Dáil Éireann díospóireacht -
Thursday, 8 Jul 1954

Vol. 146 No. 10

Health Bill, 1954—Second Stage (Resumed).

Question again proposed: "That the Bill be now read a Second Time."

Mr. J. Brennan

When I moved the Adjournment last night, I was endeavouring to point out why I believed it was unnecessary and undesirable to have postponed these services which would ordinarily have come into operation on the 1st August. One of the reasons I would like to put before the Minister in that connection is that those of us who are members of local authorities are well aware of the number of requests we get from people who might ordinarily be called people in the middle income group in regard to the fees they have to pay in local and extern hospitals. I had hoped that from the 1st August we would be relieved of these requests which are coming continually from people who are being mulcted to pay fees which they are unable to pay, and of which they would be relieved if the sections applicable came into operation at the proper date. I would argue that the people can secure hospital accommodation because they have already got treatment and the treatment they have received is at least proof that there was hospital accommodation available so far as they were concerned. Now, I fear, we find ourselves in the position in which we must continue to make representations to our county managers on behalf of these people who feel unable to pay the bills they receive after receiving treatment in local and extern hospitals.

Would the Minister inform us why hospital accommodation would not be available for such people if these sections were implemented? I refer now to those people who have already received treatment which is proof that the accommodation is there and such treatment will continue—if we are to go by the Minister's references in his opening speech—indefinitely. Those of us who are members of local authorities will have again to face the anomalous situation in which we will be continually making representations on behalf of these people who are unable to pay their bills. They are mainly small farmers in rural areas and 90 per cent. of the holdings in the West of Ireland from Donegal to Kerry would fall within the middle income group and if the sections which were to be implemented on the 1st August were so implemented, we would be relieved of one long-standing problem of trying to smooth out the worries these people have when they get accounts they are unable to meet and have to face charges which are in no way commensurate with the income of these small holders. It cannot be argued that the hospitalisation is not available. The fact that they have been going to hospitals for years and continue to go is proof that it is available.

The other important fact I was anxious to expose—if one should say so—was the manner in which these people are now asked to contribute towards the cost of giving to the insurable the benefits they will receive as from the 1st August while they themselves at the same time will secure no benefit whatever under the Act which they were anticipating and to which, mark you, many people in the country were anxiously looking forward. There is no excuse the Minister can offer for neglecting to give these people the services for which they have been long waiting and to which they are entitled, which will explain to the rural communities in the congested areas, where there are so many uneconomic holdings, why they have to contribute to benefits which will be given solely to the insured section and why they are deprived of any such benefits.

Those are all the remarks I want to make on this legislation. As I said at the outset, I do not believe the excuses given by the Minister in his very lengthy introductory speech or that they were relevant to what is actually behind the introduction of this measure.

I believe it is the first step towards abandoning the Act but possibly that was the only thing the Minister found himself in a position to do, having regard to the various sections he had to placate in order to get the Bill through this House. I hope the Labour section will be as vigilant as they have promised to be to ensure that even at some future date—and perhaps the Minister will give us the date when he is replying—the benefits of the Act will be made available to the people, and that they will press for the granting of these benefits to which the rural community are so much entitled. We can certainly assure them from this side of the House that we shall give them every possible assistance in order to prompt the Minister into doing what it is his duty to do and what the public expect him to do, by implementing every section of the Act as introduced by his predecessor.

Mr. D. Larkin

I listened very carefully yesterday to the speech of the Minister in introducing the Bill now before the House when, with great detail, he explained and gave reasons to the House why in his opinion the operation of certain sections of the Health Act of 1953 should be delayed and why, in his opinion, acting on the advice tendered to him by the National Health Council and by responsible officials of his Department, and acting on inquiries which he had made himself, he felt justified in asking the House to pass the Bill now before it. I noticed that the Minister, in introducing the Bill, indicated quite clearly that he was accepting that the Act passed by the Dáil last year should, and will, operate. He stressed time and time again that what he actually wanted in this House was permission to operate that Act in a practical manner.

The discussion which followed the introduction of the Bill appears to me to have gone completely off the rails because we have not had a discussion particularly from Deputies of the Fianna Fáil group, on the basis as to whether it would be possible to operate the Health Act of 1953 on the 1st August of this year. Commencing with Deputy Dr. Ryan, the former Minister, no real attempt was made by any Deputy from Fianna Fáil to show that it would be in fact possible to operate all the services provided for under the Health Act of 1953 on August 1st, 1954.

As I understand the problem before the House, the question is not whether the health services should come into operation; it is not whether this House in 1954 will again endorse the decision given by the House which passed the Health Act of 1953, but at what stage and at what time the services to be provided under that Act should come into operation. The problem before us to-day to some extent can be narrowed down to a question of whether it would be in practice possible to provide health services for two groups specified in the Health Act of 1953, one group being those with an income of under £600 a year and the other group being farmers of up to £50 valuation.

The Bill before the House makes it quite plain that the position of the lower income group under existing legislation is protected. It also makes plain that the position of insured workers who are now covered by social welfare legislation will not be worsened. The intention to continue in operation the various Public Assistance Acts removes the difficulty involved in reaching agreement with voluntary hospitals and other bodies in relation to these particular groups because already it has been found possible to provide these services with the co-operation of all parties interested in and concerned with the health of our people. It does appear to be the case, in order to provide the services outlined in the 1953 Act for new groups, that it is essential that some agreement be reached through the voluntary hospitals with the medical specialists, chemists, nursing associations, etc., in order to ensure that groups of people or individuals within groups will not only be entitled to services but will be assured that they will receive those services.

Yesterday I was interested to hear from, I think, Deputy Kennedy of the Fianna Fáil Party that when the health legislation initiated in England by the Labour Government was introduced no agreement was reached with the medical profession. Of course that statement is not only untrue but it has got no foundation whatever, because the responsible Minister for Health at that time, Mr. Nye Bevan, made very sure that agreement was reached with the various bodies who were going to operate the Act. As a Deputy who has been a very short time in this House, listening to the case made for the present Bill and to the specious arguments submitted by various Fianna Fáil Deputies against giving the authority required, one thing struck me immediately. Does any Deputy think that you can operate a Health Bill without co-operation from the medical and nursing professions? Can we in this House, apart from those who are members of local authorities and those who sit on the boards of voluntary hospitals, believe that a patient can be treated unless there is a doctor there prepared and willing to treat him? I think it is true that when Health Acts were introduced in England there was some opposition from the medical profession, but I think one of the things required in the interests of patients is to obtain the active co-operation of the people who will look after the sick men, women and children of this nation no matter in what group they may be under this Bill.

I would be interested to hear what actual arrangements have been made, not only by Deputy Dr. Ryan and the Department of Health, but by the local authorities throughout the country to implement the Health Act of 1953 on August 1st this year. I think that question was posed yesterday and members of local authorities were invited to stand up in this Chamber and to inform Dáil Eireann whether they as members of local authorities could say with any certainty that in their particular area arrangements had been made to operate in full the Health Act of 1953 and to ensure that each and every person entitled to the benefits of that Act would be able to enjoy those benefits as and from the 2nd August, 1954. The question was posed to those of us who are members of local authorities.

I am afraid, as a member of a local authority like Deputy Briscoe, who is not here just now, I cannot say for sure that in Dublin we can operate the 1953 Health Act in full on August 1st. As far as I am aware, no agreements have been made specifically with the voluntary hospitals to ensure that persons would get the benefits. In the Dublin Corporation, we did provide some additional finance for this purpose. As was explained yesterday, aside from the sums paid out of the rates to meet the expenses of the board of assistance, etc., the product of 1/- in the £, approximately £120,000 per annum, was provided by the corporation to ensure payment for hospital treatment of certain classes in Dublin. This year that sum was increased by £50,000 and when we decided to adopt the recommendation to increase the sum by £50,000 I think we were told that no firm estimate could be made as yet as to what the cost would be.

If the services under the Health Act, 1953, were brought into operation on 1st August, 1954, it would mean very substantial changes in the administration in Dublin. The present position is that certain sections of the health services are administered by the corporation and others, such as public assistance, the administration of St. Kevin's Hospital, and various public health services are administered by the Dublin Board of Assistance. I understand that on August 1st the board of assistance, for the moment anyway, will no longer function as a health authority and that between now and August 1st the Minister will have to make regulations providing that the services given by that body should be continued by that body, either acting on its own or on behalf of the Dublin health authority.

Nevertheless I understand that there are many serious administrative difficulties to be overcome before it would be possible to operate the Act in full on 1st August. Perhaps I might examine the matter from this angle. This is the second week in July. There are not very many days to go until August 1st. There are not very many days left in which to arrive at an agreement with those whose co-operation is essential in order to operate the Health Act successfully.

As I said earlier, I was particularly interested to hear the Minister for Health state clearly that he would operate the Health Act, 1953, and would see that the service provided for under the Act would be given to the sections of our people covered by the Act. The Minister took up office on the 2nd June and from the information given to us here yesterday and to-day he will have a total period of about eight weeks in which to reach agreement with the medical profession, the voluntary hospitals, the dentists, the chemists, the opticians, etc. He would have had about eight weeks to ensure and be assured that in the various local authority areas agreement had been reached and provisions had been made to operate the Act in full.

Yet we were told yesterday of a number of local authority areas that made no provisions to operate the Act. We were told by the Minister that he had received an official communication from a responsible authority, the Dublin Corporation, saying that a series of conferences would be necessary in order to try to implement the Act. The previous Minister, Deputy Dr. Ryan, had initially from October 20th to the 1st April to make the regulations, reach agreement and make sure that the local authorities understood the problem and were doing their part. I think it would be fair to say that Deputy Dr. Ryan had a little bit longer. He knew that his Bill would go through the House, and was aware that, aside from the Party which formed the then Government, there were certain Independents and very definitely the Labour Party who were supporting the 1953 Health Bill. Therefore, I think it would be reasonable to hold that Deputy Dr. Ryan had at least a month or so even prior to October, 1953.

Minister for Health (Mr. T.F. O'Higgins)

The Second Reading debate was in February, 1953.

Mr. D. Larkin

I want to thank the Minister for the information because, naturally, being new to the House, I am not quite familiar with what happened but Deputy Dr. Ryan had a very considerable time in which to make the necessary arrangements. We were informed yesterday that even he found the 1st April was too soon, that six months and possibly nine or ten months was too soon in his particular case. He was advised, we were informed, that July 1st would be a more practicable date. He decided himself, as the responsible Minister, to fix August 1st.

Listening to the statement in the Dáil yesterday of the previous Minister for Health, I was personally very interested to hear from him what definite arrangements were made by him, as Minister for Health, by his Department and by the local authorities throughout the country under his direction. I listened and the gap grew wider. As Deputy Dr. Ryan continued his remarks, it became more evident that he was not going to give us this information. Between the 20th October, 1953, and when he left office what had Deputy Dr. Ryan actually done, how far had he succeeded in reaching agreement with the various associations, the representatives of the various bodies, medical and nursing, etc., to operate the Act? How far or to what extent had he narrowed the field of disagreement? I was surprised to learn that the apparent efforts had practically no result.

He had not reached agreement with the medical association. He had evidently not made any arrangements with the voluntary hospitals and he could not tell us how many of the local authorities were in a position to implement the Act fully. His explanation of the resolution adopted unanimously by a body appointed by him was an explanation which would not be accepted by a child starting in the first class.

We must remember that even though some members of the National Health Council were nominated by various bodies, it was the Minister who made the final appointment. Deputy Dr. Ryan suggested that these people— representing various important bodies in the life of our community—who had been accepted by him as advisers under the Health Act of 1953 would unanimously request the postponement of an Act just because a new Minister for Health walked into their room and said: Gentlemen, I think we will have this Act postponed. I suggest that, if that was the actual position, Deputy Dr. Ryan must have been most inept when he approved of the appointment of these people on the National Health Council. I am quite sure that the representatives of the trade union and Labour organisations would not accept any such suggestion from any Minister.

This National Health Council, we are informed, unanimously requested that the Health Act of 1953 should be postponed. If, as many Fianna Fáil Deputies seem to hold, there is no difficulty in operating the Act, why has the ex-Minister for Health, Deputy Dr. Ryan, not demonstrated quite clearly in this House how easy it would be to operate the Act on 1st August? In my view, Deputy Dr. Ryan failed completely to take this House into his confidence yesterday and to tell us what progress had been made before he left office and what progress he expected could be made by 1st August.

Another thing that impressed me very much yesterday during the course of the discussion on this Bill—and I noticed it again this afternoon when Deputy Brennan was speaking—was that Fianna Fáil Deputies, one after another, asked the Minister for Health if he could indicate a date on which the Health Act of 1953 would be put into operation. I think that it was Deputy McGrath from Cork who even mentioned a period of six months or 12 months. They asked the Minister for Health to indicate a date on which the provisions of the Act would be implemented in full and, if he would do so, they would be prepared to support the present Bill. The only meaning I can take out of such statements is that each Fianna Fáil Deputy who made that offer was fully aware that there are difficulties in the matter of operating the Act on the 1st August next, that they are prepared to accept that there are difficulties and that if the Minister would specify a date they would say: Yes, Minister, we realise your difficulties, and if you will state that you will operate the Act on the 1st March next or the 1st June next, or on some other date, we will agree to this Bill.

Mr. T.F. O'Higgins

It was an admission.

Mr. Gilbride

It was not made by Deputy Larkin.

Mr. D. Larkin

I am not making the Minister's case.

Mr. Moran

You are trying as hard as you can to do so.

Mr. Gilbride

You are apologising.

Mr. D. Larkin

There was an admission by every Fianna Fáil Deputy who took part in this discussion that if the Minister would specify a date on which the 1953 Health Act would be implemented in full they would withdraw their objection to this Bill. How is it that they would be prepared to accept the Minister's statement that he wants more time if they are satisfied and could show in this House that more time is not necessary? Why should Deputy Dr. Ryan or other Deputies who are members of local authorities accept a statement from the Minister that he wants more time if, in fact, they are satisfied and can show beyond yea or nay that more time is not, in fact, necessary? Although each Fianna Fáil Deputy stated in general terms that the Act should come into operation on the 1st August and that people will suffer hardship as a result of this Bill, nevertheless, each one of them was quite prepared to accept a date from the Minister on which the 1953 Health Act would be put into operation. They will accept a date from the Minister and yet they have categorically rejected his assurance that he will operate the full Act at the earliest possible date. Fianna Fáil Deputies and Labour Deputies have one or two things in common in connection——

Mr. Gilbride

You left us.

Mr. D. Larkin

I am a Labour Deputy and I am satisfied, as are the other Labour Deputies, that the Act can and should operate. The Labour Deputies in the last Dáil supported the Fianna Fáil Minister for Health and voted for the 1953 Health Act—and the Labour Party are not departing from that position. We voted with Fianna Fáil in order to put the 1953 Health Act on the Statute Book. However, we are prepared to accept the assurance that the present Minister for Health has given that he wants a little more time to operate the Act. Where Fianna Fáil and Labour agree is that we both want the Act to operate. I think that is true and fair to say about Fianna Fáil—although judging by some of the anties of their spokesmen during the past day or two it would seem as if they did not want the Act to operate so much as they were anxious for chaos to result in the matter of health services in the country and in the city.

Mr. Gilbride

The Deputy seems to forget 1948 and 1951.

Mr. D. Larkin

Nevertheless, we voted for the Act in 1953 in order to ensure that it would be put on the Statute Book. Further, we are anxious that the Act will be implemented in full at as early a date as possible. Where we differ, to some small extent, with Fianna Fáil is that we do not say to the Minister that this Act can operate on the 1st August but that we will give him six months or nine months more. Fianna Fáil say repeatedly that it can and should operate on August 1st, and at the same time they say to the Minister: "Well, we do not believe you have difficulty. We do not think that any difficulties exist, and in fact there is no reason why it should not operate, but we will give you six or nine months." Our position is somewhat different. Unless there is some evidence produced in this House that it is possible to operate the Act in full and to ensure that all the groups covered by it and all those entitled to services would obtain those services without any difficulty on August 1st we in the Labour Party, at least, believe that the Minister should be afforded a reasonable opportunity of doing what he says he is setting out to do, to implement the Act of his predecessor.

We heard, I think yesterday, that Deputy Dr. Ryan when he was Minister for Health was supposed to have been advised that the Act could be implemented on July 1st. We were informed by the Minister as to the advice tendered to him by responsible officers of his Department. I, a new Deputy, am not very conversant with the procedure in this House, and perhaps Deputy Dr. Ryan would be in a much better position to explain whether there is any basis for the advice given at two different periods; but Deputy Dr. Ryan as the Minister for Health in the previous Government had the responsibility for ensuring that the Health Act, 1953, could be implemented, but as the ex-Minister he made no real attempt to explain in this House how he had managed to fail in the period of five months to be ready to implement the Act on April 1st of this year, and yet says to the present Minister that he should be ready and everything should be ready to implement this Act in a period of eight weeks.

I was particularly interested to hear Deputy Dr. Ryan's references to the difficulties arising under the section of the Act dealing with maternity by which a woman will have the choice of doctor. He took some minutes to explain the difficulties there would be in arranging that the woman requiring the services of a doctor for purposes of maternity would have a choice of doctor, and he went on to describe in some detail the many difficulties. I think he is reported in this morning's Press as saying that if the Minister for Health resolves these difficulties and makes it possible between now and August 1st for the women covered by this section to have a choice of doctor he will have performed a miracle; yet it will be no miracle for the same Minister not only to perform that miracle but also to ensure that local authorities throughout the country had made arrangements, that agreements were reached with the voluntary hospitals and through the voluntary hospitals with the specialists and all the other associations. Listening to Deputy Dr. Ryan when he made those statements regarding women coming under, I think it is Section 16—I am not quite clear—when he outlined the difficulties facing the Minister in connection with that small sub-section, for one moment I thought that he would have then realised his position and said to the Minister: "There are difficulties here and I think it is only fair that you should get an opportunity". But having spent almost ten minutes telling us that a miracle would be required to make arrangements under one small sub-section, he then expects that the rest of the Act would be implemented.

We in the Labour Party believe and hold the firm opinion that the Health Act of 1953 can, should and will be implemented. We recognise that there are difficulties for the Minister for Health and for the local authorities, and in view of the fact that the dates in this matter of implementing this legislation had unfortunately a habit of passing by without the service being introduced, and in view of the many difficulties, we would not think ourselves fully justified in saying to the Minister that at this juncture he could say very definitely the day on which all the services should operate. But I would put it to the Minister that, if by 1st January, 1955, he had not fixed a date for the remaining sections of the Act to come into operation, he would afford the House an opportunity of hearing a full report from him and an opportunity of expressing their opinion and their position in relation to the matter.

I do not think the question which was debated at such great length yesterday, the actual number of beds available, is of such vital importance. I do not think it is necessary to have a bed available for every sick person in the country before the Act can be implemented. The question of the number of beds required could be argued back and forward for the next six months, one side holding that a certain number of beds are required and the other arguing that not quite so many would be needed. I do not think the question of not having new hospitals built overnight should deter the Minister from operating the 1953 Act within a reasonable space of time.

The Minister asks the House for an understanding of his difficulties. I am in no position to judge, and will not attempt to judge, the sincerity of any Deputy speaking here, but I personally feel that if the Minister tells us he wants a little time and a little more opportunity to deal with the problems facing him as Minister for Health, that the Bill before the House is necessary in order that he be given that time and in order that in the meantime those classes of our people who are at present entitled to hospital, specialist and other treatment will be guaranteed that service, the House should give the Minister that time. I would put that to Deputies on all sides.

Like some other Deputies, I personally am not acquainted with problems in some of the rural constituencies, but I do know that people outside the public assistance classes, people not covered by social insurance who are at present under the income limit of £600, do require, and require urgently, the assistance provided in the Health Act of 1953.

The Minister tells us it is not his intention to see that the classes of the community under this heading and farmers under £50 valuation will be covered for the present. He, in effect, tells us he is satisfied that if the Act is to come into operation on 1st August, 1954, there will be serious dislocation in the health services. It would be very easy for us on the Labour Benches to say: "We voted for this Bill in 1953. The Bill is there and it should be operated". It would not be quite so easy if on 2nd or 3rd August, 1954, somebody came to us as his representatives in this House and said: "I am entitled to hospital treatment; I am entitled by the law of this land to treatment by a specialist; but I cannot get it." We could not very well say: "Go and see Dr. Ryan—he shelved all the responsibility"; we could not say: "Go and see Deputy Briscoe", who was very fond of the Labour Party yesterday; we could not tell him to see Deputy Kennedy, who asked the Minister to name a date and said he was prepared to meet him. If he were a supporter of the Fianna Fáil Party, he could go to a Fianna Fáil Deputy, who naturally would say: "That is not my problem. There is a new Minister for Health and it is his job to see that you get the service." We in the Labour Party agree that it is the Minister's job to see that our people get the service, and I think it was fairly clearly stated yesterday that as a Party we intend to do everything possible to see that the services are given.

The Minister surveyed the position at some length yesterday and told us he intended to operate the 1953 Act and to see that the services provided under that Act were made available. He told us that he intended to operate the Act as soon as possible and I am prepared to accept his statement. The Minister is entitled to an opportunity to demonstrate to this House whether he was sincere in his statement yesterday. As I said earlier, many Fianna Fáil Deputies appeared, in their closing remarks, to hold the opinion, at least to some extent, that he was entitled to get that opportunity, because of their repetition of the statement that if the Minister would name a date they would withdraw their objection. As Deputy Dr. Ryan, in months, was not evidently able to name a date on which the Act would fully operate, it is my view that the Minister would be entitled to some small leeway.

However, if, even at this juncture, it can be shown in this House that the services provided for fully under the 1953 Act can be implemented in full for all sections of the people covered by that Act, then I, like other members of the Labour Party, will have to consider my position. I welcome an effort to show by evidence in this House that the Act of 1953 can be operated in full and that the services can be provided in full to all classes referred to in that Act.

Up to the present we have had only a clear statement from the Minister in the matter and a statement from members connected with some two or three rural constituencies that in their particular area it would be possible to operate it. I myself have got no evidence that the Act could be operated in full in the City of Dublin on 1st August. There are not very many Deputies in this House who are also members of a local authority, and I would be interested to hear whether there is such evidence, that I have not got, that in Dublin the Act could be implemented in full on 1st August. In the absence of such evidence, and in view of the fact that the Minister has requested a little time to operate the Act in full, I feel the opportunity should be given to him.

Mr. Traynor

Deputy Denis Larkin must have deemed it incumbent on him to make that long, wearying apologia which he has made on behalf of the Labour Party in regard to the attitude which they are adopting in respect of this Bill.

Mr. T.F. O'Higgins

Is that an indication that the Deputy will not be too long?

Mr. Traynor

The Minister will have to learn to behave himself as a Minister. He is in his initial stages in that office.

Mr. T.F. O'Higgins

I think I was always able to keep the Deputy in order, and still will do it.

Mr. Traynor

Deputy James Larkin made a similar case last evening, and we on this side of the House can only assume that it is the preparation of the alibi which the Labour Party is now building up to present to the people as their reasons for taking the extraordinary and amazing action which they are taking in regard to this measure. I fail to understand it myself. I thought that the Labour Party, coming in here at this stage of the Government's career, would have done what Deputy Denis Larkin stated they would do in a full-blooded fighting speech which he made at the conclusion of the declaration of the poll in North-East Dublin. Deputy Denis Larkin, on that occasion thumping the bench in front of him, declared to those people who were listening to him that the Labour Party would see that the Government that would be elected would carry out the wishes of the Labour Party.

If that speech that Deputy Denis Larkin has just completed was made from the benches behind the Minister I could understand it. I could understand thoroughly that speech coming from the Fine Gael Benches, but I fail to understand it coming from the Labour Benches which supported Deputy Dr. Ryan as Minister for Health in the bringing in of the Health Bill of 1953, when they voted solidly with the Fianna Fáil Party.

Mr. O'Leary

I did not.

Mr. Traynor

That is all right. We will take it you were against the Bill even then?

Mr. O'Leary

I did not vote on that occasion.

Mr. Traynor

Were you against the Bill? The Deputy has made a confession here which shows that some division existed even then between the members of the Labour Party in regard to the Bill. It is an important confession. The Deputy claims he did not vote for the Health Bill. His leader voted for it as did all the other members of his Party. They voted for it for no other reason than that they believed in it and believed it would be of tremendous benefit to the people whom they were representing. Deputy Denis Larkin in the course of his speech said he did not want to judge the sincerity of any Deputy speaking on this measure. I can only recommend to him to read his speech and see the manner in which he dealt with the speech made by Deputy Dr. Ryan. When Deputy Ryan made a straightforward statement giving facts and figures about the action he had taken to implement the Act on a particular date, he threw all sorts of aspersions on those statements. Then he talks about not wanting to judge the sincerity of Deputies' statements here.

I cannot understand the Labour attitude. They have only to read their speeches when they were giving Fianna Fáil their support on the Health Act. I fail to understand their sudden change of attitude in regard to putting the Act into operation at the earliest possible date. I do not know what Deputy Larkin's point was when he was talking about various Deputies on this side being prepared to accept certain extensions of the date. Whether it is going to be an offence or not in the eyes of Deputy Larkin, I am going to subscribe to that statement also. I am supporting the statement which Deputy Dr. Ryan made at the conclusion of his speech, when he asked the Minister to name a date when he would be prepared to operate the Act. I am making that plea now to the Minister for Health to name a date. I can say also with Deputy Dr. Ryan that this Party is prepared to go as far as is humanly possible with the Minister if he thinks there is any difficulty with respect to 1st August: I am not going to make any suggestions as to what the date should be. He has given us ample reasons why he thinks he cannot operate the Act on 1st August. Let him give some other date, let it be the end of the year or still further afield and we will see what we will do on that point—but let him give us a date.

This seems to me to be suspiciously like the attitude Mr. Asquith took on one famous occasion in respect to the Home Rule Bill which was going through the English Houses of Parliament, when he put it on the Statute Book. Is that what we are doing on this occasion? Are we putting the Health Act on the Statute Book?

Mr. O'Leary

He said: "Wait and see".

Mr. Traynor

That is what you did. You never voted for the Health Act. You said you would not vote for it in any circumstances. You ought to forget it. Go down to Wexford and tell the people there you voted against it.

Mr. O'Leary

I voted against Fianna Fáil.

Mr. Traynor

Deputy Denis Larkin was not in the House and therefore may not be fully aware that the Labour Party on that occasion wholeheartedly and enthusiastically supported Fianna Fáil against Fine Gael on the Health Bill of 1953. He may not be aware of that, so I am giving him that information now for what it is worth.

Mr. D. Larkin

Thank you very much.

Mr. Traynor

Does Deputy Denis Larkin think that because this Act would have come into force on 1st August or because of the passage of the Act, the incidence of disease is going to increase to such an extent that the hospitals will not be able to deal with it? That is what he said in his apology to the House for his action on behalf of the Labour Party. The fact is that the Act would come into operation then were it not for the action which the Minister has been compelled to take by reason of the pressure that has been brought to bear on him. Does any Deputy suggest that because it would come into operation on 1st August the incidence of disease would suddenly go up to such an extent that the hospitals would be crowded out and the people would be lying on the roadsides, being operated on in fields, or that it would be impossible to deal with the situation that would arise? Surely that is a foolish belief, but that is what we are being told.

Mr. Coogan

Are they not crowded already?

Mr. Traynor

The suggestion is being made here that the hospitals would not be able to deal with the situation which would be likely to arise if the Act came into operation on 1st August.

Mr. Coogan

They are not able to deal with it at the moment.

Mr. Traynor

It is a foolish statement and would not be made by anyone who gave the matter any consideration. Deputy Dr. Ryan made it very clear that he had made all the necessary arrangements that he deemed it desirable to make.

Mr. O'Leary

He made them, but the doctors did not.

Mr. Traynor

The Minister, in the course of his speech—which was a very fine speech—marshalled his facts in a manner in which no other Minister of the present Government would have been able to marshal them. He made the best possible case out of the material with which he was presented. Even then, I am pretty satisfied that he was making misstatements to bolster up his case. For instance, he said there was not a single bed added to the beds which had been operated over the past period of time. Deputy Dr. Ryan made it clear that that was not so, that 60 or 80 beds had been made available or were about to be made available in the very near future. I think it is an abuse of parliamentary procedure to make statements of that kind which are known to be, if not utterly untrue, at least to be devoid of full facts. It does not add to the stature of the person who deals with the case in that way.

Everybody knows what Fianna Fáil has done in the course of its parliamentary career. They know the number of hospitals that have been built since Fianna Fáil came to office in 1932. I could not exactly tell the number of hospitals, but any Deputy who moves through the country can see scattered in every county in Ireland magnificent institutions which are monuments to the industry of the Fianna Fáil Government and the Fianna Fáil Party.

Mr. Coogan

Not in Galway, though.

Mr. Traynor

Now, I am making a fair statement.

Mr. Coogan

They are lying in the corridors.

An Leas-Cheann Comhairle

Would the House allow Deputy Traynor, who is in possession, to make his speech without interruption? Deputies will be allowed every facility later.

Mr. Traynor

May I remind Deputy Coogan that if they are lying in the corridors of the hospitals, those corridors were put there by the Fianna Fáil Party?

Mr. Coogan

They were not. I know what I am talking about.

Mr. Traynor

I am talking about the industry of the Fianna Fáil Government which caused those corridors to exist to-day.

Mr. Coogan

They existed since the time of the poor law guardians.

Mr. Traynor

If there is not sufficient accommodation in that particular hospital it is due to the increased incidence of disease. I must have respect for the members of the medical profession who make statements, and Deputy Dr. Ryan made it very clear that in every city in every country in the world where hospitals exist the facilities provided are usually taxed to the utmost. I think that is perfectly true and I think that the hospitals here when they are available will be utilised by the people for whom they have been provided to the fullest possible extent. If Deputy D. Larkin reads over his speech, and I am sure he will, he will be interested to discover the number of times he mentioned the Fianna Fáil Party. I suggest the Deputy should not allow it to get under his skin because he might contract "Fianna Fáilitis" and then he might be looking for hospital treatment.

Mr. A. Barry

I am glad the Deputy thinks it is a disease anyway.

Mr. Coogan

He will not get the needling that the Deputy got.

Mr. D. Larkin

Is it infectious or contagious?

Mr. Traynor

Because the Minister was absent when I made the remark, let me repeat that I am supporting the plea made by Deputy Dr. Ryan at the conclusion of his speech when he appealed to the Minister to give the House a date. Do not leave us in the dark. There must be some good reason for the Minister's anxiety not to implement the Act on the 1st August next. He has given us certain reasons but I do not accept them in full. I want to be candid about that.

Mr. D. Larkin

Watch the date now.

Mr. Traynor

I am prepared to believe that, coming in as he has done only quite recently and being confronted with this very complicated measure and with the likelihood of having the responsibility for meeting many of the contingencies which will arise, he may desire to have extra time. All we are asking him to do now is to name the date. If the Minister cannot implement the Act on 1st August, there is always the end of the year; if he finds that some time around that period would suit him better, then let us have a date. As the former Minister for Health said, if the date is suitable, we will be quite prepared to give our support to the measure which the Minister has before the House at the moment.

Mr. A. Barry

It is quite obvious that the irritation underlying some of the speeches on the Opposition Benches is due to a realisation of the fact that Deputy Dr. Ryan's plan would not work. The dating of the coming into operation of this Act was, so to speak, due to a desire to create difficulties for a new Administration. There are, of course, many points of view on this side of the House and, I think, on the other side of the House in relation to this Act. We, in Fine Gael, will not be bludgeoned by the Opposition here or in the columns of the Irish Press.

I am prepared to take the advice of the Minister that this Act cannot operate on 1st August. I am prepared to take the advice of the Health Council that it cannot operate on 1st August. I am prepared to take the opinion of many Deputies who serve on local bodies, and with whom I have discussed this matter, that the Act cannot operate on 1st August.

All of us in Fine Gael do not like this Act, but we will work it. It could have been implemented on 1st August had a more efficient Minister than the present Minister's predecessor been in charge. That is my opinion. He had a year in which to do what he wants the present Minister to do in a few weeks. He did not do what he should have done and what must be done before the Act can be implemented. Now that a more energetic Minister is in charge I am confident that the Act will operate in practice and not merely in theory sooner than it would have operated had there never been a change of Government.

Mr. Beegan

I do not inflict myself very often on this House and I would not do so on this occasion were it not for the serious position with which we have been confronted in the submission of this Health Bill, 1954, which seeks to postpone—I believe not merely to postpone but to abandon altogether— the very vital services provided under the 1953 Health Act.

The Minister came in here yesterday and, in his pretended innocence, submitted this harmless document; at the same time he made it quite clear of course that it was a very necessary document. He went to great lengths to explain to us the provisions of the 1939 Public Assistance Act which I believe a great many Deputies on both sides of this House considered at the time to be a very useful piece of social legislation. He went on to describe the categories that come within the scope of that Act. He mentioned, No. 1, those people who are unable to fend for themselves and who are by their work and endeavours unable to provide themselves with the necessary medical treatment and hospital services. He mentioned, of course, that they were being taken over into the 1954 Act on 1st August next.

I would like to remind the House that there is something bigger in all this than is apparent from the Minister's speech, something which will have much more serious repercussions than the postponement of the sections mentioned. The 1939 Public Assistance Act set out certain rules and classified certain types of persons, but that Act was very, very liberally interpreted. It was very, very liberally applied and thousands and thousands of people benefited who, had it been administered and implemented in the strict terms of the Act itself and of the regulations, would never have benefited at all.

The people who are unable to provide for themselves were, of course, catered for by that Act. But there were a number of other people, including the small farmer community, who were provided for under the Act at that time. When the Act became law we had the boards of health, which were abolished when the managerial system came into operation in 1942. With the boards of health we had the committees of public assistance; we had hospitals and dispensary committees and they, in turn, appointed what were known as wardens. The wardens generally were clergymen of all denominations, representatives of the county councils and other persons of repute throughout the local authority health area. They were given three tickets. One was a red ticket whereby the warden requisitioned the local medical officer to attend a patient in his own home; the second was a black ticket, if you like, whereby the local medical officer was requisitioned by a warden to give dispensary treatment, and the third ticket was for the local district nurse. If the doctor or the nurse found that they were unable to provide the necessary treatment for the patient either at the dispensary or in his own home, that was the passport to the local hospital to which the patients went free of charge.

In the County Galway we have something like 28,000 holdings, and of these approximately 24,000 are under £20 valuation. Nearly all the people living on these holdings were given the benefit of that Act and got free treatment if they asked for it by going to one of the wardens. That was never questioned by the doctors or nurses or by the county manager. I wonder is that going to be the position now? I believe that now, as a result of all this discussion, the people to whom the 1939 Public Assistance Act was applied, and applied perhaps generously—if you like, exceeding, maybe, the limits of the Act—are going to be in a very different position.

The county manager, in view of what was mentioned here by the Minister yesterday about the impact on the local rates, is going to become very searching in his inquiries, so that the recommendation of a warden, whether he be a clergyman, a county councillor or any other person, will very likely be scrutinised carefully by the local home assistance officer who in turn, of course, is subject to a superior, the home assistance superintendent. While the home assistance officers are, in the main, very humane and charitable people, they have a job to mind and are going to mind it. They will be careful in submitting reports. They will ensure that the report is not going to be a very lenient one, that it will not err on the side of leniency any more than do the reports of excise officers or other officers under the Revenue Commissioners.

I believe that is the position that we are going to be faced with in County Galway, and that thousands of people in that county who, previously, were free patients will now be made pay. Then we have, of course, various other people who went into hospital and were regarded as paying patients. Some of them perhaps were too proud to say that they were unable to pay. They wanted to conceal that, but when they were presented with the bill from the hospital they went to their local county councillor, irrespective of his political affiliations, and asked him to write for them and try to have the bill either remitted in full or reduced. In nearly all cases the county councillors recommended the county manager to accept what they believed those people were capable of paying, and, generally, he accepted the recommendation without question. I doubt if that is going to be the way in future. The people I have mentioned are people who, if this Act were put into operation on the 1st August, would no longer have to suffer the degradation and humiliation of having to go to any county councillor to ask to get a bill or payment demand wiped out. The position now will be that the county manager will be very careful to ensure that they will pay at least £2 2s. a week and I believe a good deal more.

There are very many such people in this country, although of course the white-collar workers think differently. There are very many farmers of £20 valuation and of £50 valuation who, if they have to pay even £2 2s. a week over a protracted period of time, will have to mortgage their families' future. That is a really serious position. It is all very well to talk about the facilities not being there and all the rest of it, but there is no mention at all of the continued hardship that will be imposed on these people by reason of the postponement in putting into operation the particular sections in question.

Numerous people allow themselves to become physical wrecks because of the colossal bills which they believe they would be confronted with either from a hospital or a specialist if they went to seek medical treatment. Not only do they become physical wrecks but many of them become mental wrecks and finish up in mental institutions. These are things which have not been mentioned here by people who should have a better understanding of the whole position. Those, however, who have served as members of local authorities or on hospital committees should understand that position.

For many years I have been longing for the day to come when I would see legislation such as that of the Health Act of 1953 passed through this House. It is all very well to talk about lack of accommodation in the hospitals. What accommodation have four-fifths of our farming community or our rural tradesmen and craftsmen for a patient that is in need of nursing and medical attention? Perhaps they have a room and a bed for the patient, but have they a separate room for the nurse supposing the patient needs attention at home? As far as hospitals are concerned, we have set a very high standard in this country. On the advice of medical men, architects, and so on, we are building what might be termed luxury institutions. Far less should provide adequate service for our people, certainly much better service than they can get in their own homes. There is more accommodation now than there was ever before and, if we have to wait for all that accommodation that we have heard so much talk about, then the Health Act, 1953, can be written off and written off for ever.

I heard Deputy James Larkin speaking here yesterday evening and I was rather surprised at his line of reasoning. I happened to be in the House when the Financial Resolution to implement the Health Act was being discussed. Every Deputy, of course, on that occasion had the right and the privilege to express his views in a general way on the Health Bill, 1953. If I remember rightly, Deputy Larkin then said that he and his Party were supporting it but that it was far from their expectations and far from their conception of what a Health Bill should be, that in fact it was a Health Bill in an emasculated form. He supported it in that skeleton form, but he did not ask any questions of the Minister as to when the various provisions were to be put into operation. He took it for granted, I expect, that it could be put into operation at whatever time the Minister might decide. But, if we had a Health Bill to meet what he and the members of his Party conceived to be the proper type of Health Bill, I wonder when would we have the facilities available to meet the provisions of that type of Bill.

Since I came into this House, I have never had the experience of such a political somersault as that of Deputy James Larkin yesterday evening and his brother to-day in the attitude that they have taken up. They all say that the Minister says that the framework of the Health Bill is not being interfered with. The ex-Minister for Health, Deputy Dr. Ryan, asked for a time limit—could the Minister name a time limit—could he tentatively say that by postponing it now beyond the 1st August, as far as he could possibly go, he would endeavour to bring it in at a date either three months or six months hence? The Minister has been very careful not to give any definite date or even any approximate or tentative date. We had the experience of Deputy Dr. Esmonde getting up in this House yesterday evening. What did he say? He did not say that the 1953 Act would ever be implemented. Quite the contrary. He said that it never could be implemented and that what the people of Dublin and this country expected was a Health Act that could be implemented. Why not give us the gist of that improved health measure that can be implemented?

Deputy Denis Larkin said here to-day that we need co-operation from the medical profession, the nurses and all the rest of it. Of course, to do anything of any use at all in this country you need the co-operation of somebody or some section of the community. We needed the co-operation of the farmers in the years of emergency to feed the people, particularly the people of the City of Dublin. The farmers are an important section and they did not hold the people of this country up to ransom. I do not believe that the medical profession either would follow such a line. They are quite entitled, of course, to make their case, to insist on getting the best provisions possible for their particular profession and to safeguard their profession. They carried out the 1939 Public Assistance Act and they helped to carry it out on a much more extended basis than was the written law of this country. They did that in many instances. I believe they would do it on this occasion also.

Do not we know very well, whatever Deputy Denis Larkin has said, that there was great resentment by the medical profession in England to the health service scheme that was introduced by a Labour Government there? The Labour Government went on with it. We know very well that the resentment to the health service scheme in Britain was to a large extent inspired by the Tory Opposition but the Labour Government went on with it and the Tory Government, that has replaced them, has not had the hardihood that Fine Gael have to repeal it in any of its phases; they are continuing it.

I believe that this Bill will have very, very serious consequences. It will create great disappointment for thousands of people all over this country who believed that they would be entitled to these services from 1st August. They can see no justification, and neither can I, for postponing them. I believe the accommodation and the facilities exist if we just had the will to go on with it. Is not it quite obvious to every Deputy who was here during the deliberations and discussions on the Health Bill, 1953, that Fine Gael obstructed it all the way through? They talk about the length of time that Deputy Dr. Ryan had from 20th October to the time when he made the Order and that he had provided no facilities. Deputy Dr. Ryan could perhaps be criticised and castigated for any omission or any lack of duty as a Minister if he had got what in my opinion he should have got, the co-operation of the Fine Gael Party when the Health Bill, 1953 was being put through this House. He did not get that. On every conceivable occasion and every time it came up they fought every line of it and every comma of it. I heard the present Taoiseach, then Deputy J.A. Costello, speaking in this House on one occasion and one of the things he complained about was this £600 ceiling. He said that that meant the household income. He mentioned the bus driver in Crumlin with his £10 a week and his unmarried son living in the house with him with £5 a week. He said that he was outside the provisions of the Bill, but, he said, of course, the farmer up to £50 valuation with his Chrysler car can come to the dispensary and avail of this free medical service.

That is the mentality behind this Bill. That is the mentality of the Fine Gael Party. I do not mind Fine Gael having that mentality, being as conservative as all that. What I do mind is the Labour Party who professed to be progressive but are not.

The Minister said yesterday that 450,000 insurable people came within the provisions of the 1939 Public Assistance Act.

Mr. T.F. O'Higgins

I said no such thing.

Mr. Beegan

You mentioned 450,000.

Mr. T.F. O'Higgins

I think the Deputy misunderstood. I said 450,000 of the population were under the Public Assistance Acts.

Mr. Beegan

You said one-third of the population in rural Ireland and one half of the population in Dublin City.

Mr. T.F. O'Higgins

Is the Deputy interested in what I said?

Mr. Beegan

You also said there were 450,000 insurable people.

Mr. T.F. O'Higgins

That is right.

Mr. Beegan

Deputy Dr. Ryan said that 450,000 was not the total number—that there were actually 750,000. If only those 750,000 people would vote Labour what a change there would be in the alignment of this House! They would certainly have an over-all majority to put their comprehensive social welfare and comprehensible health Bills into operation. Of course they do not get one-sixth of the labour people to vote for them in any election so that they cannot claim to speak for the labour people of this country at all. Certainly, as far as I know, they are not going out of their way to represent the labour people as they might be represented, but that is their responsibility.

I saw here in Dublin during the election, when I happened to come here on one or two occasions, posters on the hoardings and what was the slogan?—"Put out this Government and control the next." I am sure that appealed very much to the people in Crumlin and Ballyfermot and various other areas, but I wonder is Labour controlling "the next". I am sure that was a vote-catching slogan. I believe there are sensible men in the Labour Party who even though they put up slogans like that, if they did get control of this Government or any Government, would work on reasonable lines and I think there is nothing unreasonable in insisting that the Health Act, 1953, would come into operation on August 1st. If that could not be done they certainly should insist here and now instead of threatening to ask questions later on that a date be mentioned. They should insist also—and I do not think it would cost a great deal extra nor would it save the local rates or the Exchequer very much—that the provision for the families of insured workers to get benefits under the 1953 Health Act would be implemented and that it would not be confined altogether to the insured persons. That is another snag in all this business. I do not want to hold up the House but in my county this is going to have a very serious effect. It is going to create considerable hardship that did not exist there for a number of years. I believe that the county manager will insist on a strict enforcement to the last letter of the law of the true description of what a public assistance person should be. I believe that he will also insist in the case of hospital bills which we did not wipe out fully, except in very extreme cases where the circumstances were most compelling, on the people paying a much greater portion of their hospital bills than they were called on to pay previously.

Mr. M.P. Murphy

We will clip his wings for him so.

Mr. Beegan

We heard a lot of that kind of thing before. When there were Labour representatives in Galway I found them more often in conference with the county manager there trying to get on the soft side of him than any other party in the corporation.

An Leas-Cheann Comhairle

Will the Deputy now come to the Bill?

Mr. Beegan

I scarcely ever interrupt and that is what riles me when I am interrupted.

Mr. M.P. Murphy

You are making a very serious statement about the Galway County Manager.

Mr. Beegan

I am only giving that as an illustration to show that the Galway County Manager is just as humane a man as any other county manager in Ireland and that he is competent to carry out his duties as efficiently as any other county manager. That can be seen in the result of the work that has been carried out all over Galway, whether in connection with hospitals, roads or anything else. I think as a county it compares very favourably with any other county.

Let there be no doubt about it—this is the most reactionary Bill ever introduced into this House since the 1/- was taken off the old age pensioners. I would be prepared to hold the Government here unless the Minister is prepared to fix a time, even tentatively, for the implementation of the Act. I will keep them here until next October rather than give them this Bill because I realise it is of such importance to the people of the country.

Mr. M.P. Murphy

Why did you not implement the Act on the 1st April when the former Minister said it could be done?

An Leas-Cheann Comhairle

Order! Deputy Beegan is in possession.

Mr. Beegan

I have expressed my opinions. I believe that this Act will never be implemented and that there is no intention whatsoever of implementing or bringing it into operation and that the cat was let out of the bag by Deputy Dr. Esmonde yesterday and not by the Minister. The Minister was very careful because he is an intelligent lawyer and well able to frame his phrases so that one cannot catch him out very easily. I think another Deputy—Deputy Traynor—said that the Minister had made a very fine case for his line of action out of very bad material. I put it to the Government that if necessary we will make them sit there until next October before allowing this Bill to be passed, unless they give an assurance that the Act will be implemented at a date in the not far distant future.

Mr. Finlay

I am prompted to intervene briefly in this debate because there appeared to me, in the speeches of Deputies opposite, to have been three very disturbing features, disturbing that is to any Deputy concerned with the question of the health of the people. The first of these was the attack, direct and indirect, which was levelled by Deputies opposite, led by Deputy Dr. Ryan, on the Health Council. The Minister in presenting the Bill to the House mentioned the desirability, indeed, the necessity of removing health outside the controversy of party politics.

Deputy Dr. Ryan, in speaking on behalf of Deputies opposite, at first appeared to subscribe to that general principle but it is not sufficient to subscribe to that general principle unless Deputies opposite are willing to do something to put the principle into practice as well. It seems to me that the setting up of the National Health Council under the 1947 Act and the confirming of that decision under the 1953 Act, was a step, though a small step, in the direction of removing the subject of health and health legislation some distance from the controversies of party politics. If that is so, then the action of Deputies opposite, led by Deputy Dr. Ryan yesterday, in levelling a dangerous attack, an attack likely to cause a great lack of confidence in that council, is a very retrograde step indeed, if we are to move towards a position where we can discuss the question of health apart from politics.

Deputy Dr. Ryan said that he must infer from the terms of the resolution, which was quoted by the Minister in his speech, that some member of the council came into the meeting at which that was passed with the resolution in his pocket. He further suggested that the other members of the council present were either brow-beaten or cajoled by the Minister into passing the resolution that had arrived in the pocket of one of the members. I can conceive of no more damaging suggestion in the case of an independent council than that.

It might be no harm to remember for a second the purpose and the personnel of the National Health Council. It was created under those Acts to be an advisory body to the Minister. It was created specifically, and I think it is only right to say carefully, from groups likely to be interested in health legislation. To suggest that such a council, whose advice should be listened to by the Minister and given full weight by any Minister, could in any circumstances become overnight the pawn of the Minister or of any Party seems to me to constitute a very retrograde step, if we are to remove the question of health legislation away from the controversies of party politics. I can understand, and I think everyone can understand, the embarrassment of Deputy Dr. Ryan at what the National Health Council suggested, but that embarrassment and the special situation in which they found themselves do not justify the attack which was levelled against them.

There was one other very disturbing idea introduced into this debate by Deputies opposite. That was, in the words of one of the Deputies who spoke, that it would be well to implement the provisions of the Health Act, the operation of which it is proposed to postpone, so that we could thereby create a sense and an impression of urgency on the health authorities throughout the country who were called on to meet the requirements and provide facilities under this Act. That idea requires a little examination. What are its implications? The first is that the implementation of the Health Act on the 1st August, 1954, is going to create some situation of urgency and panic amongst health authorities.

If a sense or an impression of urgency such as Deputies opposite suggested might be produced by the implementation of the Act is to be created such a situation can only be brought about by creating a series of minor crises at the various places where the health authorities would be expected to operate these services. That would suggest that Deputies opposite accept in principle the fact that the implementation of this Act on the 1st August would be likely to create a situation of abnormality amongst the health authorities of the country. That is the first implication of that suggestion.

The second implication is even more serious, more irresponsible. It seems to me to be that, by having a larger queue outside dispensaries, by having greater crises with regard to the bedding of hospital patients and by creating more overloading of existing health services, you may have a position in which you will drive local health authorities into providing these facilities with greater speed. We believe, and I think many members of the House believe, that no local health authority requires any such emergency in order to realise the necessity and the desirability of increased facilities for health services. It is possible to conceive a situation where in industrial or other relations, the creation of a situation of crisis or near-crisis, the creation of the situation of a greater demand than supply, by direct Government action would be justified, but I fail to see how any Deputy in this House could possibly, having considered the matter, subscribe to the suggestion that a demand of sick people for attention should be created in excess of the supply in the particular service, in an attempt to create a sense of emergency, to impress a health authority or any other person.

Thirdly, I should like to refer to the attitude which has been adopted firstly by Deputy Dr. Ryan and secondly by many Deputies opposite—though not all of them, to be fair—with regard to the question of an agreement with the dental, nursing and medical professions and other groups concerned in the actual working of the health scheme. There seems to be an assertion, particularly by Deputy Dr. Ryan, that agreement with these bodies or with some of them is an impossibility and that, anyway, it is a completely unnecessary factor in the administration of any health scheme. Furthermore, there seems to be a sort of inverted pride in the fact that Deputies opposite are not interested or concerned in any question of agreement with these groups. It seems to me that in passing a Bill of this description we should consider what the Act of 1953 and the health services really mean.

Reduced down to its bare essentials, it must be clear that for the people of this country or any other country, and particularly for those groups or sections unable to provide for themselves, the essence of a good health service is attention by competent interested persons and the provision of proper facilities. It does not matter whether the service is being provided by a doctor, a dentist or a nurse, in a hospital or at home. The essence of it is the interest of the person attending the patient and the confidence of the patient. It seems to me that unless, before these health services are instituted, a genuine and bona fide attempt is made, and successfully made, to ensure that the attitude of the groups who will be carrying them out has not been unnecessarily prejudiced, that they have not been made unnecessarily hostile and that their interest in the schemes is aroused, no matter what facilities are available, no matter what instruments, buildings or beds are available, the health services will not be as successful as we should want them to be.

We have had in this debate a clear, careful and factual presentation of the difficulties which arise for the Minister. I have dealt with what have been three of the main points in the case put forward by Deputies opposite. It is regrettable to have to state that the attitude of Deputies opposite, as indicated by these three points, reveals a striking sense of irresponsibility in regard to these services.

Mr. MacCarthy

Ever since I directed my special interest and attention from the activities of the fields and the open spaces to the affairs of public authorities, nothing has affected me more than the problems of health with which I and my associates on the public bodies had to deal, because very few homes in this country escape ailments of various kinds and the problems that they present both economically and financially to the fathers and mothers of families. When it was proposed to put on the Statute Book a Health Act which would help in some way to provide for the needs of the people in this regard, all sections of the House could not be but interested in its provisions. Even the Fine Gael Party, who did not at the start show any special interest and let the Second Stage through without comment or a division, at a later stage, instead of providing amendments or alternatives wherever they saw defects in the measure attacked every line and comma of it and the principle enshrined in it and made every attempt they could to sabotage the whole scheme.

It is not surprising, therefore, to find this Bill coming before the House more or less to put the Health Act aside indefinitely, perhaps for all time. But it did surprise me to find certain members, at any rate, of the Labour Party associating themselves with that attitude and giving as their reason that the Act could not be implemented because its full effects could not be made effective right away. If that were the attitude of the public authorities or of this House in dealing with T.B., then, I fear, as has been said by other Deputies, that instead of the success already reported in regard to the working of that scheme, there would have been an entirely different tale for this House. I remember when the scheme to deal with T.B. was brought in and carried out by the sanatoria committees throughout the country there were very few sanatoria to accommodate those stricken with that disease. There were waiting lists in certain counties of 120 or 130 people, but that did not prevent the implementation of the scheme and the giving, as far as possible, to a limited number the attention they deserved. T.B. is a far more dreaded disease than many of those with which we are dealing under the Health Act because the health of those who are awaiting institutional treatment is not only endangered by the delay but there is a danger of infection in the family. Because we could not implement that scheme in full and give institutional treatment to everybody affected, that was never given as a reason why we could not implement it.

The treatment of disease is linked up with housing in a very special way. Is it contended by any member of the Labour Party that if there are 8,000 or 10,000 people looking for houses in Dublin and 3,000 or 4,000 in Cork we should not start on any scheme because we cannot accommodate all the people at once, or if we had 20 or 30 or 40 houses ready for occupation that we should not put tenants in them even though we cannot accommodate all the others whose needs are just as great or nearly as great? That kind of argument for not doing a thing will not help, because every measure brought in here to deal with social problems has to start in some way and work up by degrees according as the facilities and the institutions needed grow as the years go by.

It is no answer to the people who require attention to say: "Because we cannot treat you all right away, we will not do the thing at all." That is a very futile answer. Surely the Labour people when supporting us in this House through the whole of the very contentious discussions that arose when the health measure was being debated, are not now going to say that they were pursuing a phantom. Not only did they want that health measure, but they said it did not go far enough. If they think they cannot implement that health measure now, how are they going to implement the wider measure which they were seeking by amendments which they wanted incorporated in the Bill at the time? Is it not just fantastic that people should use the argument that because it cannot be implemented in full then we must wait and let the days drag on and the people suffer, and let the Government and public authorities do nothing to help them in their distress? Surely that is no attitude for this House or any responsible group in this House to take.

We all know that the treatment of disease in the first place, as Deputy Beegan said, is a matter for the home. In my younger days, except for very serious ailments or where operations were necessary, it was considered a reflection if a sick person had to leave the home and go to hospital unless there was nobody in the house to nurse the patient or no accommodation for a nurse to stay and care for the patient. At that time, hospitalisation was just for the most serious cases. But times are changing, and more people go to hospitals and more people are advised by the doctors to go to hospital, because the limited number of doctors who have access to hospitals and institutions are able to see more people in an hour in a hospital than they would in a day if they had to go to their homes. It is as much a matter of convenience for the doctors themselves as for the health of the people whom they consider that the system is growing up in that way.

If we could have decent homes with good accommodation much of the nursing could be done in the homes in the congenial atmosphere of the family. That is a fact. The doctors used to go round to the homes with, as it used to be called, their best bedside manner to give encouragement to the people unlike nowadays when they put their hand on the end of the bed and ask how the patient is and look for a chart. There was a different approach then. Things were not then systematised as they are now and not always in the best public interest.

We often hear talk about emigration and the leakage of the best blood of the nation. As I said at the outset, if one examines the annual reports of the medical officers in the various councils and corporations one can see, as I saw when I first entered public life, that out of every 100 live births nine or ten never saw their first year. That did not even take into account the mishaps, the miscarriages and other misfortunes which afflict people in these times.

Captain Giles

Did they miss much?

Mr. MacCarthy

I will leave Deputy Giles to judge that matter himself and consider the distress of a family which lost a child. I am sure he will agree with me that, even though we may look at the matter broadly as one of facts and figures, it affected every home seriously and brought sorrow and distress to all its members. That appalling figure has now been brought down to four or five. Indeed, it has been reduced to half and less than half —a tribute, no doubt, to what has been done. It is not hospitalisation that did it all but treatment in the homes. These little children in great measure are not brought to hospital. They are treated in their homes and attended to by their parents. They get whatever medicines or inoculations the doctors say they need and their lives are saved for the nation.

There is no case at all to my mind for postponing the operation of this Act. Doctors can treat patients in their own homes. Domiciliary treatment has to be given to many suffering from T.B. until there is room in the institutions for them. The same will apply here. The doctors will treat the more serious cases first and the others will await their turn just the same as had to be done for the sanatorium. I hope the Minister will not put the Act on the long finger. He is accepting it. I can understand his attitude. I can understand the attitude of the Fine Gael Party who opposed the Act right along.

It is said that the previous Minister did nothing about the matter, but when he found that there were no amendments put down in this House, what did he do? He went down the country and met the county councillors and the various public bodies and asked them what suggestions they had to make. He did that when he could not get the co-operation which one would expect from an Opposition in this House. After the Bill had passed its Second Reading, he travelled through the country. He saw the local authorities and got their views. Very often the views of particular public bodies did not correspond with his own but at any rate he had the advantage of them. The views of some people did not change, while the views of others did according as the Bill's provisions were explained.

Having done that, he sent circulars to the various public bodies who, in some instances, asked that a representative of the Department be sent down to discuss the provisions of these circulars with them. I know myself that these officers of the Department spent practically a whole day with the public authorities explaining the different features of the Bill and how it was to be implemented. Then, a circular was sent to the voluntary hospitals. They also asked for a representative from the Department and representatives from the Department were sent down and discussed these matters. The public authorities themselves appointed sub-committees representative of the various hospitals to discuss the matter in more detail.

If the Act is still repugnant to the Irish Medical Association, as it seems to be, it is hard for the present Minister or for any other Minister to make an agreement with people who take up that attitude. After every possible step was taken to consult public opinion both inside and outside the House, if the Act is still repugnant to some people whose efforts and co-operation are necessary to operate the Act well then, it is, indeed, a serious position that, when an Act is put on the Statute Book, some people outside this House will take it into their heads it is repugnant to the interests of their organisation and that their co-operation is doubtful, if attainable at all.

Then we have the problem of the health of our people to deal with. We have an Act on the Statute Book which was carried through this House to deal with that problem. Everybody knows that all its sections cannot be brought into effect fully at the outset for reasons which I have given. You would not have enough hospitals to house right away everybody who would look for hospitalisation but the most serious cases could be dealt with. The charges which fall on the people of high medical fees could be met in a way proposed in the Act. It will benefit not only insured workers but their families.

I hope the Labour Party will stick to the attitude they had from the start— that this Act, in so far as it went, was capable of implementation, that it had their support, that it was of advantage to the country and that it should be put into operation at the earliest possible moment. The Minister evidently seeks more time. It is hard to dispute that with him. Since certain Orders were made by the previous Minister, a general election took place and the same attention has not been devoted to the steps that would be necessary for implementing this Act. Consequently, some little delay would be only reasonable. I think it would be a very bad thing for this Legislature if Acts which are enacted here for the benefit of the people should be brushed aside and put on the long finger, so to speak, so that their implementation may never come about. That is how things seem to me to-day. Even though the Minister states now that he is accepting the main provisions of the Act, there seems to be no desire or wish to apply its provisions to the people who are awaiting its benefits.

Mr. Kyne

I had hoped that this discussion on the Health Act would rise above the level of party politics, but, unfortunately, it seems we cannot achieve that much-desired principle. It must be obvious to every Deputy that the public are sick and tired of hearing us talk about Health Acts. All of us must find in our constituencies that the people want something more positive than the great deal of talk which is taking place here, especially in connection with Health Acts.

I am not at all convinced by the case made by the Medical Association and various other people that it is interference by the State to legislate for the health of the people. On the contrary, I hold the view that, if necessary, it is the duty of the State to legislate to provide certain health services and health benefits for the people. I do not think State legislation in any way supplants the right of the family but it supplements the ability of the father of a family to give such facilities as are necessary to his wife and dependents. None of our services are compulsory with the exception of a few such as vaccination and which are thought to be necessary in the interests of the majority of the people.

I cannot accept the view that any Government introducing legislation to provide better health services for the ordinary people of the country or for the people as a whole is acting in any way contrary to the interests of the community. I have never accepted the claim of the Medical Association that, in the past, people were getting sufficient medical attention for their needs. One has only to cast his mind back to the types of services which were given, say, 50 years ago to realise the value of such an assertion. In those days, medical attention meant a hurried visit from an overworked dispensary doctor. A bottle was given out in the dispensary and in my area—and, I suppose, in other areas, too—the bottle was described as a bottle of "coloured water". If the patient had to be sent to hospital there was a pauper bed there. Such were the medical services of 50 years ago for certain sections of our people and, were it not for State legislation and "interference", if you like to call it that, we should still be at that sorry stage.

I am glad that former Governments took upon themselves the responsibility of ensuring that the people of this State would get the best possible health services. I do not believe that voluntary organisations, be they ever so well-intentioned, would have provided such services of their own free will or out of the generosity of their hearts, and irrespective of whether they would or not, it would be a charity. As a representative of working people, I take this opportunity of saying that we resent charity in any form. We feel things should come to us by right of human beings, and that was the attitude the Labour Party took when the Health Bill of 1953 was being debated in this House. The Labour Party supported that Bill to the extent that we wished only to amend it and improve it—to amend its restrictions and to improve its services. We welcomed that Bill as a step in the right direction.

Mr. MacCarthy

Charity will still be one of the Divine virtues.

Mr. Kyne

Under that Bill, this charity will be restricted by a means test of a kind which, very often, will prevent most deserving people from availing of it because charity can still bear the tinge of pauperism. Charity or a good action voluntarily done by an individual for another is a Divine virtue. However, when you find that a poor person's child is ill and that a public confession of inability to pay for it has to be made by the unfortunate parents, I am sure you will agree that that should not be so. I am afraid that if that is charity I am like a number of other people in that I do not want any of it.

I was thrilled and pleased to hear the Minister for Health state in this House that he has no intention of interfering with the Health Act, 1953. The Labour Party supported that Bill in the past and from what I know of the Labour Party I believe it would support that Bill or a better Bill in the future. There is no change of attitude on our part in that connection. The fact that the Minister for Health has stated that he has no intention of interfering with that Act is a good thing because we all know that the Party to which he belongs—the Fine Gael Party—took no positive part in supporting that Act when it was going through this House.

It is not a question of whether or not the 1953 Act is adequate to meet the needs of the people: it is a question of whether or not the Bill can be implemented on the date fixed by the former Minister for Health, Deputy Dr. Ryan—the 1st August, 1954. In my view, the Minister for Health made a prima facie case for his assertion that it is not possible to implement the Act on the 1st August, under present circumstances. I am not satisfied that the Opposition have made a good contra case. As I see it—and I think nobody is watching this Bill more intently than the Labour Party and the trade union movement—the Minister has made the case that if we extend the scope of the Act to people entitled to get services, and if the number of places where the services can be given remain at the same figure, there will be congestion and overcrowding.

As I understand the position, the public assistance group and the insured workers had a prior claim under the previous Acts and, because that prior claim is now being done away with on the 1st August under the 1953 Act and groups up to a certain level of income will have equal claim, the Minister seeks to restore the right of local authorities to treat the lower income groups in a privileged position. If that is necessary—and I think he has made a case that it is necessary—then I might say, as a member of the Labour Party, that I agree with it only as an interim measure.

The Minister indicated that when an opportunity is given to him he will consult with the local authorities and he will seek the advice of medical associations, nursing staffs, doctors and various other people without whose help we could not possibly run a health service. I think it is a good thing that he seeks that help, and I think it is desirable that every peaceful way of seeking support for a general health service in this country should be exploited before any definite decision in the contrary way should be taken.

I regretted to read in the paper to-day that the Irish Medical Association people saw fit at this time to engage in public discussion on the Health Act. I feel that they would have done a better service if they had left it to the Government and the Minister to discuss with them and seek their advice on how to implement the Act. I know that they are entitled to their views as to what they should do, and as good trade unionists they are perfectly entitled to see that they get paid for their services, but I feel that it is an inopportune time for that particular body at the moment to say, as one speaker is reported to have said, that he did not know what the coming year was going to bring, whether it was going to bring peace or war.

In the Labour Party we are determined that the people will get health services, and that whether it is peace or war the needs of the people will be met. We wish co-operation. We seek to get the best service by the best means. We realise that that needs a good deal of co-operation, but should we find obstruction we will have to support any effort made to make the wishes of the people as expressed by the majority of the elected Deputies compulsorily binding on people who do not like that.

I think it was necessary for the Minister to introduce this Bill. I would ask him to give an assurance to the House when he is concluding that in the shortest possible space of time, and if possible by a certain date, all the sections of this Act will be implemented. Should any organisation or group of people feel that a better service can be provided in a different way, then it is up to that organisation or group to provide that service. If their belief is right—I do not know whether it is or not—that by some system on an insurance basis such as is run in America and other countries they can offer a better service, then if that service is better I believe the public will avail of it; but I think it is necessary that a State service should be there and that it should be, as far as humanly possible, without a means test, because a means test can be a most intimidating weapon. Many a man who would obviously qualify under a State-sponsored scheme, if he is required to admit publicly even to officials his inability to provide for himself or his family will have to forgo the services because of the fact that he occupies a certain position in life. All of us have experience of the fact that a man holding a responsible position is very often supposed by his employers to have saved sufficient for himself to obviate his having to avail of any State-sponsored medical or similar scheme.

I cannot understand why the opposition to a no means test medical service is there when that service is operating in the T.B. service, where there is no question put to you as to what you earn or what section of the community you come from. It is looked upon as a necessity to cater for the curing if possible of that disease. Many other services such as the inoculation of children and, in fact, outside medical services altogether, such as benefits paid and children's allowances, are operated with no question of who your parents are or what income group they come from. I think that our State services should be as free as possible from means tests.

I welcome the fact that the Minister has indicated that his Government has no intention of interfering with the 1953 Act other than to endeavour if possible to improve on it. The Labour Party will be anxiously waiting and watching the progress of this Act, and we will, as Deputy Larkin said, find it compulsory on us should it not come into force——

Mr. Briscoe

When?

Mr. Kyne

——to ask the Minister to give us a date, when we realise that with goodwill from him, with goodwill from the people concerned who will administer it, that date cannot be very far away in the future.

Mr. Moran

It is amusing to hear Deputy Kyne suggest to the House that the Minister and the Fine Gael Party are not interfering with the Health Act, 1953, when in fact we are discussing a measure to repeal it. Starting with the Bill before me, the first misnomer is the long title—"An Act to amend the Health Act, 1953"— whereas, in fact, the long title should be: "An Act to repeal the Health Act, 1953", because that is what in effect it amounts to, which the Minister well knows.

I do not think that some of the speakers from the Labour benches, including Deputy Larkin, whom I listened to this evening, are quite so innocent or naïve as they would expect us to believe when they pretend that any Deputy on this side of the House is swallowing the case made by the Minister when we ask for a specific date on which the Health Act 1953 would come into operation or those provisions which are not being repealed would come into operation. The Deputy knows quite well that the reason we are asking for a specific date is that we realise that Fine Gael are being consistent in this matter, that they set out to kill the Bill, and that they are proceeding to kill it by legislation in this House. Just to make matters clear we want to invite the Labour Deputies, and we will invite them, and invite the Minister in his reply, if he is sincere as he said he was in his opening statement on this measure, to state the date when he proposes to give effect to these provisions of the Health Act 1953, the time he requires and the reasons for which he requires that time, because it would be just too much for us on this side of the House to accept the sudden conversion overnight of the Minister in view not alone of his own previous attitude to the measure when the 1953 Act was going through this House but in view of the consistent opposition of his Party at all stages of this health legislation, and not alone the consistent opposition of his Party in this House but the consistent opposition of his Party on every local authority throughout the country.

Mr. O'Sullivan

That is not true.

Mr. Moran

It is quite easy for that particular Deputy, the Parliamentary Secretary, to say that that is not true. I do not know whether he is a member of a local authority, but the very last experience I had of the implementation of the 1953 Health Act on Mayo County Council was a resolution that came in that the local authority would appoint the local health council under this Act, and the last thing that the Fine Gael county councillors and Senators on the Mayo County Council did was to divide the council on a motion by them to postpone that implementation of the 1953 Health Bill sine die. That was their aim in Mayo. They made no secret of it.

The present Minister, in dealing with the 1953 Act, said in this House:—

"We in the Fine Gael Party have endeavoured to suggest to the Government that they would serve the country better if they scrapped this Health Bill and tore it up."

The Minister also said on the Financial Resolution in connection with the 1953 Bill:—

"It is regrettable that the time of this House and the time of officials in the Department of Health should be wasted in a discussion of this empty formula."

The Minister, in introducing this Bill, purported to tell the House that he accepts the measure which he condemned in those words which I have quoted a short 12 months ago, that he proposes to accept it, hook, line and sinker, and to implement it fully, notwithstanding the fact that the measure, with the sugar coating which he has put on it, which he has put before the House is a measure to kill, in effect, the working of that Act, in his opposition to which he himself was so consistent up to the time when the Bill was introduced and to which his colleagues in Fine Gael were both here and outside so consistent in their opposition. In these circumstances, is it any wonder that Deputies on this side should ask for a specific date when the provisions of the 1953 Act will be implemented? Is it any wonder that Deputies on this side should have some qualms as to the intentions of the Minister and his Party who have been so strong and so virile in their opposition to the provisions of the 1953 Act?

A case could be made for this Bill, possibly, if the Minister had tried to work the 1953 Act and had found some difficulties. If the Minister was able to come into the House and say: "I tried to work that Act and I found certain difficulties. I am told that there is not accommodation and that there are not sufficient doctors or beds available," then the House would be inclined to accept the case made by the Minister. I suggest to the Minister that there has been, in fact, no single instance of any urgent case requiring hospital treatment that has been turned away from the door of any hospital The Minister knows, as the House knows, that there never were more beds available than are available to-day. Anybody in touch with local authorities must know that more and better provision has been made throughout this land by way of regional planning than ever was the position before.

The Minister should know, from his experience of the Department now, that, taking the West of Ireland, with which I am familiar, there are groups of counties which come together to make special provision in connection with regional sanatoria, to provide special hospitalisation facilities for orthopaedic treatment and who join for the purpose of financing the provision of orthopaedic surgeons and other doctors. I refer to such counties as Galway, Sligo, Leitrim and Roscommon. The position in the West to-day is that many hospitals which were used in a temporary capacity for the purpose of meeting the T.B. menace are now having more and more room made available as a result of patients being transferred to the regional hospital in Galway. These patients, many of whom formerly took up beds in general hospitals, are now being catered for elsewhere, thus leaving beds available which never before were available. In the same way, with the new provision being made for orthopaedic patients in regional hospitals, there are more beds available now than ever were available before, so much so, that there are strong rumours in the town of Castlerea that the very large sanatorium there is about to close down and the patients formerly housed there are going in large numbers into the regional sanatorium in Galway.

In view of these circumstances, how can it be suggested that beds are not available, that better provision had not been made and that more space is not available than was available even five short years ago? One would think that this whole nation was suddenly going to get some extraordinary disease which would flatten everybody at the one time and that there was going to be a sudden queue outside every hospital as a result of the 1953 Bill going through.

Deputy Finlay said he was disturbed that some crisis might arise if this Act were in force on 1st August. I do not know what crisis could arise or why there should be all this sudden epidemic of sickness throughout the country. I should say that there may be a certain amount of sickness when the people of the country fully realise the implications of the Bill—they may be sick and tired of the present Government—but that sickness would not entitle them to hospital treatment. The fact is and everybody knows it, that there are more beds available in this country than ever before, that, as a result of the greater regional planning and the greater regional hospitals made available, there is less pressure by external patients in rural areas on the hospitals in Dublin, that more and more people, sick people and people requiring specialist attention who formerly went to Dublin hospitals, are now being catered for under the new specialist services which are being made available throughout rural Ireland, and there is, therefore, no substance in the case which the Minister purports to make that one of his fears is that there would not be sufficient hospitalisation services.

Everybody realises that this is simply a question of £. S.D., a question of money, and that what the Minister and his Government baulk at is the provision of the financial wherewithal to implement the provisions of this Act. I do not mind so much the view expressed by Deputy Esmonde. It is the view, as we all know, which he and his Party have taken from the beginning, but the cat was very significantly let out of the bag yesterday by Dr. Andrew MacCarthy, at a meeting of the Irish Medical Association at Killarney.

Mr. T.F. O'Higgins

Surely we are not going to discuss the views of people outside the House.

Mr. Moran

Dr. MacCarthy purports to give the view of the Irish Medical Association. It is one of the matters the Minister referred to, and, if he gives his views publicly and they appear in the daily Press, I do not see what particular taboo there should be against our referring to it. The good doctor made quite clear what their attitude was. He referred to interviews, or an interview, with the Minister and what the Minister's attitude was. The Health Act is still law. The Health Act of 1953 is still on the Statute Book and is still the law of this land. This Bill has not yet passed this House and the views expressed by Dr. MacCarthy on a measure passed by this House are rather interesting.

In the first place, he states that his association had opposed the Health Act on two very important matters of principle. They felt it introduced a measure of State control over the profession which was not justified or in the best interests of the people. The second principle would appear to be the free medical services as provided in that Act. He went on to say that: "Apart from the principles involved, the association pointed out that the proposed Act must have been conceived by persons not only ignorant of the needs of the people but with little or no conception of how to provide these needs. The association stated their objections and pointed out that even with the best will in the world the profession would be unable to provide the services proposed owing to the lack of facilities." The good doctor says, speaking evidently on behalf of the Irish Medical Association, that the two former Ministers, Dr. Browne and Dr. Ryan, and the present Minister, if he accepts the Act, as he says he does, are ignorant of the needs of the people and have little or no conception of how to provide these needs. That is evidently the attitude of the Irish Medical Association. He goes further and says:—

"Some of our words fell on deaf ears but some changes were made in the Act.... The most important of these changes was the inclusion of the Health Councils, but the resultant Act remains as repugnant to us as was the original Bill."

Therefore we have the position that the Health Bill of 1953 is repugnant to the Irish Medical Association. Is that why we have this amending Bill before the House, to wipe out the 1953 Act? Is this the result of the discussions between the Minister and the Irish Medical Association? This is what Dr. MacCarthy says:—

"The Minister responsible for the Act then introduced regulations to work the Act. Having studied them I cannot see any hope that any profession with self-respect could be persuaded to agree to serve under the ludicrous conditions laid down."

The Minister tells us that he proposes to implement this Bill fully but here is the Irish Medical Association setting out their fundamental objections to it, stating that it is unworkable and that they will not try to work it. It is further stated:—

"It was noted that the new Minister for Health had accepted from the National Health Council the advice which the Irish Medical Association had been giving for many months and there were indications that a more realistic appraisal of their problems would be attempted."

I would like to know from the Minister: Is this Bill repealing the provisions of the 1953 Act? Is this one of the more realistic appraisals of the Irish Medical Association problems? Is this Bill, repealing the provisions of the 1953 Act, brought into this House at the behest of the Irish Medical Association? Is it to meet the objections as expressed by the Irish Medical Association in its interview with the Minister to which they refer? This body seems to be concerned with finality in the struggle for improved salaries of dispensary doctors and others—that seems to be their function—but they set out in no uncertain manner their fundamental objections to this Bill. Nevertheless they say that there are indications that they now have a Minister from whom they are going to get a more realistic approach. Does that mean that the provisions for free medical services, as laid down in the 1953 Act, will go? Does that mean that these fundamental objections of the Irish Medical Association are now met by the Minister? Is this Bill repealing the provisions of the 1953 Act and is it the result of the realistic approach made by the Minister to the Irish Medical Association?

Let any member of the Labour Party or of the Clann na Talmhan Party supporting this Government read that speech by Dr. MacCarthy. Let them ask the Minister to give them a specific date as to when these provisions will come into effect. If these men do not believe in Santa Claus any more, they know from that speech that this Bill is brought in here to kill the provisions of the 1953 Act and that from the attitude of the Irish Medical Association not until Tibb's Eve will this nation see a Bill in force in this country giving effect to the provisions that are in the 1953 Health Act.

When these Deputies come to vote in the Division Lobbies of this House I would suggest to them that they remember the attitude laid down in public by the spokesman of the Irish Medical Association about a law of the land passed by this House. Let them ask themselves as to whether the Minister is sincere when he says he is going to implement the 1953 Act fully when in fact his first action here as Minister is to introduce a Bill to kill the provisions of the 1953 Health Act. Let them ask themselves whether, before the people get the cheap butter to help them swallow the pill that they will have to swallow and before the people can enjoy the benefits so provided by legislation in this House, the health services provided by Fianna Fáil under the 1953 Health Act should be swept from them and killed.

I ask the Deputies from rural Ireland, and especially Deputies in my own constituency, knowing the hardships of the small farmers in these areas who were in sickness oftentimes deprived of the best medical services because they had not the wherewithal to pay for them, to realise what they are doing when they go into the Division Lobbies to vote for this Bill. They know that 99 per cent. of our people in rural Ireland have valuations under £50. They know that one of the effects of the Act would be to provide health services free for these men. Let them answer for taking those benefits away when they go back to rural Ireland.

Again I say this is purely a question of finance. This is probably some of the retrenchment and saving of money we hear so much about But those Deputies should ask themselves whether this measure is an indication of the triumphant victory of Fine Gael at the last election or whether it sounds the funeral march of Labour and Clann na Talmhan in the last election. As regards the realistic approach spoken of by Dr. MacCarthy, let me say that we on this side of the House are taking a realistic approach to this Bill. We want to know and to know now when is the vital date for the introduction of the provisions of the 1953 Health Act. When the Minister says he needs time, how much time is required? Can the date be the 1st January next or the 6th June next? Will he give an indication to the House as to what date he has in mind? Of course, we all know the position. We all know what is behind this. We all know from that Fine Gael cat that Dr. MacCarthy let out of the bag yesterday, the Fine Gael cat with bristling whiskers, tail cocked and claws out.

I suggest the only reason the Minister is so shy in giving us the date we require is that neither he nor the men behind him have any intention ever again of allowing the provisions of the 1953 Health Act to see the light of day. If any members of the Labour Party or of the Clann na Talmhan Party fall for this; if they think, seeing what is set out in black and white by the Irish Medical Association, that there is ever going to be any attempt by Fine Gael to implement the 1953 Act then they are more foolish men than I thought they were.

Mr. O'Leary

He is attacking the doctor who cannot defend himself.

Mr. Moran

They have a good defender in Deputy Johnny O'Leary. He will spring to their defence if they require it. He would have a better duty to perform here—he could spring to the defence of the small farmers or insured workers in his constituency, to the defence of all those people who would be entitled to enjoy free medical service in their homes or hospital treatment if they required it. These are the people to whose defence Deputy O'Leary should spring. He is getting hot under the collar now. It is strange that Deputy Johnny O'Leary, the stalwart of the working man, is more concerned with the specialist in Fitzwilliam Square than with the unfortunate people who cannot provide medical services for themselves because of their lack of means. I will leave the Deputy to explain that when he goes back to his constituency. I suggest to him that if this House is adjourning he should stay here in Dublin for a long period and try to let them forget about him before he goes back.

An Ceann Comhairle

The Minister, to conclude.

Mr. Bartley

No, Sir, this is too serious a matter and there is too serious a duty on us to let this matter go through lightly. Deputy O'Leary has indicated that in 20 years everything that Fianna Fáil was associated with was wrong. I think without exaggeration, without plámás and without any cur i gcéill I can quite honestly congratulate the Minister on his consistency.

He has pursued the same course in respect of health legislation and he has not deviated now. He said he was putting up an honest case and, from the point of view I have mentioned, that is quite true. He said he was not engaged in any special pleading, but it is obvious that he made a very fine effort in special pleading. He was sustained and aided by the fact that he was fully convinced of the virtue of what he was doing. It was his firm opinion all along. When Deputy Larkin got up to follow him he, too, said that he was not engaged in any piece of special pleading but he was not quite as convincing as the Minister because, if any Deputy on the Labour benches or else where knew what the Minister was doing, that Deputy was Deputy James Larkin.

After all, the Minister said quite frankly that the 1953 Act will come into operation when he is satisfied that it can be brought into operation and when certain ethical objections have been removed. That is quite a definite statement and if it did not mean anything to Deputy O'Leary it certainly meant something to Deputy James Larkin. That is why Deputy James Larkin made one of the worst speeches I have ever heard him make here. It was most unconvincing—and whatever Deputy Larkin's lack may be, he does not lack fluency or cogency. He is able to make a good speech and is as well qualified as any member of the House to make a good case of bad material. He made the most hopeless speech I ever heard him make—for the reason that he did fully appreciate and understand the meaning of the Minister's words, that the Act will not come into operation until the Minister is satisfied it can be brought in and when certain ethical objections have been removed.

Now, we know at least what one ethical objection is. It was stated quite clearly and unequivocally here that free medical services are unethical. The Minister—quite consistently, be it said about him—will see that that ethical objection is removed. Those of us who speak for certain rural areas and certain health districts are concerned at the moment more with the cost of essential treatment than with the availability of all the facilities for all the potential cases in those districts.

It was pathetic to listen to Deputy Denis Larkin this evening repeating ad nauseam that we must have all or nothing—“if we cannot get all the services provided, all the benefits and all the treatments provided in the 1953 Act, if we cannot get them all together on the 1st August, then it should be postponed; and the Minister should not even commit himself to the 1st January if he is still not convinced that he can give us all the services provided by the 1953 Act on the 1st January.” Deputy Larkin, from the tenor of his speech, would concede to the Minister the right to postpone the Act until Tibb's Eve if he is satisfied that he cannot provide all the benefits for all the potential beneficiaries. If the Labour Party mind is represented by those speakers, one can truly say that, whatever about the Labour machinery in many other matters of social consequence, their reversing gear is certainly well oiled and lubricated and in efficient working order.

Let us examine the case made by both Deputies Larkin. It was that we promised to provide all the benefits on the 1st August for all the potential beneficiaries. Deputy Traynor this evening pointed out that it was a reduction to the absurd to suggest that everybody who became legally entitled was going to be sick on the 1st August and all were going to make a beeline, say, in Galway health district for the Galway central hospital, that you could not deny it to them once you put their right to benefit in legal form. Everybody knows that it is a childish argument, that it does not hold any water and cannot be sustained for a moment. Does not everybody know that a child of school-going age has a right to attend any national school he or she chooses, but do we not know that school children have been refused admission because there was not room? Do we not know that everybody has the right to go into a public court when there is a public trial and be present at the proceedings, but also that the judge can refuse admission if the court is too crowded? Do we not all know that in a public parking place one may leave a car if there is room, but that does not mean that we can leave it blocking the thoroughfare if there is not room? Do we not know that the local authority confers a legal right on citizens who pay rates to have fires put out in their houses, but if all the houses take fire at the same time the ratepayers cannot blame the local authority if the one fire engine cannot be sent to all the houses at the same time?

One could give countless examples of this application of the legal right. It is quite absurd to think that this matter would be resolved when this Act became law by the strict application of the letter of the law. Do we not all know that hospital administrators, both professional and lay, apply their common sense and their experience to the solution of the overcrowding problems? We know that in these rural hospitals priorities are not decided by the administrators on the basis of means. We know that priority is given on the basis of the seriousness of the illness. It does not matter how poor a person may be; no matter what his medical rights are, if he comes in with a sore finger he will not be given priority over a rich man who comes in with acute appendicitis. That is only the application of common sense. Therefore, this question of the Labour Party salving their conscience because of the inability to provide all the benefits for all the potential beneficiaries on 1st August does not bear examination. They know themselves, none better, that that would not be the case; people would not be seeking admission to these hospitals in larger numbers than necessity demands.

Mr. O'Leary

Of course they would.

Mr. Bartley

The fact that our health service is not based on insurance, as some of the Labour Party want it to be based, is a guarantee that one would not have any such rush on the available facilities.

Notice taken that 20 Deputies were not present; House counted, and 20 Deputies being present,

Mr. Bartley

The danger of overcrowding and of a rush for these facilities would only arise in fact if people had to make personal payments by insurance, or otherwise. on a regular scale for the right to get hospital treatment. I understand that was the great objection to the Bevan scheme in England and Deputy D. Larkin's reference to that matter implied a condemnation of the English scheme.

My mind in this matter is not influenced by the availability or possible non-availability of all the facilities to which potential beneficiaries would legally be entitled on 1st August; what I am concerned with is practical reality. I am concerned about the sick poor, and principally about those who are not insured.

Mr. O'Leary

It is a pity the Deputy did not think of them in 1952 when he helped to bring in the Budget.

Mr. Bartley

Deputy O'Leary reacts against Fianna Fáil like clockwork. I wonder could he stop the clock for about ten minutes.

Mr. O'Leary

If the Deputy had been as kind-hearted in 1952——

An Ceann Comhairle

Deputy O'Leary is continually interrupting.

Mr. Bartley

It has been admitted that urgent cases get accommodation, but that does not mean that there are adequate medical services provided for all. I am concerned to have the 1953 Act implemented on 1st August, or at the earliest possible date, for the benefit of the sick poor who avoid both the hospital and the doctor like the plague and who only avail of these services when the condition of their health compels them to do so.

When one finds that the sick poor who are supposed to be guaranteed free treatment under the Public Assistance Act are, in fact, not getting that treatment free of charge, then it is borne in upon one's mind that the provisions of the 1953 Act are absolutely essential. We had that brought forcibly to our notice in County Galway some six or seven months ago in connection with bills that had been remitted, or very considerably reduced, on the representations of public representatives for people who were, and should be, entitled to free treatment. A Government Order arrived and ruled that these remissions were illegal and directed the county manager to institute prosecutions to recover the amounts. When we found that the Minister for Health, aided by the Minister for Local Government, endeavoured to right this matter and found they had no power to do so under existing legislation or to ensure the rights of these people under the Public Assistance Act, then, if any further proof were needed by me of the necessity for the 1953 Act, that supplied it.

There was the case—it may be regarded as an extreme case—of a widow who appealed piteously to the county manager not to prosecute her and who promised that she would earmark her pension for a sufficiently long period to wipe out the debt. When one finds a man who has lost four members of his family, one after the other, through illness—a small farmer —getting a bill for over £100 and men with small wages of £6 or £7 a week, with large families, getting large bills from the hospitals authorities, it is inevitable that one should come to the conclusion that there is a crying need for these free services.

That has been our experience in County Galway and, being our experience, we put the sick poor as No. 1 priority. We did not design the 1953 Act or aim it against any section of the community, not even against the most highly paid medical specialists. It is quite wrong to say that the Fianna Fáil Party has any objection to the medical profession getting what they can get for their services, any more than any other organised section of the community. But we feel that our first duty is to the sick poor and if, in the carrying out of that duty, the interests of other people are impinged upon, that is quite incidental and in no way intentional.

It was very gratifying to me to listen to Deputy D. Larkin's concluding remarks. He spoke for a very long time making one point, that point being that the 1st August was too soon, because the Minister said so. He finished up on this note, however: he gave it as his opinion that it is not necessary to have a bed ready for every potential patient, if it were decided to bring the Act into operation on 1st August; it is not necessary to have new hospitals; and he asked the Minister then, under present circumstances, to guarantee hospital and specialist treatment. He spoke for threequarters of an hour, and demolished his entire case in these few sentences.

Deputy Kyne said that the means test is a public declaration of one's poverty and is tantamount to charity. I would refer the Deputy to the Minister's statement. He pointed out that the Act of 1953 cannot be implemented until he is satisfied that the benefits for all the potential beneficiaries can be granted, and until certain ethical objections have been removed. The removal of these ethical objections will make this Bill entirely unacceptable to Deputy Kyne because it will remove that freedom from charity which it guarantees.

The National Health Council was used by, I think, Deputy Denis Larkin as a means for castigating Deputy Dr. Ryan. It has been pointed out here that the present Minister had, in fact, of his own volition, and without invitation, approached the National Health Council and that as a result of his approach, the council passed the resolution which has been so much publicised within the past week. Deputy Denis Larkin countered that statement of Deputy Dr. Ryan's by pointing out that it was he who had appointed the council. He said that Deputy Dr. Ryan must indeed have been a very inept Minister for Health when he appointed people of such spineless character as would kow-tow to the new Minister on his first request. Deputy Denis Larkin, however, did not tell us that these people had, in fact, been formally appointed by the then Minister, but that the vast majority of them were nominated by certain bodies, amongst them Deputy Larkin's trade union. If the charge of ineptitude is to be maintained, then by implication it originated with the bodies nominating them, There was no droch-mheas cast on the National Health Council by anybody on this side of the House. There were only two people who attempted anything in that direction, Deputy Larkin in the remarks to which I have referred, and the Minister. The Minister, in his opening remarks, made a facetious reference to the National Health Council by indicating that it came into existence on All Fools' Day.

Mr. T.F. O'Higgins

I was referring to a different person.

Mr. Bartley

The Minister's statement was that the National Health Council came into existence on All Fools' Day, passed from and left it at that, quite unvarnished. We, on this side of the House, have, I think, shown a reasonable and accommodating attitude on this very vital question. Our accommodating attitude has been used by those opposite in an attempt to bolster up some of the arguments that they have been resting upon to justify their reversal of attitude in relation to health. We said that if the Minister would name a time, not too far distant in the future, we would reconsider our attitude. Some of the speakers on the other side have used that to indicate that we, too, are convinced that this Act cannot be implemented on the date mentioned, that we are really speaking with our tongues in our cheeks and that our opposition is obstruction and nothing else.

Comparisons have been made between the present Minister and his predecessor. It has been pointed out that, if the present Minister were in office in time, he certainly would have been in a position to implement the Act on the 1st August. There is one thing which I think should be said now. It is this, that we all know—we need not go into great detail on the matter and we need not get very hot about it—that the prospect of Deputy Dr. Ryan as Minister making an agreement with the Medical Association was very thin indeed. In fact, the Medical Association stated quite categorically that they would make no agreement with Deputy Dr. Ryan, when he was Minister for Health, on the basis of the 1953 Health Act. I concede that if there is anybody who can induce the Medical Association to change that viewpoint, it is the present Minister, but I do not expect even the present Minister to succeed in getting the Medical Association to do what the Labour Party have done and that is to reverse engines.

The Medical Association are not going to agree with any Minister, with any Party or with any group on the basis of the 1953 Act. The Minister for Health knows that. Deputy James Larkin knows it. The Minister, as I said at the beginning, is quite consistent. He is not going to seek agreement with the Medical Association on the basis of the 1953 Act. What he is really saying is that the 1953 Act, as Deputy Moran has pointed out, is here and now by this Bill never going to come into existence. The removal of the ethical objections to which the Minister has referred, being a necessary pre-requisite, will have to be dealt with before the Minister can get agreement with the Medical Association. The Medical Association know that and we know it. We know that the Minister knows it, and we are not expecting him to do the impossible. He will not get agreement, and we know that he will not get it. We know also that these free services will never come into being without agreement with the Medical Association. I am not cavilling at their attitude. They are defending themselves as a trade union. We concede to them the right to do that. But the people about whom I am concerned are the sick poor in my own constituency and in the County Galway health district. They are not even getting the benefit of the Public Assistance Act and this Minister will not now, under existing legislation, be able to guarantee it to them. It is because I know that to be the situation that I am opposing this as vehemently as I do. I called in the assistance of two Ministers—the Minister for Health and the Minister for Local Government—and the local government auditor was able to rule both of them out and insisted on people who are genuine public assistance cases being made to pay and being prosecuted when they refused to pay.

If the Minister does not accept my statement on this matter—Deputy Beegan and others referred to it—he will be able to get the information. I do not know whether it is in Local Government, in relation to his supervisory duties over county managers, or in his own Department of Health, but it certainly will be available to him and he will be able to verify the truth of what I am saying that, on the arbitrary action of a local government auditor, these people were denied their rights which I believe are their rights under the Public Assistance Act.

There is no question there of the availability of all the facilities for all the possible legal beneficiaries on 1st August. It is a question of making available the facilities that are there. We have quite good facilities in these county hospitals. They have done very good service for both the sick poor and those not so poor, and when it had to be a case of priority the priority has not been on the grounds of means; it has been on the grounds of the urgency and the seriousness of the illnesses in question.

We want to ensure that those who cannot pay for them will have services made available to them and, beyond that, we want to ensure that people who are now neglecting their health because of the fear of cost will cease to have that fear and will take the necessary steps in time, when treatment can produce good results and have some curative effect. We do know that people have been neglecting their health and that their cases have deteriorated to such an extent that when they had, willy-nilly, to go into hospital, medical science was able to do nothing for them. These are the cases we are concerned about.

It is disgusting to listen to the speeches of the Labour Party who now display such a cynical attitude to these sick poor because they are uninsured and because they are unorganised and because they are scattered in places where their votes cannot affect Labour politics.

Deputy Dr. Ryan's rôle here in leading the opposition to this Bill was certainly quite different from his experience when he was over there in the Minister's place and when he had Fine Gael here using every weapon in their armoury to discredit and discount what he was about to do and when he had every Labour Deputy prodding him to go still further. Between these two extremes of interest, he worked out what was really a good measure. Now, the Labour Party, most unconvincingly—I do not suppose anybody will be more dissatisfied with his own speech than Deputy James Larkin will be when he reads it— cynically turn their backs on these sick poor. One of them tried to seize on the fact that the previous Minister had from last October sufficient time to provide all the necessary facilities and the Minister corrected a Deputy who said that and pointed out that he had, in fact, a longer time than since last October, that he had from February, 1953, to provide these facilities. I want to point out to the Minister that his Minister for Health in the Coalition Government in 1948 had three years in which to implement the 1947 Act.

Mr. T.F. O'Higgins

We were building hospitals that your Government had neglected to build.

Mr. Bartley

They had from 1947.

Mr. T.F. O'Higgins

Do not make any mistake.

Mr. Bartley

They had from 1947 to do what they charge Deputy Dr. Ryan with not having done since October.

Mr. T.F. O'Higgins

Not a single hospital had been built for ten years before that.

Mr. Bartley

The Minister for Health knows that when Dr. Ward was piloting the 1947 Act through this House Fine Gael would not even argue the case. They walked out in protest and left empty benches—the first time that the Opposition benches were empty.

Mr. T.F. O'Higgins

Is this the Act that was repealed?

Mr. Bartley

That was the attitude of Fine Gael on the 1947 Act.

Mr. T.F. O'Higgins

What happened to the 1947 Act?

Mr. Bartley

They were so opposed to it they would not even discuss it and when they came in as a Government in 1948 they saw to it that neither a Health Bill nor a Social Welfare Bill was allowed to be brought in. For three years these things were dangled in mid-air.

Mr. T.F. O'Higgins

The hospitals were built.

Mr. Bartley

That fact, which is known to every Labour Deputy, is proof of what I said about the Minister's opening statement and supports my statement that the Minister is quite consistent in his attitude and I will give him all credit, without any plámás, for that. He is consistent in his attitude. His Party have proved, since 1947, that they would have none of this and the Minister now has, quite consistently, in this Bill, taken the necessary legislative step to ensure that his viewpoint will, in fact, be carried out.

Mr. T.F. O'Higgins

The Deputy is rather nauseating.

Mr. Bartley

We know it. Perhaps some members of the Labour Party do not know it but certainly Deputy James Larkin knows it. He has no doubt whatever about the meaning of the Minister's words.

We feel very strongly on this question because the sick poor, the unorganised poor, the people who have no help except what their public representatives can ensure for them, are now being left again. They are now being thrown again to the wolf of ill-health because they cannot pay. Whatever about the prices of essential foods, we think it is more important to ensure that the price of essential medical services should be brought within the competence of all the people.

I make no distinction on this matter of health between the rich and the poor. It should be brought within the competence of all the people. Whether we like it or not, very many of them have been put into the category of the middle income group and have been forced to pay for the services which should be provided, and which it was intended should be provided, free.

I do not wish to speak on this matter for the purpose of speaking. I do not want to stand between the Minister and the passing of this Bill if, in fact, the Dáil is going to pass it. I do feel that there is an obligation on me, as representing an area which has a keener interest or as keen an interest in health legislation as any constituency in the country, to ensure that the filching of these rights from them will not be carried out without a protest from me.

I want to finish on the note that the Minister is quite consistent. He is doing what his Party said they would do. The Leader of the Fine Gael Party said that when they got the opportunity they would scrap this Act. If they had an over-all majority in this House, the Minister for Health would not have turned to Deputy Larkin yesterday and said: "We intend to implement this Act but we cannot do it now. We will do it when the facilities are available and when certain ethical objections have been removed." If the Fine Gael Party had an over-all majority in the House, the Minister for Health would not have made that remark to Deputy Larkin. Deputy Larkin appreciated its significance. That is why we have concentrated so much on the Labour Party in relation to it. He knows what it means. He has no doubt in the world. Whatever Deputy O'Leary may think, Deputy Larkin is under no illusion. Because of that, we on this side of the House protest very vehemently against the cynicism and the reversal of engines of a Party that prodded the Fianna Fáil Party to go much further than in fact we did go.

Mr. Allen

The Minister introduced his Bill yesterday asking for a postponement of certain vital sections in the Health Act. He made a statement, side by side with that, that it was his intention to operate fully the Health Act, but when challenged by Deputy Dr. Ryan, on this side of the House, and asked for a date, this year or next, when these sections of the Health Act which he is postponing under this Bill will come into operation or when the Minister might be ready, he would not say "six months" or "three months" or "12 months" or any date whatever. We all know quite well—and the House knows and the country knows—that Fine Gael are able to get the Labour Party to support them and to be as meek as mice. Deputy Dillon, the present Minister for Agriculture, made a statement in this House that the Labour Party in the 1948-51 Coalition Government were as meek as mice. The present Minister for Health has found that the Labour Party are even meeker than mice in this Government and while he can get those meek-as-mice members of the Labour Party to accept that he is going to implement those sections of the Health Act in the future—well, the Minister and his Party would be inconsistent if they did not continue to "cod" the Labour Party as long as they could fool them by pretending that they were going to implement this Act in the future. Since the first Health Bill was brought in about 1946 in this House, Fine Gael have apparently opposed any new health legislation or any improvement in health legislation every time. No measures brought before this Dáil in the last eight years were more consistently opposed by them than were measures of health legislation or measures for its improvement.

I am disappointed with the Minister in only one thing—that he was not honest with himself, his Party and the country in saying outright that they were opposed to this health legislation that the Dáil had passed last year. They obstructed the passage of that legislation by a majority in the Dáil for the longest period that any social legislation was ever obstructed in this House, and they would be consistent if they were to say now that they did not believe in it and that they would do anything they could to prevent it from operating in the future so long as they got the support of a weak-kneed Labour Party.

In all the years that I have been here, I have never seen a more complete surrender of any group than that which was led yesterday by Deputy James Larkin, a surrender of principles that just six months ago, or in the late summer of last year, they voted for in the House. In fact, at the time, they were dissatisfied with Deputy Dr. Ryan's measure and it was described by them as a half-baked measure that only went half the way they wanted it to go. It was extraordinary how strong the demands were which they made on the Fianna Fáil Government but they were prepared, in order to maintain the Coalition and to keep the three or four Labour Ministries in that Government, to accept anything. They will grovel and surrender before the Minister every time. They will be quite entitled to do that but they did not ask their constituents if they were to surrender on the Health Bill. Right through the country during the election they campaigned for better health services and the Labour Party asked for more and better health and social services. I suppose any of them that were elected were elected on that basis but now they are prepared to accept the policy of Fine Gael.

Fine Gael are not one bit inconsistent —I give them that credit. It has been their consistent policy all the time, but they should say what the Minister's colleague—Deputy Dr. Esmonde—said yesterday when he spoke on this Health Bill. He was one of the leaders of the opposition to the Health Bill, 1953, and what he said yesterday was that that health legislation never could be operated and never would be operated by the Government. At least he was consistent and honest, but the Minister tries to have it both ways and tries to retain the support of the back benchers of the Labour Party and their supporters outside. He knows quite well that device can only last for a short time and that sooner or later it will cause serious damage to the whole structure of government in this country. You cannot fool all the people all the time although you may fool some of them.

Mr. Briscoe

The people are now finding out who fooled them.

Mr. T.F. O'Higgins

You did it for 20 years.

Mr. Allen

The Minister tried to fool the Labour Party and they are not a bit concerned in this matter. They walked the plank that Fine Gael put there for them, but it is a very shaky, narrow plank, I can tell them.

The Minister did say that he was going to operate fully this Health Act in the future and that he was going to bring in immediately after the 1st August certain clauses in the Health Act. The sections he is bringing in as far as I can see are those which are already in operation, except, perhaps, milk for mothers and children, and even that could be said to be available at the moment. Then there are dental and ophthalmic services for school children, school health examination and child welfare services—whatever services are in operation for the lower income group at the present time, these are the services the Minister proposes to bring in under the Act. The 1953 Health Act has a big number of sections in it and the Minister knows quite well there are about half a dozen vital sections that bring in new services to the community.

It is an Act of some 72 sections and there are about half a dozen that bring new services or change over from one Act to another. The Minister proposes in the Bill before the House to set aside the proposals in these sections: that is the effect of what he is doing, and he is going to carry on under the health code rather than under the previous code the assistance of the lower income group in this country, the group that is entitled up to now to free medical and health services.

There is one section of this Act in operation since January last and that is the maternity grant section. It is a peculiar thing that when that Bill was going through this House from the Labour Party point of view the grant was not nearly big enough and from the Fine Gael point of view the grant should not be there at all, but they are tumbling over each other since last January—both Fine Gael and Labour— to try to get the grants paid to those people who are claiming them. They are trying to ensure that everyone, whether in the lower income group or not, will get these maternity grants. That shows how popular that section is. It is a wonder the Minister did not set out to set that section aside. It is a very popular section and it is the only one in operation. Had the other sections been in operation the Minister would not dare to set them aside.

What are the provisions made in Section 15? Section 15 makes provision for a considerable section of the community who are paying all the time in taxation and rates for the services given to the lower income group. Amongst the middle income group there are large numbers of small farmers, small shopkeepers, tradesmen, fishermen and different types of people who are not entitled to any hospital services whatever at present, unless they can pay for them out of their own means. Time after time many of us have had to go to boards of health to try to get free hospital treatment for some member of the community who was not entitled to get it under the Medical Charities Act. Many of us had to come up here to approach some hospital, some member of the medical profession or the governor of some hospital to try to get free hospital treatment for some person who was not entitled to claim such treatment from the board of health. Section 15 makes provision for these people.

Remember, the majority of the people on the land in this country live on holdings that are under £20 or £25 valuation. There is no provision whatever for these people at present. They are a section of the community for whom members of local authorities have been pleading for quite a long time and the provisions made in Section 15 were the result of long years of experience on local authorities. That is why these provisions were inserted in the Act and for no other reason. The Minister is at the disadvantage that he has not been, so far as I know, a member of a local authority. I do not know whether he is a member of any local authority in Dublin.

Mr. Briscoe

He is not on any local authority.

Mr. Allen

His brother is, I believe.

Mr. T.F. O'Higgins

Did that give you some added wisdom?

Mr. Allen

Had he been a member of a local authority for the last 20 years or so, he would know from experience that there is a very large and deserving section of the community who have been called upon to pay to the full extent of their means for treatment for other sections while they themselves were not entitled to treatment and will not be entitled to treatment until these sections of the Act are put into operation. That is the difficulty in relation to this matter.

The Minister was asked by Deputy Dr. Ryan yesterday whether he would even at this late stage say when these sections would be implemented. He was told yesterday that he could get a speedy passage of this Bill through the Oireachtas if he would make that statement. Had he made such a statement we could all have gone home on our summer holidays. He was not prepared to mention any given date, some time this year or some time next year, when he felt he would be in a position to implement the sections which this Bill is putting in abeyance. If he had been more honest, perhaps he would have said, as some other sections of the community are saying, that such a provision is unnecessary and unworkable at all times. The Minister yesterday used the word "ethical" in stating that for some ethical reasons there might be a change. Perhaps he might throw his mind back and consult other people as to the ethical objections to treatment under the T.B. services. Every section of the community irrespective of whether they are in the lower, middle or higher income groups are claiming and getting free medical service under the 1947 Health Act so far as T.B. services are concerned and there is nothing unethical about it.

Mr. T.F. O'Higgins

Not a bit. Why should there?

Mr. Allen

We never heard of any objections to such treatment up to now, but if a person needs a serious operation for some other illness and he owns ten acres of land, it is apparently a crime to claim free medical service. Is that not what it boils down to? It does not make sense to me. Deputies are fully aware that many of their constituents, small farmers and others have been claiming this treatment for years but they are not entitled to it until these sections are put into operation. There is not a day passes that members of all Parties have not to be pleading with county managers to try to get so-and-so hospital treatment to which he is not actually entitled. Auditors, as Deputy Bartley pointed out, because of the fact that the Exchequer is paying half the cost of the medical services have become very wary in regard to who is getting this treatment and if there is any question that a person was not entitled in absolute law to get this treatment, auditors are surcharging county managers. That is what is happening at present because of the fact that the State is paying half the cost.

The Fine Gael Party are responsible for any politics there is at present in health administration in this country. They have been responsible for the last seven or eight years because of their attitude and the line of action they took. There is no reason in the world why the House should be divided about this very important matter. We should have absolute agreement on the question of trying to improve the health of the community and for the last 25 or 30 years, since the State was set up, there has been a vast improvement in the health services provided for the people in the way of hospital treatment. The Minister was at great pains yesterday to tell the country that the hospital beds were not there and that no hospital could take these deserving people if they were in need of hospital treatment, under Section 15 of the Act. Does that mean in effect that they cannot under any circumstances if they need urgent medical and surgical treatment get it, that it is not available to them, that there are no beds whatever available for them, that there is no place at all where urgent surgical operations can be provided for that section of the community known as the middle income group?

As I said before, for the last 30 years there has been a vast improvement in hospital services. I want to claim this for the local authorities. was the local authorities all over the country who improved those hospital services in the last 30 years. There is no doubt about that. Any improvement that has taken place all over the country in the county hospitals from Donegal to Cork was due to the local authorities. There was no such thing whatever as hospital services in this country when this State was established, outside the City of Dublin and the City of Cork. You had the poorhouse and nothing else. You had no surgeons and no nursing services. A vast improvement has been made all over the country by the local authorities, public authorities and legislation passed through this House over the years. Were it not for that we would not have the improvement we see in the medical services which are available all over the country.

People talk about these services being undesirable. We know the viewpoint that prevails among certain sections of the community for whom Fine Gael speak. We know their viewpoint quite well. We heard it expressed before now by Fine Gael. We heard every piece of health legislation opposed. The wonder in the country to-day and the big shock is that the Labour Party, led by Deputy Larkin who, we were told, was a man of iron, surrendered at the very first occasion pressure was brought to bear on him in order to keep the Coalition Government together.

Fine Gael were opposed to this Act and legislation from the beginning. Perhaps they will change, and see the light and see the need for progressive health legislation as enshrined in Deputy Dr. Ryan's 1953 Health Act. Perhaps they will see the need for that in the future and they will change from their old conservative attitude of opposition to health legislation. Perhaps they will bring into operation that progressive piece of legislation enshrined in the law of this country by the majority of the members of this House inside the last nine months.

Mr. M.J. O'Higgins

I just want to intervene briefly in the discussion. I think it is regrettable that Deputies opposite should at this stage endeavour to continue the controversy which has been associated with the question of public health and health legislation in this country. When this Bill was introduced, the Minister made quite clear the scope of the Bill, the purpose for which it was being introduced and the difficulties which were bequeathed to him in connection with the implementation of the Health Act of 1953.

Deputies opposite have endeavoured to colour this debate and to present the case that we were faced with a choice of health service or no health service. I think it is quite clear that that is a false picture and one which should not be spread from this House by any Deputy who does not want to leave himself open to the charge of playing politics about the sick poor to whom Deputy Bartley referred. I think most Deputies accept —in fact, I think it would be quite impossible for Deputies not to accept— the fact that the lack of adequate arrangements has made it quite impossible to implement the Act of 1953 by the particular date proposed by the former Minister for Health, the 1st of next month.

So far as I and the Party which I represent are concerned, we follow the statement made here by the Minister for Health and we are prepared to accept all the implications of the statement which he made with regard to the health services and the health Act of 1953. I think it is rather more than uncharitable for Deputies opposite in that atmosphere to endeavour to propagate that spirit of controversy which has surrounded questions of public health here for a number of years past.

The very fact that that controversy was there and the very fact that there are those who endeavour to fan that controversy into flame to-day will show why it is quite impossible for any responsible Minister, aware of the responsibilities which face him in connection with this matter of public health, to place any dead-line as to when a particular service can or cannot be brought into operation.

The difficulties which exist at present have been outlined by the present Minister. I think that any Deputy— he need not be a medical man; he need not be either pro the Irish Medical Association or anti the Irish Medical Association—will appreciate the fact that not alone must there be discussions but there must be discussions with a view to agreement, resulting in some kind of working agreement with those whose duty it will be to implement these services when they are brought into operation. It is not suggested—it has not been suggested— that the former Minister for Health did not engage in some discussions but even the Deputies sitting behind the former Minister for Health—the most decent of them being Deputy Bartley— have been broadminded enough to concede that Deputy Dr. Ryan could not and would not ever have reached any kind of agreement with regard to these services with the medical profession. I do not think I am in any way colouring the statement made by Deputy Bartley in this regard. Taking that as a fact, taking it even as a probability that the circumstances outlined by Deputy Bartley existed, is it not only reasonable that another Minister should be given an opportunity to enter into whatever discussions are necessary with a view to trying to get an amicable agreement which will give the people the health services that Deputies opposite say are so urgently needed?

As I say, it is not a question of health service or no health service. It is a question of endeavouring to give the best health services in a way that will work to the benefit of the people who require those services. It is a question of putting into operation services not merely within the framework of an Act of this House but it is a question of giving the people real services, services that will be of value to them and not giving them paper services, paper rights and paper titles which they may or may not get.

I merely rise to say that I hope the Deputies opposite will not continue on the line which has been adopted here for the past two days—the line of assuming that everything said by the Minister is misleading and untrue and insincere, the line of assuming that those who support the present Government are determined to see to it that the people do not get adequate health service. That is not the case. I would ask Deputies opposite to accept it that those of us in the Fine Gael Party, like our colleagues on the Labour Party Benches, are as anxious as they are to ensure that the people of this country will get adequate health services and will get those health services in a way in which they can be operated on a practical basis—in other words, that they will get those health services in reality and not merely on paper.

Mr. Carter

We on this side of the House find it somewhat difficult to accept the apologia of Deputy O'Higgins when one considers the attitude of the Fine Gael Party when we were in Government and when we were piloting the Health Bill of 1953 through this House. Of course, at one time it was no harm to play politics. At one time it was not considered taboo to play politics with regard to the provision of improved health services for our community. To-day, there is a strange contrast. We, who sit on these Opposition Benches, are told to be good boys. We are told not to demand better health services for the small farmers of our respective constituencies. We are told not to ask, like Oliver Twist, for more but to accept the assurance of Deputy O'Higgins and the other Parties that make up the Coalition that the people will eventually get better health services.

It is difficult indeed to reconcile the Bill which is now before the House and which the Minister introduced last evening—a Bill which completely emasculates the provisions of the 1953 Health Act—with the statements made by the Minister in relation to the 1953 Act. It will take a good deal more than the assurance of Deputy O'Higgins or, for that matter, of the parliamentary Labour Party to convince us that they are genuine in their claims that they are concerned about the well-being of their constituents or, indeed, that they intend to implement the 1953 Health Act.

Those of us on this side of the House who have the privilege of speaking on behalf of rural communities are concerned with the fact that the section in the Health Act which provided for medical facilities and services for the small farmer and the farmer up to £50 valuation is to be completely ignored in this new Bill which is before the House. We meet people, off and on, who are faced with various problems arising out of illness. We meet people who have received bills from almoners or secretaries either of voluntary or of county hospitals in respect of members of their families. We are often concerned to see that they get a reduction in those bills, some of them at any rate, which seem to us oftentimes to be a bit exorbitant. It is too bad that those people should be put in the position of having to approach either their local or their central representatives and ask for a reduction in the bill in respect of services which were rendered to them.

It was our concern when we were in Government to ensure that the Health Act of 1953 would be fully implemented. At that time, we were subjected to some propaganda. It would, indeed, have saved us a good deal of trouble if some of the Deputies and Ministers opposite made the statements which they are making now prior to the general election. I suggest they should have said to the farmers: We intend to put our Minister for Health standing at the door of the Hospital and you will not pass without paying your way and we shall see to it that you will not pass.

Another disturbing element in this Bill is that the insured section of the community are to be transferred to each local authority. We are often told that the transference of the workings of various Departments to local departments will not mean any increased cost. I suggest that most of the farming community who would have enjoyed the benefits of our 1953 Health Act will now find themselves paying an increased rate without, in fact, enjoying any of the benefits which it was intended to provide for them in that Act. In my time, I have met smallholders whose life savings were wiped out by having to pay for medicines and medical treatment for, perhaps, the mother of the family or for the family.

It is no excuse for the Minister at this stage to come along and say that there is an insufficiency of hospitals and an insufficiency of appointments so far as the provision of a panel of doctors and nursing staffs is concerned. If Dr. Jenner had had to postpone his research in respect of a cure for smallpox, we should not to-day have a serum to cure the Black Plague. If Florence Nightingale had to postpone her trip to Scutari during the Crimean War we would never have the modern nursing methods we enjoy to-day. I say to the Minister that at the time both Doctor Jenner and Florence Nightingale were thinking of embarking on their various missions, they had not the sanction of their medical board either, any more than he would the sanction of the Irish Medical Association to-day. In effect, he comes up with the excuse that, because we have not enough accommodation, and because every person in the country who might be a potential patient might be expected to fall sick at the same time, hospitals would be crowded out, etc.—that is one of the reasons he gives as prompting him in his decision to bring into the House this 1954 piece of legislation which I say is calculated to delete the vital sections of the Health Act, 1953, and devitalise it.

It is difficult indeed for those of us who remember Labour's attitude in this House during the passage of the Health Act to contrast their conduct this evening and look over at the benches and see the interest they are inclined to display in the health of the community. At that time they nagged us and prompted us and told us that we were not going far enough in our efforts to provide medical services for the people. They went one better, and Deputy Norton, who was then Leader of the Party, assured us that he would bring into this House a much more comprehensive programme and that if given a mandate from the people either on his own or in company with a group of other Parties he would not have any hesitation about doing so, that he would not delay in doing so and that he would urge whatever Party he coalesced with to do it. It is a strange action to-day on the part of the Labour Party that they are collaborating with the Fine Gael Party, as I say, to delete vital sections of this Health Act.

The phase of the public health which presents itself to us down the country is that farmers are hesitant to take advantage of medical treatment because of the cost involved. Sometimes, in the case at any rate of one of our most dreaded diseases, cancer, it happens that the disease has got a grip and that it is incurable, and from that point of view it is too bad that our people should be prevented from having recourse to the best medical advice when stricken with that dread disease. I say again that it is no argument for the Minister to come into the House and say: "We are not ready. We have not the appointments. We have not the doctors or the nurses." We have to make a start somewhere.

I noticed last night and the night before, as quoted in the Irish Press, that if the parliamentary Labour Party display complacency over the Health Act their followers in Dublin and the country do not seem to be so complacent. Here is a quotation from a news item which appeared in the Irish Press:—

"The Dublin Trades Union Council last night decided by 36 votes to five to refer to the executive committee a motion from the Irish Women Workers' Union protesting against the delay in the implementation of the Health Act. The motion called on the Labour Party to do all in its power to secure its implementation no later than October next so that the lower income groups of the community may not be deprived of such relief from the financial burden of illness as they have learned to expect from the promised dates."

One would think that the parliamentary Labour Party would display more interest in a resolution of that type coming from the rank and file of labour. We on this side of the House, as I said before, who fought so hard to pilot this measure through the House in 1953, cannot but deplore the action of a group who told us then that we were not going far enough; but, as it transpires, we went a bit too far, apparently, for the conservative leaders of that Party.

I suggest to the Minister again to reconsider his decision on this whole matter and, if he is not in a position to reconsider it, to give this House an assurance that he will implement at an early date the three vital sections which, as I say, were the three sections on which the Health Act of 1953 was hinged. If he does so, he will satisfy the House and the country that Fine Gael and their colleagues in the Coalition are sincere in their speeches and in their talks regarding the health of the people.

Mr. J.J. Collins

I do not intend to keep the Minister long. I notice that he is in a hurry to get in but I would just like to say a few words in this debate. I believe that all the time spent so far in discussing this Health Bill, 1954, will be justified, and all the suspicion that was raised on this side of the House can be very easily allayed if the Minister, when replying, will definitely tell us that it is his intention only to postpone Sections 14, 15 and the other sections that apply to the middle income group to a specific date. If we can get that assurance in pinning the Minister down that the sections he is now deferring which relate to and deal with the middle income group will come into operation in the very near future, I think that, notwithstanding the delay we have caused to this Bill by all the speeches made from both sides of the House, something good will have been achieved.

Personally, I think that the Minister for Health, Deputy O'Higgins, has his hands full in this matter. In this morning's papers we read a report of the meeting of the Irish Medical Association in Killarney yesterday, and the incoming chairman of the Irish Medicial Association clearly stated that they are absolutely opposed in toto to the implementation of the 1953 Act. I know myself, and many Deputies on this side of the House also fully realise, in fairness to Fine Gael, that they have been consistent. They opposed this Health Act tooth and nail when Deputy Dr. Ryan was putting it through this House, and they even went further afield.

They even sent out whips to their representatives on local bodies to oppose it vigorously, especially at the estimates meetings, so as to ensure that financial provision would not be made for its implementation and operation. We had that clearly demonstrated in the County of Limerick. However, we went ahead and I can say that I have not heard that the Minister has mentioned that he recived any complaints, or objections rather, from the County Limerick as to our ability or otherwise or our means in implementing that Act. I am certain that were it not for the fact that he is dependent on the Labour Deputies to keep his Government, the Fine Gael Government, in existence, it would be the genuine form of the Fine Gael Party to revoke that Act in its entirety.

I was disappointed by the speech of Deputy James Larkin. I thought that he, as one of the most independent of the Labour Deputies, would have taken a different line from the line he took. His summing up of the situation was that, if the Minister would give the House and his Party an assurance that the Act would not be too long delayed, if he would pin himself down to a definite date for the full implementation of the sections of the Act which apply to the middle classes, he might satisfy the Labour Party and possibly we on this side would be pleased also.

We can understand that it may not be easy for a new Minister in the transition period to get a proper grasp and a thorough knowledge of all the duties and responsibilities attaching to his office, but he mentioned in his opening statement that there were ethical matters which must be considered. I should like him to tell the House if it is his intention to operate the Act and to bring into force those sections which deal with the middle income group, and, if he finds himself up against strong organised opposition from the Irish Medical Association, exactly what his attitude will be.

If we are to take it that the policy of that association is as was outlined by the incoming president yesterday, that they are not prepared to implement the Act or operate it in any shape or form, what will be the attitude of the Minister and of the Fine Gael and Labour Deputies supporting him? Will he tell the House whether he will be prepared, in the event of his failing to secure agreement with the Irish Medical Association, to publish the terms of the employment and the fees being offered to the profession?

There is talk about the lower income group and about the provision made for them in the 1939 Act and the 1947 Act but we know how difficult it is, unless a person qualifies 100 per cent as a red ticket case, for many patients in that class to get the medical or hospital treatment needed. We have every other day members of the small farming community who will not qualify on the basis of home assistance and who will not qualify on the recommendation of the local dispensary doctor in relation to going into the county home. We have a voluntary hospital in Limerick —I think there are only two other such hospitals in rural Ireland at all events —which we regard as an overflow hospital for our county cases, but we have from the West of Limerick and the mountainous portions of East Limerick patients going in there day after day who do not ordinarily qualify as members of the lower income group.

We have to take these people into our county infirmary and the charges they are asked to pay are absolutely beyond their capacity. We have meeting after meeting at which bills come before us and at which the secretary of the hospital produces letters from farmers and their wives and from others of that class stating that they cannot pay. Last year I brought three farmers whose valuations did not exceed £12 10s. to Dublin for treatment. They had to get that treatment at a terrible sacrifice to themselves and their families in a Dublin hospital. They had to pay hospital fees and surgeons' fees and in one case the charge was so high that it crippled the family for years to come. I went back to the county manager in Limerick and asked him if he could do anything to relieve them of this heavy charge and he said he could do nothing, that the particular patient, from the report received from the home assistance officer, did not come within the classification of the lower income group. Therefore, from the health estimate of County Limerick, we were not able to contribute one penny.

The point is made by Deputies and even by the Minister that if these provisions came into operation on August 1st we would have something like an epidemic of sickness and that suddenly all our hospitals would be besieged by patients in every county, in Dublin City and in our other cities. That is not so at all and it cannot possibly happen. There is the ordinary percentage of sickness from August 1st to December 31st that we have experienced for the past three or four years and I would much prefer to see the Minister coming in here and saying straight out and bluntly that he was not ready, that, as a new Minister, he had not had the time or opportunity to get a thorough grasp or understanding of the Act. Instead, he came in here and talked about certain local authorities. He did not include Dublin Corporation until Deputy Briscoe extracted the information from the Parliamentary Secretary to the Taoiseach that Dublin Corporation had clearly stated in their communications to the Department that, if they had had the opportunity of having the conferences for which they had asked, they would have no bother or trouble in implementing the sections which are now to be deferred.

If we can put any value on the words spoken at the meeting of the Irish Medical Association in Killarney, and give them their true interpretation as we read them in this morning's Press, where it was clearly stated that they intend opposing the 1953 Health Act from A to Z, the Minister must be a miracle worker if he can get the Irish Medical Association to come here between July and the end of the year and tell him that they are prepared to operate that Act.

If the Irish Medical Association give the Minister a refusal, the only thing he has to do is to publish the terms and the fees that the Department of Health are prepared to give all our eminent physicians, practitioners, dispensary doctors and other doctors in rural parts of the country for the services they render under this Act.

There seems to be a great objection to this Health Act among the doctors of this country. I met a few of them who went to the trouble of studying the Bill and who took some little time to make up their minds in this matter. From the doctors' point of view I do not to think it is a bad Act at all. In the long run it might prove itself to be a good doctors' Act. We do not mind if it should prove itself thus so long as the people in whom we are interested, the people in the middle income group, the farmers with a valuation up to £50 and the people whose incomes do not exceed £600, get the services we believe they are entitled to receive as incorporated in the 1953 Health Act.

The Minister, Deputy O'Higgins, will allay all the fears and suspicions that have been aroused here for the last couple of days if he will tell this House when he is concluding—we will give him full credit for the points he says influenced him in postponing the operation of the Act—that he will name a specific date for the implementation of the sections he is now asking the House to defer.

Mr. Maher

The decision to put in abeyance the operation of the 1953 Health Act results in denying to a very needy section of our people a measure of relief that is long overdue to them. I am referring to the small farmers of the country. Under the provisions of the 1953 Health Act certain facilities were provided for the agricultural holder whose valuation did not exceed £50. We believe these facilities were absolutely essential and barely met the requirements of the people to whom I have referred.

I became a member of a public health authority some three or four years ago, and I can say truthfully that since then not a single week has passed that I have not had occasion to go to the county manager and plead on behalf of a small farmer asking to have the bill incurred by himself, his wife, or one of his children reduced or wiped out. I am personally conversant with all the circumstances, and I am convinced that in the vast majority of cases these people are unable to pay their hospital bills.

At our estimates meeting in County Laois we made the financial provision that was necessary in order to implement the services under the 1953 Health Act. We felt we were doing our duty in that way. The reason we felt it necessary to do that is that in County Laois we have 4,191 agricultural holders whose valuations are between £4 and £30; and in County Offaly, the other county in the constituency, we have 4,166 people in that category, making a total of 8,357 agricultural holders whose valuation is above £4 and does not exneed £30.

These people by the working of their small uneconomic holdings are unable to get the county council rate of pay from their activities. I believe they have not as high a standard of living as the county council worker, and in a lot of cases I am afraid their standard of living is below that enjoyed by the agricultural worker. They have no guaranteed remuneration. They have only two or three times a year to sell pigs, fowl, or a couple of small cattle. Their position is anything but sound as far as finances are concerned. Consequently, they are unable to pay hospital bills when they have the misfortune to run into a period of adversity or when sickness strikes their household. Sickness, as we all know, is an unprovided for reverse and when it comes most people are not able to face up to the financial liabilities involved.

Although a lot of progressive legislation has gone on the Statute Books of this country in the last 22 years little or nothing has been done for the smallholders to whom I have referred. They have been at the giving end for 22 years. They were about to be brought to the receiving end for the first time under the terms of the 1953 Health Act. It is a major blunder and I am very sorry that the Government should decide to put in abeyance that Act which conferred a long overdue benefit on a very needy section of the people. The services that are provided under all the measures that were passed by this House have to be paid for out of local or general taxation.

The uneconomic agricultural holders have born the full brunt of the steep increase that has taken place in rates over the years. They have been contributing through their bottle of stout and their packet of cigarettes to the national Exchequer and they have figured prominently as far as contributing to the Exchequer for the other public services is concerned. This is the first time they were ever going to receive a benefit and the Minister and the Government are making a mistake by denying it to them. I feel that in the circumstances the best that can be done is to give us a specific date letting us know exactly when the people will come into receipt of these benefits.

It has been said here that the required accommodation is lacking. I do not accept that argument. From my own personal experience—again I am referring to the smallholders—the plight of these people has always been the hospital bill they got in respect of treatment of which they have already availed. The accommodation and the facilities were there; it was a question of finance. They came along with the bill of £25, £40 or maybe £50 and when a public representative, a county councillor or a Dáil Deputy, made representations to the county manager, inquiries were instituted, inquiries that I believe were of a very humiliating nature. The home assistance officer was sent out to make inquiries as to the financial position of a particular person. He counted the hens, the hen eggs, the number of in-calf heifers and he searched the place. In so far as it lay within his power he did his best to ensure that that person would pay the hospital bill that had been incurred. It was only where a person could declare himself a pauper that the bill was wiped out. I believe these inquiries were humiliating to the people concerned.

I felt that under the 1953 Health Act they were given facilities that were long overdue to them. As I said already, it is the first time that this important section of our people—4,191 in my own county and 4,166 in the adjoining County of Offaly—was being considered. I felt that these people were being denied that measure of relief to which they were legitimately entitled. Apart altogether from that, there is still a number of people who would, perhaps, qualify as public assistance people. The total number of agricultural holdings in my constituency and in the Minister's constituency of under £50 valuation is 12,405. That represents a fairly significant section of our people.

I would ask the Minister, as a very special request, to give a specific date as to when he will be in a position to implement those sections of the 1953 Act that will place those people in the position that they will no longer have to come along to myself, the Minister, a county councillor or anybody else and declare, with their hats in their hands, that they are not able to pay the hospital bills in respect of their wives, their children or themselves. The question of accommodation does not arise. It is entirely a question of finance. I would ask the Minister to give favourable and sympathetic consideration to the plight of these people and endeavour to do what he can to help them. If he does that, he will do a very good job of work for the people who for the past 22 years have been at the giving end and who were coming to the receiving end for the first time under the 1953 Act.

Mr. Killilea

The Minister, in moving this Bill yesterday, gave us details of his efforts to find out why the Act should not be put into operation. He told us that we should have had discussions with the doctors, nurses, chemists and hospital authorities but he carefully avoided telling us what he proposes to do either now or in the near future. That is one of the things we are very anxious to find out from him before we consent to give the Second Reading to this Bill. He told us that no action was taken until the general election appeared on the horizon. He also outlined a number of other things which should be done. He told us it was only on the 31st March that his predecessor decided to put into operation on August 1st certain sections of the Health Act, of 1953.

He did not tell us that Deputy Dr. Ryan, who was then Minister for Health, had met the representatives of every county council in Ireland and had given them details as to what he intended to do and when he intended to give effect to certain sections of the Health Act. He did not tell us that those representatives came back, prior to the striking of the rate by the different local authorities and county councils throughout the country, and indicated to their councils what the Minister's intentions were, thereby enabling those people to strike a rate to give effect to the provisions of the Health Act. I do not think I know of any county council which did not strike a rate for that particular purpose.

The Minister went on to explain that the National Health Council was established on 1st April. I should like to know what exactly were the functions of this council when it was established. If they served any purpose at all to my mind that purpose was to give effect to and see that arrangements were made to give effect to the Health Act. We were led to understand that he met them at a later date. I think that none of us took from his speech that the purpose of his meeting them was to stress the importance of getting to work and having arrangements made to give effect to the sections of the Health Act that were to come into operation on August 1st. He left doubts in the mind of many of us as to what his purpose was. He left us quite open to believe that his main purpose for having called that meeting —the chairman arranged the calling of the meeting—was in order to see that the Health Act would not be given effect to.

Yesterday Deputy Dr. Ryan asked him what were the arguments used with the chairman of that council. We have not yet heard what they were, but we are, as I say, quite entitled to believe that they were purely for the purpose of seeing that the Health Act would not be given effect to. It is very evident to all of us what the attitude of his whole Party is. I am rather surprised that the Labour Party have seen fit to support this Bill in order to help the Fine Gael people not to give effect to the Health Act of 1953.

I would advise every member of the Labour Party, particularly the new members, to go into the Library and take up Volume 138 and read it carefully page by page. It is a pretty big volume but it affords a very useful study because you have there the whole attitude of Fine Gael towards this Health Act—the same attitude which they had to all social legislation introduced in this House as far back as I remember, and that is quite a long time.

The Minister has never been a member of a local authority; neither does he appear to know anything about the work that local authorities do. If he did, he would fully realise that the hospitals are doing their work. I know of no patient requiring hospitalisation who has not received it. I know of no patient requiring any type of medical attention who has not got it. I know that in every post I get there are a number of bills forwarded to me by people who are unable to meet the demands made on them by the county managers. That has been a very big problem in our county council. It is one of the biggest problems we have.

The Minister seemed to go to a great deal of trouble trying to find out what councils were not prepared to give effect to this Act. If he went to the same trouble to find out what councils are prepared to give effect to it, I am certain we would find that those prepared to give effect to the 1953 Act would be in the vast majority. Day after day we find ourselves confronted with unfortunate people who are unable to meet their hospital bills.

The present Taoiseach, when he was discussing the Money Resolution which was to give effect to the Health Act, 1953, made a number of statements, and I think it would be well worth while if Deputies examined his different statements. They would not have to go any further in the Fine Gael ranks, though they would find very interesting speeches from every member of Fine Gael who voted against the Health Act.

Any of us who might be led into the belief that Fine Gael are anxious to see a Health Act pass through this House for the benefit of the poorer sections of the community can have no doubt as to what the attitude of Fine Gael is in that regard when we read the speeches made in the past by the present Taoiseach. In Volume 138 at column 47 of the Official Report he is reported as saying:—

"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."

Now the middle classes, I take it, are those who are defined as being in receipt of an income of less than £600 per year, or the farmer under £50 valuation; that is the farmer that the present Taoiseach told us rides around in a Rolls Royce. So far as I am concerned, those farmers are the hardest-working section of our community; they have to work hard in order to make ends meet. According to the statistics published, we have in County Galway 21,429 farmers living on holdings under £15 in valuation and we have 48.3 per cent. of farms in County Galway under 30 acres. I wonder how many of those ride around in Rolls Royce cars. I wonder how many of those can afford to pay very high hospital expenses or live in luxury, as the Taoiseach would have it. In the main they are the people who are appealing to us day after day to make representations to the county manager to try to have their bills reduced. They are the people for whom we are anxious to provide the best health services that can be provided because they are the hardest-working section of the community and they are, therefore, entitled to the best services that can be provided.

Further on, the Taoiseach stated:—

"We are against the proposal in the Bill and the expenditure of money on the Bill.... 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."

In page after page, that is the type of speech one will find coming from the present Taoiseach. The principal interest of the vast majority of the members of our county council, and I think I can say that I am speaking for every political Party represented on that county council, is to make full provision for hospitalisation; we are wholly dissatisfied with the procedure and the manner in which bills go out indiscriminately to every type of patient, be they poor patients, middling poor patients or middle class patients. I know of the case of a man with perhaps a fairly high valuation who met with a stroke of very hard luck. His wife and himself became ill. Some of his cattle died. During the time that his wife was in hospital his son had to go into hospital and later a daughter of his. Even though that man had a fairly good valuation he was a poor man, and yet our county manager proceeded to recover from him some hundreds of pounds that were due in the way of hospital expenses. How could a man in his circumstances meet a bill of that kind? How could he, with all his family worries, be considered to be in such a financial position that he could meet that bill?

It is because of cases of that kind that I feel satisfied the Minister should put into operation as soon as possible the provisions of the Health Act. If at the moment he does not know how he stands with regard to the Act, we are prepared to give him time to examine the position thoroughly, to make whatever arrangements he wants to in regard to doctors, nurses and other people who will have to be consulted before he can give effect to the provisions of the Act. I am asking him now to give us the date on which he thinks he will be able to do that. Surely that is not asking too much.

We are giving him a reasonable chance to name a date at his own discretion. No undue pressure will be brought to bear on him. But, as I have said earlier, I am quite satisfied that it is not the intention of the present Minister or of his Party or of the one other Party supporting him now, a Party which supported the Act when it was going through the House as a Bill, to see that effect will be given to that Act. All the speeches that we have heard from them are a clear indication that they are not prepared to do that.

As regards the rush and the burden which the implementation of the Act would, it is said, place on local authorities, I remember distinctly, in connection with another Act, that the Department insisted that the local authority in my county should, without warning and almost overnight, appoint, I think, 12 additional doctors and a number of additional nurses within a period. So far as I know, the county councils did not kick-up about that even though they were not given time to think the matter over. They just did the job. I agree with those people who say that if the Minister was sincere in his desire to give effect to the Act he could, if he wished, get the local authorities to co-operate with him so that certain sections of it could come into operation on the 1st August.

I was amazed to hear some of the speeches which were made by members of the Labour Party, particularly by those who were inclined to come to the assistance of the Medical Association. I read over the speech which was made by Deputy James Larkin on the Financial Resolution and I could not gather from it that he had any sympathy with those people. He indicated quite clearly that it was not too much to expect from them that they should place their professional knowledge at the service of the people who required it. I agree with him on that.

We have been told that the hospitals in the country would not be able to cater for the thousands and thousands of people mentioned by the Minister. As regards maternity cases, I think it is true to say that, ordinarily, women prefer to remain at home if it is possible for them to get there the care they require. If we can make suitable provision for them in their own homes, by way of financial help and the service of doctors and nurses, then I think we will be able to relieve to a very great extent the pressure on our hospitals. If the Minister indicates that he is prepared to do that he will get co-operation and help from this Party in any step he takes in that direction.

Mr. Burke

I am rather disappointed that a question concerning the health of our people should be responsible for so much political controversy. The Minister, at the end of his speech yesterday, said that he did not want to see acrimony entering into the debate. I was sorry that he did not say that in the opening part of his speech, because I believe that if he had done so it would have been a valuable contribution to the debate.

The people of Ireland have sent us here as their representatives. They expect us to be fair and impartial, to do the very best job that we can for them and not try to secure political kudos. From time to time, very hard things have been said here about the medical profession and the Medical Association. I know, of course, that medical men have their own job to do. Quite a number of them give their services for nothing. There are specialists in Dublin and a number of very good dispensary doctors throughout the country who, to my knowledge, have done very good work, completely free, particularly for the poorer sections of the community. If they are displaced from their employment, and if that is the reason why they are making their objections in connection with this measure, then I think the State should make sure that they are paid for any losses which they may sustain.

I do not want to say hard things about people who are not in a position to defend themselves. During the Second Reading of the 1953 Health Bill hard things were said here that did not do any good to any section of the community. Are the members of the Government Parties standing over the present position? I can quote a case of an ordinary road worker in North County Dublin whose father was in hospital. The county manager said that the son was well able to pay for the father. The mother died and the father died. The road worker came to me and asked me if I could do anything in the matter as he was not in a position to pay the bill. The county manager said that there was another brother in the house who was doing casual work. The result was that this man, who was only a road worker, had to pay the bill weekly. Are the members of the Labour Party and the members of Fine Gael standing over that and saying that that man will have to continue paying? Are they standing for the position that a man who needs hospital treatment will refuse to go into hospital because he will have to pay dearly for the hospitalisation?

There are sections in the Act which the present Minister states he will allow to go through. The Minister made a very dishonest statement the other day when he was introducing this Bill. He said that there was not enough hospital accommodation. Does any Deputy believe that anyone is going to get sick immediately and rush to hospital because the Health Act becomes law? No man or woman in this country believes that statement. We are supposed to be a Christian State. We should look after every section of our people as benefits the traditions of a Christian State. Yet we heard that statement made by a responsible Minister that we have not enough hospital accommodation. I maintain that that was a very dishonest statement. Nobody will go to hospital unless he is ill. When a person is advised to go to hospital he does so very reluctantly. If the Minister for Health made some other approach and made an honest statement and said: "I feel it is not an opportune time. We want to put it off for six months"—or gave some other valid reason, I expect the House would co-operate with him.

During the passage of the 1953 Bill I made an appeal to the Medical Association and to Deputy Dr. Ryan. Deputy Dr. Ryan met members of the Medical Association and other interests concerned at that period. I was hoping that that spirit of co-operation, goodwill and common understanding would exist now. I appeal to the House, even at this eleventh hour, to have the Bill taken out of this debate and appoint a Select Committee of the House and have consultation with interests outside this House so that there can be a common understanding and a spirit of goodwill and of give and take so that the Health Act of 1953 can be implemented.

Statements were made the other day about the fact that the Vote for the Department of Health had gone up from £5,000,000 to £11,000,000. As other Deputies have stated, the introduction of the T.B. allowance in 1947 was one of the greatest national investments of all time. It has paid dividends. It has saved the lives of our people. It is responsible, in conjunction with advanced hospital treatment, for reducing the death rate from T.B. by from 25 to 30 per cent. It will further succeed in reducing the death rate from T.B. Can any man or woman in this House state that any money we invest in the health of our people will not pay the nation and posterity? The various health services that were introduced by Fianna Fáil during the last number of years are paying the nation in the improved health of our people. Anyone who would say that any act of ours is responsible for interfering with the rights of any individual is wrong. We leave it to posterity to judge whether or not it is a crime for Fianna Fáil to support a Health Act designed to be fair to the sections of our people who were not in a position to get up-to-date treatment. The people who are trying to misrepresent anything we did during our period of office are not friends of this country. The Minister for Health, even at this eleventh hour, should take this Bill out of this debate altogether and say: "I am prepared to let this Bill go to a Select Committee of the House and to meet all other sections outside this House who have anything to say against it."

An Ceann Comhairle

I think the Deputy said that before.

Mr. Burke

I did but you cannot say a good thing too often.

An Ceann Comhairle

Repetition is out of order.

Mr. Burke

Anything that we have done was done in the interests of the greater number of our people. If the Minister is sincere and if he states that he will implement the 1953 Act in the course of five or six or seven months, or any such time, I, with the remainder of my Party, am prepared to say that that is fair. I am not convinced that the argument that he is putting up is true, that we have not the services, that we have not the hospital accommodation, that we have not the clinics and all these things to implement the Act. That is why I am on my feet. I do not believe that argument is true because I believe that we will not have a sudden rush on hospitals or clinics or anything else. I am convinced that the normal procedure will take its course. The Minister should re-examine the position in the light of this debate and, if he can do anything to bring about a spirit of goodwill, I appeal to him to do it so that much good can be achieved.

Mr. T.F. O'Higgins

We have now come to the end of the debate which commenced yesterday and in which many Deputies took part. I think anyone who has listened to this debate or who has followed what has been said by Opposition Deputies must come to the conclusion that they have contributed very little to the solution of this Parliament's problem, which is my particular obligation—the provision of proper health services for the people of this country.

I came in here yesterday with a Bill. I put it before the House in as fair a manner as I could. I asked for goodwill; I asked for co-operation; I asked for understanding, and I asked for help from the Deputies elected to this Parliament representing the people of this country and, instead of getting that goodwill or co-operation or help from the Fianna Fáil Opposition, I have had to listen to, and see, for the past two days a political game being played by experienced players.

I do not say that every Deputy of the Opposition who has spoken was indulging in politics. "Briseann an duthchas tré shúilibh an chait," and the innate decency of some Deputies of Fianna Fáil made their approach to this measure what I would expect of a proper public representative. But they were in the minority. The majority of the Deputies opposite once they got to their feet forgot completely about the sick and needy in this country and were prepared merely to score political points off either my colleagues in the Labour Party, or of my own Party, or other Parties supporting this Government. I hope they enjoyed themselves and I hope it gave them some pleasure to add further to the confusion and acrimony that has surrounded the provision of decent health services for the people of this country, because that is the only pleasure they are going to get.

I think it is fair to say that some things have emerged clearly from this debate. I think first of all it is fair to say that from this debate it is clearly established that the case made by me as a member of the Government in proposing this Bill to the Dáil has not been answered even in the slightest by any Deputy from the Opposition. I told the Dáil that the Health Act, 1953, conferred on better-off sections of the community equal rights with the sick poor and the insured workers without the provision of the necessary extra facilities for those added classes. Has any Deputy in the Opposition attempted to deny that? Has there been any shifting of the onus that I believe was placed by the case made for this Bill? Is it not true now as it was when this debate started that unless this Dáil intervenes on August 1st next the distressed people in our community, who total one-third of our population, instead of having prior rights to existing hospital accommodation are going to be forced to take their place in a queue comprised of three added classes? That fact is still a fact and cannot be controverted.

Secondly, I said in opening this debate that prior to August 1st, when the Health Act will come into operation, every poor person in this country has a statutory right—I hope Deputies realise what that means—to get prior treatment in any hospital in this country. That is enshrined in the Public Assistance Act, 1939. It cannot be denied to any poor person who is sick and in need of hospital treatment. The right is there enshrined in the statutes of this Parliament. At the same time, as a result of the contracts and agreements worked out by the Department of Social Welfare, insured workers enjoy also an equal priority right. On August 1st, the Public Assistance Act, 1939, is repealed, torn up, gone away. The charter of the poor disappears and what is given to them instead?—an assurance that they may rub shoulders with every farmer whose valuation does not exceed £50, with every person whose income does not exceed £600, and with everyone else who can prove a bit of hardship in paying hospital bills, and instead of having the prior rights that their circumstances in ordinary Christian decency should dictate, they take their place in a queue comprising a number of added people. Again, that fact has not been controverted or denied. Concealed, of course, it has been, in a web of words spun by different Deputies over there, but the fact still remains that under this legislation, unless we take steps to prevent it, the poor people, instead of being at the head of the queue, will take their place at the end.

Thirdly, I said in opening this debate that every local authority hospital and every voluntary hospital in this country—all our hospitals—are at the moment taxed to capacity in providing for the sick poor and for the insured classes the necessary hospital facilities that their sickness or conditions require. Has that been controverted? Any Deputy who spoke or contributed here either avoided what I said about hospital accommodation, or throughout his speech had to concede that the facts were as I stated.

I said, fourthly, that as a result of these facts and without any argument from me—because facts are the best arguments—with limited hospital accommodation barely able to provide for existing classes, if those classes are added to with the statutory right given to added people to demand hospital accommodation which is not there, someone is going to suffer. It may be a matter that will give some satisfaction to legislators and planners and schemers in this Dáil to put down in black and white on a page in our Statute Books a statutory right that a person who is sick and in need of hospital accommodation can go to a local authority and demand that accommodation.

That may be a source of pleasure to some people, but it is a heartless thing to do to those who expect that an Irish law enacted by an Irish Parliament means something.

As I said yesterday, in promising that by our statutes we were doing something which we were unable to fulfil, we were sponsoring hopes amongest certain needs people of this country, hopes that were bound to be dashed. I think it fair to say, as I said yesterday—and nothing said in this debate has in any way vitiated the conclusion at which the facts must lead everyone to arrive—that someone must suffer if the Health Act of 1953 is not amended in the slight particular I have proposed in this House. As I have said, there was an amazing effort, by Deputies in the Fianna Fáil Party who spoke, to avoid dealing with the hard and unpleasant facts which I placed before the Dáil. Instead, in a side-stepping sort of manner, we had a great number of irrelevant matters drawn into this debate. I am not going to deal with all of these irrelevancies; with some of them I shall deal. Perhaps if I take them in the order in which Deputies spoke in the debate it might be the best way to deal with them.

Deputy Dr. Ryan led off for the Opposition and naturally, being more or less on the defensive, although I was not concerned at that time to be unduly hard on Deputy Dr. Ryan, he felt that some explanation was expected from him because of the appalling situation that his action or inaction had allowed to develop.

He, first of all, denied what he took from my opening statement—that he had no discussions with those whose services would be required to provide the facilities set out in the Health Act of 1953. Of course, Deputy Dr. Ryan had discussions with the doctors. We all know that. We all know also that those discussions led nowhere and that agreement had not been reached. In fact, the last time Deputy Dr. Ryan met the doctors was away back on the 12th January of this year. He never met them after that, never discussed with them the making of the regulations which brought on the situation I have discussed. He met them on the 12th January but not since.

Of course, the voluntary hospitals were informed of what was proposed. They got a circular sent out to each one of them. Some officers of the Department went along to them but no effort, good, bad or indifferent—these are the words I used yesterday and I repeat them now at the end of this debate—was made by my predecessor to get the representatives of the voluntary hospitals together and to try to get an agreement with them as to the terms and the conditions on which they would provide the essential services required for the operation of the Health Act. My predecessor never met the nurses. The nurses are an important organisation to provide the necessary services under the Health Act, 1953. He did not meet them and, in fact, the nurses' organisation and allied bodies are extremely concerned at the fact that regulations have been made affecting their interests without their views, their comments or their recommendations being considered. My predecessor never met the dentists. It is true that a particular meeting was arranged but it did not take place, due to no fault, I hasten to add, of my predecessor. In fact, he did not meet the representatives of the dental profession.

This morning every Deputy will have received a communication which I may assure the Fianna Fáil Party I did not write—a communication from the chemists' organisation in which they write, I assume, to every Deputy and certainly to me:—

"Our organisation, representative of Irish chemists, regards with dismay the proposed regulations which have been issued under the present and previous Health Acts. The ultimate aim of these proposed regulations is the establishment of dispensaries, clinics, and various hospital centres throughout the country, through which every section of the community is to be supplied with all medicines and surgical and medical requirements. The regulations are a directive to abolish our profession and the retail business of over 1,000 chemists."

That may be right or wrong—I do not know—but there is a protest and an objection raised again by a body of persons whose services must be availed of by me, or by whoever from time to time may be charged with the administration of these necessary services. Again, there is the situation now obtaining in relation to that important body.

I am trying to be as fair as I can, but I realise that I am only human and patience is limited, and I feel entitled to ask this of my predecessor. If he did not get agreement with the doctors—apparently, according to the contributions of Fianna Fáil to this debate, it is a bad thing to agree with the doctors, but leave that aside—if he did not get agreement with the dentists, the nurses, the chemists or the hospitals, who was going to work this Health Act? Who was going to provide the services? Were operations to be done by carpenters, by cobblers, by policemen, by Guards or by county managers? Who was supposed to provide the services promised by our legislation for the sick, the needy, the distressed, the hopeless cases and the afflicted in this country? Who was playing politics? Would it be fair to ask what sense of responsibility permitted any Minister in that situation to stand idly by doing nothing—I have no doubt whistling to keep his courage up, believing in the same way as travelling actors always believe, that "although things look bad now, everything will be well to-night." That is a fair question to ask, but no answer to it has been given in this debate.

I am afraid the picture on examination became much worse. In relation to these fundamental matters, the inaction—that is the best word and it is apt in this connection—on my predecessor's part was not of short duration. The Second Reading of the Health Bill 1953 took place in February 1953 and the Bill was eventually passed in October of that year. From October until March no regulations had been made. The Health Council had not been formed, no agreements had been arrived at, but everything was going along smoothly. From time to time, if a public statement had to be made, my predecessor was in the habit of saying: "Oh, well we hope to have the health services on April 1st or as near thereafter as makes no difference". He went on in that sort of way, promising, promising, promising health services but doing nothing until the former Taoiseach announced on 6th March, 1954, that a general election would take place and that the Dáil would be dissolved. Then the lethargy disappeared, the inactivity was thrown to one side, and my predecessor became a bundle of energy, a dynamic force in the Custom House.

On the 22nd March, as I said in opening, a memorandum was suddenly submitted to the Government. The provision of health services had become a matter of urgency for the people of this country. On the 31st March commencement Order was made bringing this Health Act into operation without any preparation, any proper examination—bringing it into operation on August 1st. On the following day the National Health Council was formed.

A few days later, seven sets of regulations were thrown at them and they were told to examine them and give them back to the Minister by the 5th May. On the 15th May, three days before polling, these regulations were made by my predecessor and were published in the daily Press so that every person in this land who went to vote on the 18th May would vote with the assurance on paper that on August 1st if they were sick, distressed or afflicted with any disease or malady, hospitals were there for them, surgeons were there for them, doctors and nurses were there for them. I call that irresponsibility of a high degree. I call that doing a very serious disservice to the people of this country.

I have no doubt that the making of that commencement Order and the issuing and publication of these regulations were intended to constitute an appalling political trick on the man who might succeed my predecessor. I do not in the slightest belittle the acumen, in terms of politics, of the brain that devised this particular episode. As I said to the House yesterday it was not any source of pleasure to me, to this Government, or to any Party supporting this Government to have to come into this Dáil with another Health Bill, to suffer the odium of the jeers and sneers of the Fianna Fáil Opposition. But we have done it because we are a responsible Government; we have done it because we are concerned to see that our people will not suffer, that our poor will not be made pawns in the political game. We have done it because we believe that no matter what the price may be, doing the right thing will be always recognised by our people as best in the long run.

Deputy Dr. Ryan blew a fanfare at Lower Mount Street, Dublin, the other night before this debate started. He got together a meeting of a Fianna Fáil cumann and he made a speech. Just listen to what he said. The heading to the report of the speech in one of the newspapers supporting the Deputy's Party was as follows:—"New Bill Designed to put Health Act in Cold Storage." Here is what Deputy Dr. Ryan said:—

"When the Act was going through the Dáil last year Fine Gael used every conceivable argument against it, and among them was one from the present Minister for Health, Mr. O'Higgins, who said that the Government had no intention of implementing the Act, but was forcing it through the Dáil for political reasons. I replied that it was proposed to bring the Act into operation on April 1st, 1954. We were again accused in the Seanad of having no intention of implementing the Bill, and I reiterated the intention of bringing it into operation on April 1st. When April 1st was approaching, and when I saw that it was not possible to operate the Act on that date, I discussed the position with the Department, whose officers were in a position to give an informed and objective opinion, and I was advised that it would be quite feasible to operate the main portions of the Act on July 1st. With my usual caution, I decided to allow another month, and made the necessary Order to bring the Act into operation on August 1st."

I direct the attention of the House to this sentence: "When April 1st was approaching and when I saw that it was not possible to operate the Act on that date..." I would have expected the Deputy who made that speech to have been able to tell the House what happened after April 1st to make the services under this Act more operable than they were on April 1st. Did anything take place in this country to make it possible to provide, on August 1st, what Deputy Dr. Ryan said could not be provided on April 1st? We all know nothing— except the general election. That is the only new factor, the only new thing, that cropped up or emerged in the situation—nothing except a general election. I charge that, for purposes of that election and for those purposes only, my predecessor made this commencement Order, published these regulations, scrambled the egg, threw it at the public and sat back to see what would happen. I am sure that he may regard that as being smart politics.

Donnchadh Ó Briain

Hear, hear:— on the part of the Minister.

Mr. T.F. O'Higgins

However, there are hundreds of thousands of people in this country who were being led up the garden path in a most uncharitable way.

Donnchadh Ó Briain

They are being led up it now.

Mr. T.F. O'Higgins

We will not stand for that.

Dr. Ryan

Would the Minister read the rest of that speech? The Minister quoted part of my speech. I think he should be made read the whole lot.

Mr. T.F. O'Higgins

If the Deputy thinks there was anything worth while in that speech, he had an opportunity yesterday of making it.

Dr. Ryan

I do. That is why I want the Minister to read it.

Mr. T.F. O'Higgins

I am not finished with it yet.

Dr. Ryan

Read it all.

Mr. T.F. O'Higgins

The Deputy went on to refer to the National Health Council.

Dr. Ryan

Read it all, not just excerpts.

Mr. T.F. O'Higgins

I expected, of course, that the resolution of the National Health Council would cause a certain amount of anger amongst the Deputy's Party. Again, it is good to repeat these things. The National Health Council is a body which was formed and appointed by my predecessor. They were appointed in accordance with an amendment specially introduced by my predecessor one famous afternoon to the Health Bill of 1953. I think I will just read the relevant section of the Health Act because it may be material to some Deputies who just did not follow the function of the National Health Council. The National Health Council was formed to advise the Minister on such general matters affecting or incidental to the health of the people as may be referred to them by the Minister and on such other general matters relating to the operation of the health services as they think fit.

Dr. Ryan

"As they think fit."

Mr. T.F. O'Higgins

"As they think fit."

Dr. Ryan

What about "as the Minister thinks fit"?

Mr. T.F. O'Higgins

Under the Act, this advisory body could do two things. First, they could advise the Minister on the problem the Minister himself put before them or, secondly, they could advise the Minister without being consulted by him. It is an advisory body which was framed, designed and appointed by my predecessor. That body held seven meetings. Their last meeting was held on the 25th June—at my request. I do not make any secret of that. I was only two days in the Custom House when I was informed in my Department that the National Health Council were meeting the following day and expected me to go along and speak to them. I said I did not feel I could do it because I was only beginning to learn some of the problems that faced me. However, I said I hoped I would be able to meet them some time later. Being concerned —and, indeed, I was concerned—at the appalling situation that I saw looming up as the 1st August began to approach, I asked the chairman of the National Health Council to convene a meeting so that I could place before them the problem as I saw it in accordance with what that statute—being no more than Deputy Dr. Ryan's own statute—asked me to do. I went to them and spoke to them for three minutes. I placed the facts before them. Then I left them, asking them to give me their advice. I did not suggest any course to them, good, bad or indifferent. I merely put the problem before them and left them.

Deputy Dr. Ryan tried to suggest— of course he did it by way of innuendo —that here was a specially got together meeting of the council with a prepared resolution pulled out of somebody's pocket and probably written by me.

Dr. Ryan

Not by you.

Mr. T.F. O'Higgins

Probably written at my direction. Then, a chorus of "Ayes"—and the Minister gets the advice he wants. Let me say that that advice from the National Health Council was unanimous. Amongst those present were at least two staunch supporters of the Fianna Fáil Party. Also amongst those present were two county managers— whole-time officials not subject to direction from me or anyone else, not concerned with or interested in politics. Amongst those present, in addition, were two other nominees of the Minister—persons appointed by him, not by me, and persons not sent there by any nominating body. That council, framed and formed in that way, unanimously resolved that, by reason of the situation which they saw and knew of, I should be advised to take whatever steps would be necessary to postpone the repeal of the Public Assistance Act, 1939, and postpone the operation of Part III of the Health Act. There is their unanimous opinion—and, just because it does not coincide with the political views of Deputy Dr. Ryan, the National Health Council were told by him yesterday that they are going into politics.

Dr. Ryan

I said they were brought into politics—by you.

Mr. T.F. O'Higgins

Because they happened to express a view that does not suit Deputy Dr. Ryan! Did you ever hear such an approach! He puts in the section their statutory right to advise the Minister. He appoints the body himself and then, when they advise the man who succeeded him, they are told they are being brought into politics!

Dr. Ryan

Yes.

Mr. T.F. O'Higgins

I wonder if the Deputy would bear with me for a moment. You see, I was not Minister for Health on the 29th May and I could not have convened the National Health Council. I did not even know then that I was going to be Minister for Health. On the 29th May Deputy Dr. Ryan was still in the Custom House. He still controlled the National Health Council. He pulled the strings, if strings were to be pulled.

Dr. Ryan

I pulled no strings: I loosened the strings. The Minister is pulling strings. No strings were pulled at that time. The strings are pulled now, though.

Mr. T.F. O'Higgins

The Deputy will not succeed in preventing me from saying what I intend to say. I think he knows what is coming.

Dr. Ryan

Pulling strings.

An Leas-Cheann Comhairle

Order!

Mr. T.F. O'Higgins

On the 29th May, the National Health Council sent to my predecessor—Deputy Dr. Ryan —the following unanimous resolution:—

"The National Health Council, having further considered the Maternity and Child Services Regulations, passed the following resolution and directed that it be transmitted to the Minister for Health—‘Having regard to the complexity of the regulations, the absence of the necessary services and the importance of full and proper consideration by the council of the regulations in the interests of the people and the undetermined arrangements regarding hospitals and medical and nursing staffs, etc., the council gravely doubts whether the facilities which are required for the operation of the Maternity and Child Services Regulations are available, or can be made available at the date of coming into operation of these regulations. The council accordingly requests the Minister to inform the council as to the arrangements made in this connection. The council further desires to inform the Minister that they propose to submit to him a list of the facilities and requirements which are necessary for the provision of satisfactory services.'"

There is a view in relation to the maternity end of the problem which I discussed yesterday expressed by the Health Council on the 29th May.

Dr. Ryan

Without any strings being pulled?

Mr. T.F. O'Higgins

I do not know what sort of strings the Deputy has in mind. It was his council then.

Donnchadh Ó Briain

A very unhappy phrase.

Mr. O'Sullivan

He is taking his medicine at the moment.

An Leas-Cheann Comhairle

The Minister.

Mr. T.F. O'Higgins

I suppose I could go ahead and read the various other protests of the National Health Council sent to the Minister from time to time since they were formed on April 1st. On an earlier date, on the 10th May—I wonder were strings being pulled then?——

Dr. Ryan

No, only since the 2nd June.

Mr. T.F. O'Higgins

Only since the 2nd June? Well on the 10th May the council had occasion to protest to the Minister as follows:—

"I am desired by the National Health Council to refer to your letter of the 6th instant——"

That was a letter from the Minister agreeing to extend the time for consideration by the council of the regulations from the 5th to the 15th May.

Mr. Killilea

I thought that the Minister did not do anything at all.

Minister for Defence (General MacEoin)

No, but the election was on. This was one of the strings that was pulled.

Mr. T.F. O'Higgins

The National Health Council wrote on the 10th May:—

"I am desired by the National Health Council to refer to your letter of the 6th instant, and to state that the council have asked me to express their regret that the Minister could not allow them the time requested to consider the drafts in question."

They had requested that the Minister give them a further time to consider all the complications of these draft regulations, and the Minister failed to do that, and they expressed their regret. On the 1st June, the day before the Minister left the Custom House, they sent in a letter as follows:—

"I wish to inform you that at their meeting on the 28th May the National Health Council directed me to register a protest at the action of the Minister for Health in making the recent regulations under the Health Act, 1953, before the council had an opportunity to consider them adequately."

Now, in these circumstances and in the light of these facts, is there any Deputy in the Fianna Fáil Party who can deny the fact that this whole thing was a ginger-up for the election and nothing else? I have no doubt that that was the sole purpose which impelled my predecessor in a hasty, thoughtless, inconsiderate manner to band together seven sets of regulations, to force them into the public Press on the 15th May, and then to sit back, having brought the Act into operation and having made the regulations, knowing that it would be somebody else who would have to try to meet and solve the situation.

Deputy Dr. Ryan also said that he was concerned about the section in the Health Act providing for a choice of doctors, and he said that he would have thought that I would have advanced the difficulties in providing a choice of doctor as being one of the insuperable obstacles in my way. He went on to say that if I had advanced that argument, well, there would be a lot in it. Nevertheless, his Act tells the people that on and after August 1st they are to have a choice of doctors. Is not that merely putting a right on paper and not trying to provide it in fact? I am going to do my utmost, I can assure the House, to ensure that after August 1st or as near to that date as possible a choice of doctor will be available for everyone who requires it; but I know that in that connection I have got to meet and try to get the agreement of doctors. I cannot have a choice of doctors by getting two Guards or two nurses. I cannot get two doctors, but I am going to try and I hope I will succeed.

My intentions are to do my best, in any event, but I do not minimise that there is a difficulty there and that there is a problem that has to be faced. I will not be satisfied, I can assure the House, with being able to say: "Well, I provided for it in legislation but I did nothing else", because that is not a fair or reasonable approach to solve the difficulties of the people of this country.

Deputy Dr. Ryan also said: "Well, why does not the Minister come in here, not with this sort of Bill but with a Bill giving to the poor of this country a priority?" That, again, is the kind of illogical approach that I just cannot understand from Fianna Fáil. I thought the Health Act was trumpeted around the country as being a measure which was abolishing the term "public assistance" and the old poor law class and all the rest of it, and that never again would you have a red ticket or anything of that kind. Nevertheless, this reasonable measure is countered by Deputy Dr. Ryan by saying, in effect: "Why do you not bring in a measure to restore the priorities that existed under the public assistance code?" I do not know whether that appeals as good sense to anyone. It certainly does not to me.

The Deputy ended his speech by saying, in effect: "Well, look, give us a date and we are going to be very reasonable." Therein lies the whole answer to Fianna Fáil's approach to this measure. Therein lies complete proof of the play-acting that has been going on, because if they believed sincerely that these services could be provided on August 1st, if they believed sincerely that on August 1st everything under the Health Act would be there available to our people, that no one would suffer, no one would be disappointed, have they a right to say to me: "Give us another date and we will be satisfied"?

Donnchadh Ó Briain

But Deputy Larkin asked for the same thing.

Mr. T.F. O'Higgins

That is an admission by them that they knew that they could not have them by August 1st.

Dr. Ryan

Is not that a twist? That is a twist.

Mr. T.F. O'Higgins

It is a complete proof that we are right.

Dr. Ryan

It is a complete twist.

Mr. T.F. O'Higgins

I am not going to give any date.

Dr. Ryan

I know that.

Mr. T.F. O'Higgins

I am not going to raise false hopes again.

Dr. Ryan

No.

Mr. T.F. O'Higgins

I have pledged my political honour as a member of this Government sincerely to try to provide for the people of this country better services in fact rather than on paper, and I will do that as quickly as I possibly can. I realise only too well that the job that lies ahead will be a difficult one, and much that has been done may have to be undone, much may have to be done again; but I am not going to point to a figure on the calendar and let everybody know that I am working against time. If I did that I would achieve nothing. I ask Deputies to believe me when I say that I am going to do my best to provide these services as quickly as I can for the people of this country.

Other Deputies intervened in the debate and I should like Deputies to understand that I do not mean any offence to them if I do not mention them by name. They were so numerous that it would be impossible to do so. Any number of Deputies in Fianna Fáil made, in fact, the same speech. I always admire the Fianna Fáil Party for one thing: they can always get their boys to walk the same line and dance to the same jig. All their speeches were, in fact, the one speech, and the one speech was made by Deputy Dr. Ryan. It had a little bit of politics; it had a little bit of back-slapping; and it had a little bit of——

Captain Giles

Codology.

Mr. T.F. O'Higgins

That is a rather strong word—a little bit of offer of co-operation. They all ended, however, with: "Give us a date." I could not attempt to answer all the points made, but from time to time I was amused to see the absurdity into which trying to argue a bad case often leads one. My friend Deputy Dr. Hillery opposite was guilty of this extraordinary statement—that it is a good thing we have not got the hospitals and a good thing we have not got the facilities because. by not having them, by having people queueing up to get into them, we were going to create a public opinion and get them built.

Mr. Cunningham

He did not say that.

Dr. Hillery

I did not make any such statement.

Mr. Brady

It is only one of his usual twists.

Dr. Hillery

I will repeat what I did say, if I may.

Mr. T.F. O'Higgins

The words I took down from the Deputy were: "Let the people suffer and we will get the hospitals built."

Mr. Cunningham

NOt at all.

Mr. T.F. O'Higgins

That is my recollection of what the Deputy said.

Mr. Cunningham

And it is wrong, as usual.

Mr. T.F. O'Higgins

I took down what the Deputy said as he spoke it and that is my note of it. If the Deputy cares to give me what he said, I will give way.

Dr. Hillery

What I said was that, implied in the argument that implementation of the Bill would cause congestion in the hospitals is the fact that at the moment there are people without services and that until we get adequate accommodation we will not get services for these people and we will not get adequate accommodation until the people are fully conscious, by having to queue up, of the need for this accommodation. I see absolutely nothing funny about that, any more than I see anything funny about delaying the implementation of the Act.

Mr. T.F. O'Higgins

We have all heard what the Deputy said. I understand that to mean that, in the Deputy's view, it is a good thing to let the people suffer because then you will get the hospitals built. That is my understanding of what he said.

Mr. Cunningham

A lawyer's interpretation.

Donnchadh Ó Briain

Another twist.

Mr. Killilea

You will make sure that they will suffer.

Mr. T.F. O'Higgins

That particular meaning was also taken from it by Deputy Larkin who said that, if you let them die, you would get the hospitals built more quickly. We do not intend to let anyone suffer and we do not intend to let anyone die. We do intend to provide these facilities for the people of the country and we will do it, despite Fianna Fáil.

Donnchadh Ó Briain

Where is the political rancour now?

Mr. T.F. O'Higgins

There appears to be a mentality in this country, practically completely represented in Fianna Fáil, that you complete a necessary job of work by passing an Act to have it done. I want to assure Deputies that you are only starting when you do that and you have to make sure that what is on our Statute Book is not merely so much window dressing in a shop front with nothing behind it.

Dr. Ryan

Like the Republic of Ireland Act.

Mr. T.F. O'Higgins

We made Deputy Dr. Ryan a republican Minister of a republican Government.

(Interruptions.)

An Leas-Cheann Comhairle

Deputies should cease interrupting. The Minister should be allowed to conclude without any further interruptions.

Mr. T.F. O'Higgins

I want to apologise to the House if I do not deal in detail with all the other speeches. With regard to general matters of policy, I said in introducing this Bill that it is my intention and the intention of the Government to do our utmost to get the Health Act to work and to provide for the people the services under it, but I do not believe that the Health Act of 1953 or the services it provides represent all our people should get. That particular view was the view expressed by the present Taoiseach time and time again in the past few years. We are concerned to see that in as short a space of time as possible real decent services will be provided for the people of this country. To that end and with that aim, after the passing of this measure I hope to have a full examination of the entire problem in this country, an examination which, I hope, will lead very quickly to the provision of better services for our people. We cannot, I think, afford to be complacent in matters of this kind and we cannot afford idly to fashion into this country ideals which were sponsored elsewhere and I think that, strictly in accordance with Irish ideals and principles, it will be possible very quickly to provide better services for the ordinary people.

An Ceann Comhairle

I am informed that one of the tellers mentioned by the Chair is not in the House. I will, therefore, have to ask the House that another teller be appointed.

General Mulcahy

Have we to vote again?

An Ceann Comhairle

I think it would be a better procedure if the Deputies resumed their seats and the motion was put again.

Question put.

The Dáil divided: Tá: 73; Níl: 60.

Tá

• Barrett, Stephen D.
• Barry, Anthony.
• Barry, Richard.
• Belton, Jack.
• Blowick, Joseph.
• Burke, James J.
• Byrne, Alfred.
• Byrne, Thomas.
• Carew, John.
• Casey, Seán.
• Coburn, George.
• Collins, Seán.
• Connor, Johnny.
• Coogan, Fintan.
• Corish, Brendan.
• Cosgrave, Liam.
• Costello, Declan.
• Costello, John.
• Crotty, Patrick J.
• Crowe, Patrick.
• Davin, William.
• Deering, Mark.
• Desmond, Daniel.
• Dockrell, Henry P.
• Dockrell, Maurice E.
• Donegan, Patrick S.
• Donnellan, Michael.
• Doyle, Peadar S.
• Dunne, Seán.
• Esmonde, Anthony C.
• Fagan, Charles.
• Finlay, Thomas A.
• Flanagan, Oliver J.
• Giles, Patrick.
• Glynn, Brendan M.
• Hession, James M.
• Hughes, Joseph.
• Kenny, Henry.
• Keyes, Michael.
• Kyne, Thomas A.
• Larkin, Denis.
• Larkin, James.
• Leary, Johnny.
• Lindsay, Patrick J.
• Lynch, Thaddeus.
• MacBride, Seán.
• MacEoin, Seán.
• McGilligan, Patrick.
• McMenamin, Daniel.
• Madden, David J.
• Manley, Timothy.
• Morrissey, Dan.
• Mulcahy, Richard.
• Murphy, Michael P.
• Murphy, William.
• Norton, William.
• O'Carroll, Maureen.
• O'Donnell, Patrick.
• O'Donovan, John.
• O'Hara, Thomas.
• O'Higgins, Michael J.
• O'Higgins, Thomas F.
• O'Reilly, Patrick.
• O'Sullivan, Denis J.
• Palmer, Patrick W.
• Pattison, James P.
• Reynolds, Mary.
• Roddy, Joseph.
• Rooney, Eamonn.
• Sheldon, William A. W.
• Sweetman, Gerard.
• Tully, James.
• Tully, John.

Níl

• Allen, Denis.
• Bartley, Gerald.
• Beegan, Patrick.
• Blaney, Neil.
• Brady, Seán.
• Breen, Dan.
• Calleary, Phelim A.
• Carter, Frank.
• Childers, Erskine H.
• Colley, Harry.
• Collins, James J.
• Cotter, Edward.
• Crowley, Honor M.
• Crowley, Tadhg.
• Cunningham, Liam.
• Davern, Michael J.
• Derrig, Thomas.
• de Valera, Eamon.
• de Valera, Vivion.
• Egan, Nicholas.
• Fanning, John.
• Flanagan, Seán.
• Flynn, John.
• Flynn, Stephen.
• Geoghegan, John.
• Gogan, Richard.
• Harris, Thomas.
• Hillery, Patrick J.
• Hilliard, Michael.
• Kelly, Edward.
• Brennan, Joseph.
• Brennan, Paudge.
• Breslin, Cormac.
• Briscoe, Robert.
• Burke, Patrick J.
• Butler, Bernard.
• Kenneally, William.
• Kennedy, Michael J.
• Klilea, Mark.
• Lahiffe, Robert.
• Lynch, Celia.
• Lynch, Jack.
• MacCarthy, Seán.
• McEllistrim, Thomas.
• McGrath, Patrick.
• McQuillan, John.
• Maguire, Ben.
• Maher, Peadar.
• Moher, John W.
• Mooney, Patrick.
• Moran, Michael.
• Moylan, Seán.
• Ó Briain, Donnchadh.
• Ormonde, John.
• Ryan, James.
• Ryan, Mary B.
• Sheridan, Michael.
• Smith, Patrick.
• Traynor, Oscar.
• Walsh, Thomas.

Tellers:—Tá: Deputies Doyle and Kyne; Níl: Deputies Ó Briain and Hilliard.

Motion declared carried.

An Ceann Comhairle

When is it proposed to take the Committee Stage?

Mr. T.F. O'Higgins

Would it be possible to get agreement to take all stages now?

Dr. Ryan

No.

Mr. T.F. O'Higgins

What about to-morrow?

Dr. Ryan

No. I want to table some amendments.

The Taoiseach

Very well. Next Wednesday.

Committee Stage ordered for Wednesday, 14th July, 1954.

The Dáil adjourned at 10.25 p.m. until 3 p.m. on Wednesday, 14th July, 1954.