and sustained by a rump section in the Oireachtas which had exercised its political power to advance its destructive ideas. It was a pity to see a great political Party such as Fianna Fáil led by the nose by a few paranoical mal-contents and a sensible Labour Party lending itself to the idea of supporting the pauperisation of large sections of the community."
Perhaps it is in accord with his medical training that he should refer to five Deputies in this House as "paranoical malcontents."
That is what the public think.
At least we have been elected to this House—all of us— on more occasions than one. The same gentleman was unable to be elected to the Seanad.
That does not arise on this.
I am referred to as a "paranoical mal-content" in a speech by that doctor on this Bill.
The political history of any particular doctor outside this House does not arise on this measure.
Very well. I will not refer to his politics: I will refer to what he said. When he was dealing with this Bill he had forgotten that this Bill had been passed unanimously by this House. Deputy Costello said to-night that he whispered "No" when the question was put but there was no division on the Minister's Estimate for his Department which made provision for the money that is to be spent under this Bill. I think the Irish Medical Association and the doctors areperfectly entitled to make any attacks they like on the Bill but I do think that they are going too far when they make personal attacks on individual members of the Oireachtas. However, that may be in accordance with their higher medical training.
We are providing in this Bill certain free medical services—just as we are providing free education for the doctors in the primary schools, the secondary schools and the universities. If we, as we do, pay most of the cost of educating these doctors they have no right to make an attack on this State or on the people of this State who have done so well for them. Most of the doctors who are attacking this House have become doctors through the moneys provided by the Oireachtas and the people of this country. The sooner they realise that the better. They benefited very well from the moneys that were provided for their education. Let us hope that their patients will benefit as much from the moneys that will be provided in this House in the future for the medical services which we will have under this Bill.
Another of these eminent gentlemen has this to say :—
"We, at all events, as professional men, have not, ostrich-fashion, hidden our heads in the sand. This lust for State control—this ‘hungry edge of appetite' grows by what it feeds upon. To-day it is the doctor; to-morrow the architect and engineer —in the planners' prospect three easy victims, lured by the tempting vision of building programmes to come;"
Would the Deputy say what is the quotation from?
Deputy Briscoe's manuscript.
It is from the Irish Independentof 13th April, 1953, from an article written by a man who calls himself Dr. Doolin.
What a disappointment to Deputy Rooney.
I understand he is the literary part of the campaign against this Bill:—
"later, the man of law ; then perhaps —who can foretell?—the Church?"
Here is the finishing gem:—
"Was it to establish a Tito-State that the ‘terrible beauty' of Yeats's vision was born 30 Easters ago?"
The Minister remembers it: "Cherishing all the children of the nation equally." These are the people who attack us, who attack this House, who have personal abuse for Deputies who stand in this House for what they believe in and support what they believe in by their votes. These doctors are doing grave damage to their own profession by their conduct in this crisis. This State will not stand for blackmail of that kind from anybody no matter what his standing is in the Irish Medical Association.
We are out to improve the health of the people. That is our job. The suggestion is made in an article by Dr. O'Connell that a few of us are leading this Government by the nose. As the Minister said to-night, and said quite truly, the genesis of this Bill is the Health Act of 1947, which was passed before I became a member of this House. The mother and child scheme which Deputy Dr. Browne endeavoured to implement and put into operation was provided for by that Health Act of 1947. I supported the Deputy in his endeavours to put that scheme into operation. When there was a change of Government the Minister announced he was bringing in a new Health Bill and that he would not be dictated to by any outside source, that when he came to a decision he would not be prevented by anybody on his own side of the House from bringing it before this Dáil.
I speak for myself. I had no consultation with the Minister or with the Government with regard to this Bill or with regard to anything in the Bill. I put down amendments to this Bill to improve the Bill, but some of those amendments in accordance with the rules of the House have been ruled out by you, a Cheann Comhairle because they would put an extra charge on public funds. I would like to see this a better Bill than it is, but it is a better Bill than I thought it was whenI read it first. It is being made better and better by the opposition I see growing up in regard to it, an artificial opposition that is being created by published articles from smart Alecs, some of them in a tone that would not do credit even to very low literary standards, and by the artificial opposition I see here this evening when the thundering Leader of Fine Gael comes in and says he intends to oppose this measure hook, line and sinker. He is not going to allow one penny piece to be paid by this House to improve the health of the people. When I see that conduct, when I see these challenges to the State, I am beginning to think that the Bill is a better Bill than I thought it was but, such as it is, it has my full support, and I know it will have the support of this House.
Our objection to this Financial Resolution on this side of the House is its very ambiguity with regard to the amount that is required. Deputy Captain Cowan, the last speaker, has suggested that it is the duty of this country to provide health services for the community irrespective of cost. That may be good political propaganda but a responsible Deputy must know that——
Deputy Costello said that.
Deputy Cowan said it.
Your Leader said it.
I am speaking about Deputy Cowan. Any responsible Deputy must know that a Government in a country has no money except what they get by taxation from the people. If you introduce health services and you have not the money to pay for these health services, or you do not even know what money you want to pay for them, does that make common sense? Is that good economy or good finance?
Since I have been in this House, under two years, from the benches over there I have listened to the Minister for Finance explaining to the Dáil and to the country that the difficulty is that they have got to balance the national accounts. Is there any sensein a responsible Deputy making the statement that you must give health services irrespective of what happens and giving no indication as to where the money is to come from?
Queen Victoria said the same thing in 1841.
Have we not heard the Taoiseach saying the ceiling of taxation has been reached? Is that a true and a fair statement? The ceiling of taxation has been reached. Yet the Minister for Health is introducing a Financial Resolution this evening for a Health Act, but there is no indication in that Financial Resolution what the ceiling is. Do the Fianna Fáil Deputies opposite and the people who support them, the four Deputies who have voted for them all along and will vote for them to keep them there, not realise they have some responsibility to the country? Where will the money come from?
Is Labour not supporting this?
I am speaking as a Fine Gael Deputy to which Party I belong, and I am expressing the sentiments of my own Party. If the Minister had come into this House and given us a specific sum we then would have been in a position to deal with it. We have no specific sum and we do not know what it will cost.
We have sick people.
I will deal with that presently. Nobody knows that better than I do. Let us deal with the Health Estimate in Britain which has a parallel with regard to finance.
Britain again.
Yes, I am going to point out to the Minister that Britain paid very dearly for her Health Act, and that the people of Britain did not get what they were expected to get. They did not get the medical services they were promised. They got plenty of State control and plenty of taxation, and that is what we are going to get in Ireland, too.
No improvement in health?
Perhaps the Deputy would give me a chance. I am only developing my argument. The original British Estimate was £178,000,000—a sizable sum even for a very wealthy and a big nation. That subsequently rose over a period of five years to £460,000,000. Then by withdrawing and reducing certain of the benefits, they cut it down to a ceiling of £400,000,000. At least they have controlled the amount it is going to cost them over there. The Minister for Health is introducing a health scheme here and he is perfectly frank about it. He says he does not know what it is going to cost. In reply to parliamentary questions and in debate he has made that statement quite frankly. We are also quite frank about it in saying that we do not know what it is going to cost, but we feel that we owe a responsibility to the taxpayer and to the people of Ireland generally, and we should like to know what it is going to cost. So far there has been no indication from any Minister or any Deputy who is supporting the Government as to what it is going to cost.
Is it not reasonable for the Fine Gael Party to oppose the giving of a blank cheque to the Minister for Health for health services with which I shall deal presently, and which, in my opinion as a Deputy and a doctor, mean nothing at all? We object to giving the Government a blank cheque for health services, because we realise that the money comes in the final analysis out of the pockets of the Irish people and the Irish people have reached the limit of taxation.
May I digress for a moment to say that if the people had an opportunity of expressing an opinion at the polls to-morrow they would put the present Government out of power? As matters stand, we cannot get them out of power, so that all we can do, as Deputies of a responsible Opposition Party, is to point out to them that what they are doing to-night is bad policy and bad economics for the country.
Bad medicine.
We are told that they are going to give the country vastly increased health services. In spite of the fact that we have been told that we are reactionary politicians and that we oppose anything for the good of the people, we would be the first to admit, and Deputy Costello admitted it here to-day, that we want to improve the health services in this country, but we are not going to give the Government a blank cheque to enact a Health Bill that is of no conceivable benefit to anybody. Deputies, first of all, know that to have a health service you have got to have the material to run this health service.
Human material or raw material?
You have got to have the material—perhaps I should use the term in the abstract. You have got to have hospitals to start with. Perhaps the Deputy would give me time to develop my argument, and I shall be delighted to answer any questions he may have to put afterwards. We want the material to deal with these services. The Minister told us that we are going to have a much improved child welfare and maternity service. That is a very good idea, and it sounds very good, but to have that improved maternity service or child welfare service it is necessary, first of all, to have an ante-natal service, and for that you have got to have clinics, places which expectant mothers can visit, to have records and so forth taken. Outside the cities of Dublin, Limerick and Cork and Waterford no such institutions exist except in a very few cases.
Again, to deal with maternity cases you have got to have beds available in hospitals. At the moment you have scarcely got sufficient maternity beds in Ireland to deal with the cases that come along in the ordinary course of events. I shall give you a few figures. I shall take, first, a Dublin hospital, and then my own constituency, as being the places which I know most about. In the National Maternity Hospital in Holles Street, an up-to-dateand, in my opinion, a well-run hospital, of which I had considerable experience as a doctor, there are 132 maternity beds. These beds are in the public wards, the class of bed which was referred to the other night by Deputy Dr. Browne as pauper beds. I and several other Deputies remarked that nobody ever heard of a pauper bed except Deputy Dr. Browne. These are public wards and there are 132 beds in them; 21 of these beds are for ante-natal cases and eight for isolation cases. In every maternity hospital you must provide for every contingency that may arise, and there are cases that have to be isolated. Eight beds are allocated in this hospital for isolation cases. At times that may mean a dead loss, but you cannot move ordinary cases into isolation beds. That leaves 103 beds for post-natal cases. The total admission to the National Maternity Hospital in one year amounted to 4,696, and the total deliveries were 4,162. That shows that there are not any beds to spare in that hospital to which we have over 4,000 people admitted in the year. Mark you, these cases are not all coming from Dublin. A number of them come from the country, and many of them are emergency cases from rural Ireland. It is necessary to keep beds in the hospital for such cases. They cannot fill all the beds and leave none vacant for emergencies. They have to be ready for any emergency cases that may come along. It is a question of saving life when they arrive.
It has been suggested here—I think it was Deputy Dr. Browne made the statement; somebody can correct me if I am wrong—that there were no real specialists in Ireland, that our doctors were only of general practitioner standard. I should just like to give some results from this hospital. The mortality rate in Holles Street Hospital into which emergency cases and really difficult cases not alone from Dublin but from all over Ireland are brought is 3.5 per 1,000 or .35 per cent. That is not a bad record considering the difficulties under which they have to work very often. Virtually they have to clear the beds there as soon as it is humanly possible to do so to made room for other cases coming in. We inthe Fine Gael Party fully agree with the extension of maternity services if we have the material to do so. Deputy Briscoe asked whether it was the raw material or the human material. That is the answer; there is the material available in one of the leading maternity hospitals in the country. We have not got the beds. There is no use in codding the people by saying that you are giving them a free-for-all maternity service if you have not got the beds.
All maternity cases do not go to hospital.
Deputy Briscoe should allow Deputy Dr. Esmonde to make his case.
I am a governor of a maternity hospital too.
Deputy Briscoe can give us the benefit of his observations afterwards.
The figures which I have given you are figures which can be quite easily checked.
They are figures to cod the people.
That is the position in a Dublin hospital. May I give some figures for my own constituency which is also represented by the Minister for Health?
We have, between Wexford, New Ross, Gorey and Enniscorthy, a total of 29 beds and, in 1951, there were 1,925 deliveries there. These 29 beds are for the people who at present enjoy free medical treatment. As Deputy Briscoe says, not all the people go to hospital, but the vast majority of these people have to go into hospital, and nowadays when a woman is going to be confined, she very often has to go to hospital for domestic reasons—it is impossible for her to get anybody to look after the house or she may have small children, and so on. The majority of people of the working class prefer to go into hospital because it is cheaper and easier for them. It is very much easier for the working class woman who is rearing a young family to go tohospital to have her baby because she is free from the anxiety caused by the other children knocking around the house and they have not got much accommodation in these small houses.
The point I want to make is that the Minister is offering—and is asking us to give him a blank cheque for it—a free maternity service to everybody. The people who will be covered by this are entitled to go into these hospitals free of charge, except that in some cases they may be charged two guineas, as the Bill permits, and they will be competing for the beds for which these other people to whom I have referred in the two hospitals I mentioned are competing now. It simply means, in effect, that the Minister is offering something he is unable to meet. The Minister has probably been advised by his official advisers that this is the correct health service to give us and that this money is necessary to improve the health services.
I should be the first to admit that there is plenty of room for the improvement of health services and of maternity services, but there is no use in trying to kid the people that you can give them something which you cannot supply. It is a known fact, and it has always been the same, that if there are too many people competing for too few things, it is always the weakest who suffer hardship. That is what this great measure is going to do.
Is that a reactionary statement? It is not. We have just as much interest in the low-income people and the honest workers of this country, the thousands of people in the country who support members of our Party, as anybody else, and may I say, with all due humility as a doctor, that there is no use in this continuous slanging match about health services? We have had people standing up here to-day and denouncing the doctors right, left and centre.
Tell Mr. Doolin and Mr. O'Connor that.
I make the case that there is no controversy, so far as I know, at the moment, between the medical profession and the Minister, except in one respect. By the medicalprofession, I mean the Irish Medical Association, and, whatever the merits or demerits of the Irish Medical Association may be, they are the representatives of the doctors, or of the majority of them in Ireland. They are the democratically elected representatives of the doctors and they are voicing the opinion of the doctors as a whole. There is no controversy between the Minister and the doctors with regard to fees or anything like that. It is a question of the principle of the thing —that is all there is between them.
What principle?
What I have just been saying, that they have not got the accommodation to deal with the situation. I quoted the figures with regard to the Deputy's constituency.
It is not principal, but interest, they are after.
Is that a principle?
There is no controversy whatever between the Minister and the doctors with regard to finance or medical fees. The controversy, as I see it as a doctor, is that we have not got in this country the facilities to deal with these health services.
Where will the beds come from under the Irish Medical Association scheme?
I am dealing with the position in the Irish hospitals.
Why not answer the question?
Since the Deputy has asked me a question, may I try to answer? He asks where the beds are to come from. I believe the Irish Medical Association scheme to be a contributory scheme.
Where will the doctors get the beds then?
A contributory scheme is not a new thing. It exists in America on quite a large scale. It exists in Canada where the Civil Service have a contributory schemewhich covers maternity, accidents and so on.
You will not need any beds under that scheme.
Give me a chance to develop my point and do not get cross about it. The Irish Medical Association have suggested a voluntary contributory scheme. The voluntary contribution entitles them to a certain rate of money—£200 for a family. These people will be going into nursing homes and will not be competing with the necessitous people for the public wards. That is what no one can accept, but a contributory scheme means that a householder is being eased of the burden and responsibility of paying the cost of private medical fees and nursing home fees and will not be competing with these people.
You will want more private homes then.
No. There are plenty private homes to accommodate the people now, as Deputy ffrench-O'Carroll can probably verify. I have never had any difficulty in getting anybody into a private home and I might say en passantthat I never had any difficulty in getting anybody into a public hospital. I have never been refused a case for a public hospital yet and have never been asked what a public patient whom I am sending in could pay the doctor. It is I myself who have indicated that to the doctor —whether the patient could pay a fee or not. If he cannot, he is taken in just the same. That is the point in this measure—the Minister is introducing a scheme without the material to deal with it. The principle of his idea, the improvement of health, maternity and child services and easing the burden of specialist services is very good, but we must be practical about things. If you have a scheme, you must be able to meet your obligations and if you run a scheme like this, it is reasonable that the Minister, with his expert advisers and so on, should be able to tell the country what it is going to cost. The Minister has no idea whatever what it will cost, and even thisResolution speaks quite definitely of “whatever sums may be necessary.”
Did the interParty Government ever tell the Irish people what the social welfare scheme they were going to bring into operation was going to cost?
My answer to that is that I was not a member of the last Dáil. I do not know what happened in the last Dáil. I am dealing with the Health Bill at the moment and the Money Resolution in connection therewith. After all, if the Deputy wants to ask me a question about the Health Bill, as one doctor to another, I will try and answer it. Deputy Dr. Browne asked me a question. I just explained the difference between this and the Irish Medical Association scheme. The Irish Medical Association scheme is a contributory scheme utilising the private wards as against the public wards.
Did the interParty Government tell the public what the costs of their health services would be before they were introduced?
They would have given those figures when they brought in the Bill.
They never had any intention of bringing in a Bill.
The Deputy should be allowed to speak without these interruptions.
With regard to the local charges, whatever sum of money we raise in this House and whatever this Health Bill costs, I understand that the local taxation will have to pay half of it. Is not that right?
More or less.
It is the generally agreed policy of every Deputy in the Dáil that we want to try and improve the standard of living and the social services of our people in so far as it is possible for us to pay our way. I think it is agreed by every Deputy that the best way to do that and the surestroad to economic stability is to increase our agricultural production. As an Opposition Deputy, I could hardly be expected to give any figures particularly when neither the Minister nor his Parliamentary Secretary can give them. The Minister's Parliamentary Secretary, speaking in Sligo, was quoted in the Irish Pressas saying: “I cannot guarantee that it will not cost more than 2/- on the rates.” Whatever it will cost, is it not an accepted fact that the rates are going to go up? The rates are going to go up in Dublin. The rural rates are going to go up. Does not that mean that on the major industry in this country, on the farming community, there is going to be an extra impost? Is not that detrimental to the increase in the national income?
Will the death rate go down?
I hope the death rate will go down. It is not terribly high in this country. It is supposed to be high but it is not really high. To return to the point, the rates are going to go up and this health Bill is going to increase local and central fund taxation to a sum of the size of which no one has any idea. Is it unreasonable for the Fine Gael Party to oppose that? We say to the Minister, the Fianna Fáil Party and its associates—two of them are in the House and two have gone out—that we object to giving a blank cheque to the Fianna Fáil Government to put this charge on the people. In actual fact they are offering the people something that they really cannot live up to.
I ask the Minister to accept this fact. I ask him to withdraw this Health Bill and introduce something that is practical. He will have the support not only of the people on this side of the House but of all the people in the House if he can produce something that will be of benefit to the Irish people. After all, ours is a Christian country. In the world to-day there is not much Christianity. It is our proud boast in Ireland that we are a Christian country and that we believe in the home. The cry that is heard all over the country to-day in every walk of life is that we are taxed beyond our capacity to pay.
Let the Minister introduce a scheme by degrees. Let him work on the foundation of whatever good exists in our health services at present. Let him work it by degrees and try and get the people something that will really be of benefit to them. Let him concentrate upon producing something that will not cause hardship to the weakest section of the community. Let him forget the will-o'-the-wisps or catch cries in regard to a free for all service. Two Irish Ministers for Health have so far produced health services.
Deputy Dr. Browne had a health service which was not acceptable or feasible. The present Minister has rehashed that with slight alterations. If the Fine Gael Party felt it would be of benefit to the Irish people to pay for a Health Act that would reduce mortality, wipe out T.B. and ensure a proper health service of lasting benefit not only for the working classes but also for the salaried classes they would support it. I ask the Minister to withdraw this Health Bill and introduce something that is not produced by civil servants. No doubt the civil servants are doing their best to advise the Government but the Minister should consult the people who know. Let him take into his confidence doctors, dentists, chemists, nurses, trade unionists and the representatives of the farming community. Let him accept advice from those people. Let him still be the Minister for Health but let him be big enough to accept advice from the people who know. If the Minister introduces a Health Bill that will be in keeping with the purse of the people, we will not obstruct it but will be proud to go into the Lobby to vote for it. But in all conscience no member of the Fine Gael Party could vote for this rehash that is dished up to us now.
I fear very much that in its impetuosity the engine of the Opposition went off the rails and all the carriages are not careering properly. Without even going into the smoke of the engine, they are raising smoke-screens of their own.
That is right.
The basis of this Bill is to be found as far back as 1947. Certain sections of the 1947 Health Act have been progressively implemented and that is what Deputy Dr. Esmonde is now seeking. They have got on very well and I do not see why the Deputy should anticipate any other approach in regard to this particular matter.
The Opposition seem to be very much perturbed because they were not given a precise estimate of what this particular Bill will cost when implemented. They must surely recall that, when the first phase of the Act was being put into force, we had in regard to the T.B. services, for example, no thoracic surgeon in this country. People who required such treatment had to go to London. Until Deputy Dr. Browne brought over one or two of these surgeons, we had no man competent to operate skilfully in regard to that particular disease. Furthermore, we had no hospitals in which to put these patients.
I remember when I was a member of a local authority, one of these doctors offered to come to this country if given 25 beds. The beds could not be procured in the hospital. He said he was not looking for the beds in a voluntary or high-class hospital, and that if he could get them in the county home hospital he was prepared to come back. Even though we were not able to get the beds for him at the time, he did come back. The mobile units were put on the roads in Cork and elsewhere and so there was early examination of patients and early diagnosis of disease. The scheme was implemented in that way. Beds were procured here and there. Treatment was given to people in their homes when hospital treatment was not available for them. They were given advice and their health improved.
I heard an eminent surgeon in Cork say the other day—he is a general practitioner and is not in the T.B. service at all—that, with the progress that is being made at present in tackling T.B., he is hopeful that in six or eight years the T.B. service will be almost unnecessary. In that event, sanatoria will be available for some other purpose.The general health of the people will have been improved, with a consequent reduction in the number of deaths from T.B. We can hope, too, that many of those getting treatment will have so regained their health as to be able to resume gainful employment. That has been the experience in one branch of the medical service. We had more difficult health problems to deal with in the past than will arise under this Bill, and they were dealt with successfully.
Deputy Dr. Esmonde said that the cost was the most important factor so far as the scheme was concerned, while his Leader said that if it cost £6,000,000 or £8,000,000 it would not matter if the general scheme was a good one. Let us remember that before this Bill got a Second Reading the Minister visited all parts of the country and met the public representatives composed of members of all Parties. They are the people who will have the administration of this Act. The Minister pointed out to them that the scheme was to be implemented in a progressive way. It was not going to be shot out all at once. It was pointed out to them that getting the clinics ready would take time, but what the services would be provided within a reasonable period of time. That is just what Deputy Dr. Esmonde wanted towards the end of his speech, although earlier on he was opposed to the whole thing because the cost was not detailed. If the alternative is to be that a person is to be allowed to linger and die because treatment is not available for him or because he cannot afford the cost of it, then I say that we, as a Government, would not be using the resources of the nation in the best interests of the health of the nation.
We all know how serious the position in regard to infant mortality is and how necessary it is to have a proper mother and child scheme. It will not be necessary for everybody affected to go to hospital right away. Advice will be given under the Act and specialised treatment made available. Quite a lot of treatment can be given to patients in their homes. The advice and treatment offered will undoubtedly help, ingreat measure to reduce the infant mortality rate. It has been so high in many of our cities that really it has become alarming.
It has been said, of course, that there are some diseases which are more deadly than T.B. These can be dealt with in due course. There is not much comfort in telling a person: "You must die because you cannot afford the medical treatment that is necessary to effect a cure and the Government of the country is not interested in the health of the nation." These are problems that we must tackle in a businesslike way. It will be necessary, of course, for the Dáil to make funds available for people who cannot provide specialised treatment for themselves as well as for the provision of hospitals.
The attitude of the medical profession is somewhat disconcerting. In one way or another, I have been associated for a long time with voluntary hospitals in the same way as the Lord Mayor of Cork and other members of the House have been. We know the excellent work which these hospitals are doing and will continue to do.
At the same time, they have certain drawbacks. I can never forget my first association with one of these hospitals. Six beds became available and rather than appoint another doctor the six beds were divided amongst the existing medical staff. That decision certainly did not make available for those who wished to attend that hospital the services of a greater number of medical practitioners. Patients attending there were limited to the doctors already attending the hospital. Perhaps there was a certain amount to be said for that. These hospitals grew up under the particular system that was there at that time, and in its own way it was very admirable. We will not get anywhere by condemning good work where good work is being done, but at the same time it is necessary to branch out and make extensions: to give a better choice of doctors and, in some cases, to make treatment available at a higher level.
The dispensary system was condemned completely by some members of the Opposition, even though DeputyCostello in his opening remarks, said that they were out to improve it. We must all recognise that there is great competition amongst doctors for dispensary appointments. A big number of doctors—most of them, I am sure, are members of the Medical Association—compete for these vacancies when they offer. The appointments are made by the appointments commissioners. The doctors appointed are very suitable and admirable people. The Minister, in order to improve the dispensary system and to speed up the services which it should provide, has sent out a model plan for rural dispensaries. His action in doing so is calculated to bring to an end the delays formerly experienced by local authorities not only in the matter of the acquisition of sites for dispensaries but in the building of them.
Such steps are being taken. There is a grant of £600 for the erection of dispensaries. I do not know from where all the opposition to this Health Bill comes or what is behind a good deal of it.
It seems to me that the Bill is designed, as sections of the 1947 Act were designed, to improve the health of the people. At this stage not even our best statisticians can say what it will cost. When the Minister made money available for T.B. patients and their families so that they need not work themselves to the bone before going to a sanatorium or resting at home he was unable to state what the cost would be. All these things are approximations. If it is the right thing to do, let us do it. This Bill gives an opportunity to the local authorities to do something for the health of their people, to enable people who cannot afford to pay to get specialist services. Prior to the introduction of the scheme of allowances for T.B. patients and their families persons who contracted the disease were reluctant to enter hospital for treatment because of the hardship involved for their families. That scheme helped to solve that problem. The same applies under this Bill.
The Bill aims at improving health. The Minister has gone a long way tomeet reasonable opposition, to answer questions that have been put to him publicly and privately and has done it in a most efficient and effective manner, notwithstanding some of the ill-mannered opposition with which he has had to contend. If the Medical Association say that they will not implement certain Acts of this Parliament, they are adopting an unconstitutional position. If the health of the people is to be risked by opposition of that kind, this Parliament will have to take serious notice of it.
If reasonable amendments are proposed the Minister in his usual efficient and considerate way will deal with them but the line adopted by some members of the Opposition is: "We are opposed to the whole thing; we are opposed to the Bill because it is no good; we are opposed to it because we do not know what it will cost; we are opposed to it anyhow". That seems to be the attitude. With the experience we have had of the 1947 Act, with the experience we have had of mental hospital schemes and other matters, we can make this Bill effective and useful. If we do not get the co-operation that we expect from the Opposition, the Dáil will go ahead and do its best for the people.
I approach the Money Resolution from a different point of view from that of my colleagues and members of the Government Party. It has been said that the Public Health Act, 1947, was the charter of public health. That statement cannot be upheld. As the Minister is looking for a blank cheque to carry out what he describes as an extension of the 1947 Act it is no harm to consider the 1947 Act. May I point out to the House, to members of the Government Party and to my colleagues on these benches, that the Public Health Act, 1947 was condemned by the bishops of this country and that in a letter which they addressed from Maynooth to the then Taoiseach they directed his attention to Sections 21 to 28. They wrote that letter to the then Taoiseach on the 7th October. 1947. The then Taoiseach replied to them, but not until he was a defeated Taoiseach, that he did not propose totake any action on that Bill or on those sections as the constitutionality of the sections and of the Bill was then in question. We must be grateful to Deputy Dr. Browne for the publication of these letters because if he did not publish them the chances are that we would not have the benefit of them.
It appears to me that every Deputy this evening has deliberately ignored the fact that that Act was considered by the Hierarchy in Maynooth and condemned. It was condemned by the Hierarchy speaking as the Hierarchy and the Church of this country. I owe no apology to any person or any Government for accepting the teaching of the Hierarchy on that particular matter.
We have had speeches here this evening to the effect that the opposition to the Act of 1947 was led by the doctors. The argument was put that the reactionary Fine Gael Party of 1945 opposed the 1945 Bills. How right we were. If the Government of the day in 1947 had taken our advice much hardship and much ink would have been saved.
It is true that this Bill repeals in part Sections 21 to 28 of the 1947 Act which were then condemned by the Hierarchy. I am not satisfied, and the Minister has not told us, and I think he should, that this Bill meets with the approval of the Hierarchy.
I know that people say that the Hierarchy have no right to butt in. Of course they have. They are charged with the responsibility before God to lay down the law of the Church and the law of Christ. It would be a poor day if we in this House could ignore with impunity what they say. It is time that we took stock of where we are going irrespective of which side of the House we are on.
There are two things that should be made clear. When the Minister for Health in 1950-51 submitted his scheme it was condemned by the Ordinary of the diocese and, make no mistake about it, the then Minister for Health appealed to the Catholic Hierarchy to have that condemnation set aside. Instead of that condemnation beingset aside, the fact of the matter is that the Church, sitting in conclave in Maynooth, confirmed that condemnation and set out, under seven headings, the grounds on which they condemned that scheme then. I want to remind every Deputy that the question of a free-for-all scheme was only one of seven points. There were six others, but hearing the discussions that took place here and outside one would think there was only one point.
You gave us all that argument again on the Adoption Act.
The Adoption Act does not arise.
If Deputy McGrath wants to challenge what I am saying. I may add for his information or that of any Deputy who challenges it, that I left the papers below on the table in the Library, where anyone can go down and check them.
You told us the same thing about the Adoption Act.
The House is not discussing the Adoption Act.
Deputy McGrath seems very anxious about legal adoption and public health when he mixes the two so freely together and he puts the condemnation by the Bishops of the Public Health Act, 1947, as being of no importance, or equal only to the importance that I gave to the condemnation of the legal adoption legislation. It shows how shallow his mind is, but I cannot improve Deputy McGrath's mind on that particular matter. I would remind him that if the 1947 Act was condemned by the Hierarchy of this country, the Fianna Fáil Deputies went through these Lobbies supporting that measure as being the charter of their freedom as far as health was concerned.
We are not told to-day how far the Hierarchy approves. I admit it is not necessary that they should give approval, but as the matter has been at issue I do not think that any Government or people in this country should give the impression that theycan ignore the Hierarchy with impunity. I do not care who likes that or dislikes it. I believe that and I feel that the obligation is on me to put that view to the Deputies here.
It is true that this Bill is only an enabling Bill, that up to a point it has no regulations; but it gives the Minister power to make regulations of a very extensive nature. While I know that the present Minister and the present Government would not make a regulation that would be in complete variance with what we hold to be the truth and believe to be right, what is the guarantee that it will not be taken as a precedent for a future Minister 50 years or even 20 years hence? This is a long-term measure.
I was astounded when I heard Deputy MacCarthy declare that the Minister had consulted the local authorities, who were going to work this Bill and administer it, and that they had certain rights in the matter. Does not everybody know that the local authorities—to wit, the county councils, the McGraths and the MacCarthys and the others—will have as much say in the working of this legislation as any worker with a bag on his back? Does not everyone know that it is the county manager who will operate this? Does not everyone know that, if the local authority refuses to strike the necessary rate to pay for what the Minister says should be done, the body can be dissolved or the manager can strike a rate himself for that purpose and there is nothing that the local representatives can do?
I firmly believe that no matter what the expense is, if it is going to improve the health of the people we should pay it. I hold that expense should not be a reason why a Public Health Act should not go through. At the same time it is essential that we should leave the responsibility where it should be. Everyone knows—even the most insignificant person who reads the penny catechism—that the obligation is on the father and mother to bring up the children and rear them according to the law of God and sustain and support them, and that the State is not to take over the full responsibility for that.
People are not to hand over to UncleJoe Stalin or Uncle Eamon de Valera or anyone else the responsibility that devolves on the people of the country. We are to assist them and help them, and we are to make the conditions such that people can support their children and maintain them in their own homes. We have to go further and see to it that taxation is so reasonable and so correct that the people can afford to sustain themselves and their families. Everyone knows that the lowering of the standard of living is one of the greatest causes of ill-health. If we can improve housing, food, clothing and all the things we should do in the homes of Ireland, then half the hospitals will not be wanted.
Do you think the Bishops are wrong in not telling us that?
I will leave Deputy Browne with the Bishops. If I had my way, Deputy Browne would say whether he accepted the Bishops' decision or not. He has not yet told us that, but he asserts that the Government ran away from his scheme. The Deputy has not answered my question. However, I will leave Deputy Browne at that.
Did you not tell us all that on the Legal Adoption Bill?
The Deputy did not answer the question.
Deputy MacEoin should be allowed to speak without interruption.
Deputy Browne should not talk about the Hierarchy. I would be glad to hear his answer to the public question as to where he stands in the matter, whether he accepted their decision or not. He looked for the decision; he got it and he has never told us since whether he accepted it or not.
It scarcely arises on this Resolution.
I admit it does not. I should like to know from the Minister whether the Bill meets with the approval of everybody concernedby the inclusion of the contribution of £1 per annum by certain people— that that eliminates the means test or establishes a sort of contributory system. We have not been told what will be the likely revenue from that or whether it is to be paid in one sum or in four quarterly payments of 5/-.
There are many other matters I should like to discuss, but I feel that this House should not be asked to pass this Resolution until the Minister has told us just how far it meets with the requirements of the moral law. If the Minister categorically states that it does, I will accept his word because, believe it or not, I do not think he would tell a deliberate lie. We are entitled to ask what is the position. It is true that in 1945, because the question was only raised in a newspaper, the then Parliamentary Secretary could ignore it. It is true that in 1947 when the previous Bill was going through there was no public pronouncement against it. But it has now become well known publicly that the Act was condemned in a very positive way by the Hierarchy. We know that the headings of a scheme outlined by his predecessor, Deputy Dr. Browne, were condemned. Therefore, we should know now where we stand in that particular matter before this House votes any money for this Bill. On the occasion of the Second Reading, the Minister gave no indication as to what was the position and we expected that at some stage since he would have clarified the position.
Why did you not ask him on the Second Stage?
Why did you not ask him? You were outmanoeuvred.
I expected that when the Minister was moving this motion he would have told us, but he did not. He acted like a dummy on that occasion. (Interruption.) It is a great blessing that we have not to depend on Deputy Dr. Browne to loosen our tongues, because if we were guilty of breaches of confidence in publishing documents we would not be very dumb. I would be very glad if Iwould be allowed to make my speech without the help of Deputy Dr. Browne. I expected the Minister, in moving this Resolution, to say that since the Bill got a Second Reading certain things had happened, that certain points had been brought to his notice, and that he could assure the House that everything was in order. We do know that under the Bill the Minister has power to order the compulsory examination of children in schools and that he can direct the local authority to get that done. In an amendment, however, he goes further and says that the local authority may direct that an inspection shall take place and, in the next one, that it may direct that it may not take place. Therefore, the Minister, by an executive Act, by the writing of a letter, can order the local authority to do it or not to do it, just at his will and pleasure.
Does not that apply to the primary schools at present?
I am afraid the Deputy is making a Second Reading speech.
He did not make it at the right time.
I seldom address myself to problems of this type. There are other people more fitted to do that than I am. But I feel that I am entitled to express my view on the Money Resolution as to whether the House should or should not vote the money required to put something into operation which we feel has not the approval of the Irish Medical Association and of the only moral authority that I recognise and that I know every Deputy, bar two, accepts.
Name them.
The Deputy should not refer to other Deputies in this manner.
I did not refer to any Deputy, I said "bar two". Perhaps I might say "bar none". I accept the Christain philosophy.
Is Deputy Dockrell one?
Deputy Dockrell accepts it. Deputy Briscoe does not accept it.
It takes the Minister to make a remark like that.
Why would I not make a remark like that?
It is a free country. I want to make the point and if I am to stay here until to-morrew night I will make it. I will remain on my feet until I make it.
You are trying to talk it out.
The Deputy should confine himself to the Money Resolution.
If the Minister would obey the Chair I could do it. We should get from the Minister an authoritative statement.
As to what it would cost.
It is a pity Deputy Cowan was not here to help Deputy Dr. Browne. I want an authoritative statement as to whether it is accordance with the moral law.
I move to report progress.
Progress reported; Committee to sit again.
The Dáil adjourned at 10.30 p.m. until 3 p.m. on Thursday 16th April.