Seanad Éireann díospóireacht -
Wednesday, 17 Jun 1931

Vol. 14 No. 22

Public Charitable Hospitals (Amendment) Bill, 1931—Second Stage.

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

Minister for Justice (Mr. Fitzgerald-Kenney)

This Bill brings in some amendments to the Charitable Hospitals Act of 1930. Under the original Act, a considerable number of sweepstakes, with gratifying results to the hospitals, have been held. This Bill proposes to make certain alterations in the distribution of the moneys available under the sweepstakes held under the provisions of the original Act. Certain hospitals were not eligible to come in under the provisions of the Principal Act. That is to say, they did not give a certain proportion of their beds to free patients. Owing to the particular work they do, it would not be feasible for them to give that proportion of their beds to free patients. Section 2 proposes to add six hospitals to the list of hospitals eligible to participate in this scheme. The first hospital in the list included in that section is Our Lady of Lourdes Hospital, The Cedars, Dún Laoghaire. That institution was, up to some time ago, a sanatorium. It has lately become a hospital for tubercular bone disease, doing for adults what the two hospitals mentioned later in the section—Cappagh Hospital, and St. Joseph's Hospital, Coole, Co. Westmeath—do for children. They deal with tubercular bone disease. Peamount Sanatorium, Hazelhatch, Co. Dublin, is also an institution which we suggest should benefit under this scheme. They have started a new village for tubercular patients, where the tubercular patient is able to work and to earn wages. Though, of course, these patients cannot do a full day's work and cannot obtain a full day's wages, still some of them are able to save comparatively large sums, because their upkeep is not costly. Some of them are able to save 9/- and 10/- a week, which makes them independent of their people at home and, in certain circumstances, enables them to contribute to their people at home. I think the House will agree that all these hospitals are doing excellent work and are entirely within the spirit, though they do not come within the strict letter, of the original Act.

Section 3 provides for the setting up of a Committee of Reference. The duty of the Committee of Reference will be to see that such sums as are available for the voluntary hospitals will be divided fairly and equitably amongst them. Up to this, there has been, I admit, very little trouble with the voluntary hospitals as to the distribution of the proceeds of these sweepstakes. But though they have completely agreed amongst themselves and have always come forward with an agreed scheme, I came to the conclusion that some hospitals—especially the smaller hospitals—were receiving too much and that even some of the larger hospitals, as things go on, will inevitably receive more than they really require. I think it is right and proper that there should be an independent body to examine into the needs of the hospitals—to see what structural alterations they want, what is the state of their accounts and matters of that nature—and to see that the hospitals receive sums of money proportionate to their individual needs —that it will not be left to bargaining between the hospitals themselves. which is not very satisfactory and which sometimes may lead to the hospital whose claim is put forward by a more skilful or a more persistent advocate gaining more than a hospital whose claim is not quite so well urged.

A new principle is introduced into this Bill dealing with the allocation of the proceeds of the sweepstakes. Heretofore they have gone entirely to voluntary hospitals and not to hospitals which receive help out of the rates. Under the provisions of this Bill, county hospitals, county homes, and institutions of that sort will benefit to the extent of one-third of the proceeds. That figure of one-third was rather hard to arrive at. After considerable discussion in the Dáil. that was accepted as an agreed figure. The amount available for these hospitals which receive assistance out of the rates will be paid to the Minister for Local Government and Public Health, and he will see that it is distributed according to the needs of the various hospitals for improvements, but not for maintenance of patients or anything which could be said to go directly in relief of rates. It will go to what possibly ought to be done out of rates—improvements, better equipment, and the provision of better medical appliances, things which, of course, ought to be done out of rates, but which, in fact, will not be so done, because they would put rather a heavier burden on the ratepayers of most counties than would be justified at the present moment. These sweepstakes have brought in a very considerable sum of money. There have been three held already, as I dare say the Seanad knows, and another sweepstake, which has now been launched, is to be held on the Manchester November Handicap. The hospitals mentioned in Section 2, and also the rate-aided hospitals—I am using the words "rate-aided" loosely, because some of the hospitals that come in as voluntary hospitals are rate-aided hospitals—will come in under the provisions of Section 9 and be able to participate in the November sweepstake.

I do not intend to go into the general question of sweepstakes at all. Whether sweepstakes are good or bad, and whether hospitals are wise or unwise in participating in a sweepstake scheme, does not, I think, really arise on this particular measure. These are matters on which people may differ, and do differ, but at present there is an Act legalising sweepstakes for hospitals, and the question now is simply how the proceeds of these sweepstakes are to be divided.

Mr. Vincent

I am in favour of this Bill, so far as it goes. But there is one omission in it which I think is quite important. You have got two sets of hospitals. In the first set are those whose income is assured on the rates. Under this Bill—very properly —any money they receive is to be spent not in alleviation of rates but by way of capital improvement. That, I think, is a very sound provision. In the other category are voluntary hospitals. That is to say, they have practically to beg for their bread and butter, year in and year out. They are to get two-thirds of the available surplus and the others are to get one-third. I think it is of the utmost importance that there should be some provision, or supervision, by which portion of the money that they receive would be invested for future use. The way I look at the matter is this: if I owned a gold mine and knew that it had only a three years' life, I should consider myself very foolish if I were to spend all the money I received yearly by way of dividend. An investment fund should be built up. The question may be a difficult one, because the Government do not wish that this should in any way be looked upon as a State lottery. However, I do not think there is insuperable difficulty in the way, because the machinery has been set up for another purpose. The body set up to advise the Minister as to the proportions in which the funds are to be distributed to the various hospitals should give some supervision to the manner in which the hospitals dispose of these very large sums which they are to get. This matter is of the greatest importance, because if this sweepstake innovation is to go down in the history of this country as a very successful venture, the public, not only here but elsewhere, must know that every step has been taken to ensure that the large sums which are coming into this country are dealt with in the most businesslike and practical manner. I do not say for a moment that the governing bodies of the hospitals are not very fine bodies. I make no allegation against them whatsoever, but human nature is human nature, and if you look around at boards of directors you will find that there is a great difference between one board of directors and another board.

All I want to ensure is that in no case, unless exceptional circumstances are proved to the satisfaction of the authority that has already been set up, is all the money going to be devoted to capital expenditure. It is most important that some provision for the future should be made in the case of the voluntary hospitals, and, before they are allowed to spend in capital outlay more than fifty per cent. of the sums they will receive, they should be able to satisfy this body that is already advising the Minister in other important matters. I think that is of the very greatest importance, because easy money, all the world over, is easy money, and it would be lamentable if, after all these sweepstakes are ended, some hospitals found themselves in a worse position than they are in at the present moment by an increase, through capital expenditure, of their running expenses.

Dr. Gogarty

I do not aspire to persuade the House, now that this thing has gone so far, to object to an extension of the sweepstake funds to country hospitals. I do not suppose there are many Senators who would agree with me were I to endeavour to persuade them to do so. I will take this opportunity of giving a sort of survey of the relations between the easy money to which Senator Vincent has referred and the hospitals. We have in a small country, with a population that hardly compares with the population of the City of Vienna, a capital city with nineteen hospitals, nineteen laundries, nineteen x-ray rooms, nineteen staffs, with patients to stretch over them all. It would really seem as if disease in this country is a good business. One thing that has been omitted in the case of the hospitals that are benefiting through the sweepstakes is the number of people who form staffs and who are directly deriving a livelihood through the hospitals. There are many hospitals that one could describe as more or less racketeering disease, to use an American expression. All that may seem strange coming from me, but these are really the facts. In other words, there are no voluntary hospitals in the country at all. The industry of disease supports people who are not diseased. There are certain ineradicable circumstances, and perhaps it is not desirable that they should be eradicated, which prevent a merging in this city of its nineteen hospitals, nineteen laundries and nineteen x-ray rooms.

The reason I object to an extension of this fund to almost one hundred hospitals is that it would not be good in the long run for the patients, because they would not have the advantage of a centralised system. This country is really a small country, and an accident could not occur anywhere outside a run of five hours to the city; in other words, the victim of any accident could easily be taken to Dublin within five hours. Unless you centralise medical services you will never have efficiency such as is at the moment desirable. It is a question whether you can have very competent service in the case of a surgeon who has not about one hundred beds. It is considered that Belfast will overtake Dublin, because in Belfast they have more beds and, consequently, they are likely to be more experienced and more competent. They are more centralised in Belfast, whereas in Dublin we are divided up. If you neglect to centralise the hospitals you will merely be putting the doctor in control of a local hospital in a very anomalous position. He will have to know all about eyes, ears, midwifery and kidneys. Of course, he could not be expected to be a specialist in all these matters. The great advances made in medical and surgical spheres tend naturally towards what is called specialisation. To become a specialist in any one matter affecting the human body entails many years of study and experiment.

The spending of this fund which has been accumulated through sweepstakes will, in my opinion, tend to increase the maintenance of hospitals. Every hospital which has benefited through the sweepstakes has either built additions or planned to extend buildings. Looking back over a period of twenty-five years, I do not think that there has been a single life lost in this city on account of inadequate hospital accommodation. In no instance has the roof leaked, and nobody has lost his life on account of inadequate architectural construction. I think it is madness to extend the maintenance charges. If that practice is allowed to go on, in a few years there will be bigger hospital buildings with higher maintenance charges, and in that connection there is no provision envisaged. When we are dealing with this sweepstakes fund we should bear in mind what happened in the case of the Road Fund. It might not be wise in the case of the hospitals to set aside a sum of one million pounds for the future. I strongly urge upon the Committee not to allow the money to be run into architecture. The other day a sum of £700,000 was set aside for cancer research. That will probably result in a skyscraper, reaching to something like one thousand feet, and the human element will scarcely be considered at all.

I am strongly of opinion that the revival of certain country hospitals should not take place. Certain country hospitals have been merged into county infirmaries, and workhouse hospitals have been similarly merged. I would like some assurance that we will not have more than one hundred hospitals when all the awards have been made. It is evident that the sweepstakes cannot go on for ever. There are certain things that may be called national sweepstakes. In Spain and France they had a system of lotteries, and after a short time people became apathetic about them. The sweepstakes that have been organised in this country have been the means of accumulating large funds, which will be divided amongst the various hospitals. If that sort of thing continues, we may easily have more hospitals than we can ever hope to have patients to fill.

There is not so much extraordinary illness in Ireland. If a man breaks his leg in the country, it is quite easy to get a local person to diagnose what has happened, without having any x-ray treatment at all. Thirty years ago one was supposed to diagnose cases of fracture without the assistance of all the equipment we have in modern times. I cannot see the necessity for an extension of this money through the country. What should be done in the interests of the public is to centralise all the hospitals. In this small island there is no need for so many different buildings, and there should be a general merging. We will at least have it on record that somebody saw the farce of having twenty hospitals in a city with about 400,000 of a population. A large city like Vienna, with two million people, has only one hospital. People come from the very ends of the earth to get surgically treated there. Many of the outstanding discoveries which have lessened the burden of human misery have come from places where disease was concentrated. It is at a place like that, where disease is concentrated, that alleviation will be found.

We are merely dissipating our energy by throwing money into every village in the country. If a man is seriously injured in the country, he can be taken by bus to Dublin within a few hours. If a country doctor declares that he is not an eye specialist, he will lose prestige for having some hole in his armour. In Dublin, a specialist can say: "I know nothing about the eye; you will get better treatment in the next wing." You are merely putting a doctor in an anomalous position if you set him up as specialist in a country village. Many unfortunate cases have failed to get relief for the simple reason that the diagnosis was not arrived at in time. Human nature will scarcely prompt a doctor in the country to say "I do not know what is wrong with you, but I may be able to tell you in about six months." There have been instances where relief has been too late just because the diagnosis was not arrived at in time.

There are many places in the country where the unfortunate local doctor is expected to know more than all the medical men in the City of Dublin. That condition of things will be accentuated if you start to endow the county infirmaries. It was stated here that money has to be spread over nineteen hospitals in Dublin. Years ago a sum of two million pounds had to be refused simply on account of the conditions under which the hospitals were originally founded, conditions which made religious considerations paramount. That was a really lamentable condition of things. I am satisfied that people realise now that it is high time there was a merging of the Dublin hospitals, as far as it is possible to bring that about.

I will go back now to staff conditions. Suppose we had the nineteen Dublin hospitals merged to-morrow, we would have nineteen leading physicians and surgeons all over the place, becoming senile. The whole question of medicine will have to be considered. It might easily get to be considered here if it were mixed up with economics. The question might arise: What are you to do with the doddering doctor? I must be the lonely voice in this matter. It is not that I wish to deprive anybody in the country of assistance. The fact is that there are too many hospitals in this small country. By endowing district hospitals you are putting further away the day when centralisation will be facilitated. The advantage of centralisation will be denied the men who are practising in this country. It is a very serious thing. Belfast is getting ahead of us, because in certain hospitals there they have more beds. We have more buildings, but not more beds.

I am speaking on this matter without any ill-feeling. I have no axe to grind. I was very nearly presiding over the distribution of £100,000 yesterday. A certain hospital got a large grant from the Government, and it proposes to spend £100,000. Sweden has the latest hospital. In Sweden there are no more than four people in a ward, and, therefore, it is a much later hospital than the one which has eight people in a ward. The whole thing is perfect nonsense. There is not a single hospital in Dublin that is not water-tight and clean enough. Of course we may have local philanthropists interested in running up a shack. If a wealthy man is ill he goes to a private home; but that is really only a lodging-house with a good deal of plumbing at the back. It was never built as a hospital, and one of the effects of these private homes is to lower the rateable value of Merrion Square, Fitzwilliam Street and around that area. The man who has a good deal of consideration for the value of his life goes there. Where the geraniums used to be there are now buckets and pipes and tin tables. The sooner we get rid of the nonsensical mixture of charity and pathos, with a foolish administration of cash, the better.

There is no need for any new building in this city. There is really great need for the nineteen existing hospitals to be merged into one big central hospital. Another thing to which I would like to draw attention is that the hospital are erected in the most insanitary parts of the city. That is the extraordinary thing about it, that notwithstanding the great advance in medical knowledge our hospitals are still situated in the slums. The slums are round the hospitals because no one wants to live near the hospitals, and the fact that the hospitals are there is one reason why the slums exist around them. Suppose the nineteen sites were sold and a central hospital were established, the position would be ever so much better. In my opinion, however, the sites should not be sold; they should be turned into playgrounds. One big central hospital should be built near the mountains, up at Kilbride, say. That is only a matter of eight or ten minutes in a modern bus. Of course, that will never be done. They will prefer to go on enlarging the hospitals.

Let us even take Dublin City. It was never built by sanitary engineers. Those who built the city built it round a large sewer which is punctually emptied by the tide. It is about the most punctual service that we have in the City. The City of Dublin was never built by people who had any idea of health. If ever there is a big central hospital built the question of the site ought to weigh very considerably with those in authority. It is monstrous to have this city splattered all over with lazar houses. It must be a strange thing to come to a city where you see nothing but saints and doctors and cinemas. If the Corporation are not checked we will soon have a cement lid in the middle of the River Liffey for the accommodation of transport. The suggestion has been put forward that they should build a big bus garage over the Liffey. I hope the citizens of Dublin will take serious consideration of this proposal. The only ventilator we have is the Liffey; brings the land and sea breezes up every day. Some provision ought to be made to prevent any attempt to make the city more unsightly and unhealthy by extending the existing hospitals in places where a hospital should never have been erected.

Mr. Connolly

I was very much interested in the speech delivered by Senator Gogarty. I am sure we all found it very refreshing to hear Senator Gogarty discussing this subject. However much the Senator inclines towards centralising the hospitals, in my opinion he is taking on a very big job if he proposes to have a centralised scheme carried through. I can imagine him going to the boards of the various hospitals and fighting out that issue with them. He would have to fight out that issue with them before he would convince us in the Seanad. As regards the Bill, I would like to ask one or two questions. I think we would be all glad to see certain hospitals given a share of the sweepstakes fund. I cannot speak for all of them, but I do happen to know something of the work carried on in a couple of them, such as the Cappagh Hospital and the Coole Hospital. I am quite sure there are other hospitals equally worthy of support.

I would like to make some reference to the accounts connected with the sweepstakes, the accounts of the Hospitals Trust, Ltd. I would like to know from the Minister if it would be possible for members of the Oireachtas to get a balance sheet relating to the sweepstakes fund, or is that something that we are not entitled to see? It would be interesting to know how the various percentages work out as regards the expenses incurred, as distinct altogether from the allotment for the various hospitals. We would like to know exactly what percentage goes to cover expenses, what amount goes to the hospitals, what amount has been spent on advertisements, and so on. I think that is information that should be supplied to the members of the Oireachtas. They have given their authority to the legislation enabling sweepstakes to be carried on. I would be glad to see the accounts submitted to the Oireachtas in the way I have mentioned, so that members of the Dáil and Seanad may be able to inspect them.

Section 6 allots to the Minister for Local Government and Public Health one-third of the available surplus. The Minister might be able to tell us, without going into exact details, how it is proposed to distribute that. Is it to be allotted so that an equitable distribution per county or per area, on a population basis or otherwise, will be made, or is it to be solely at the discretion of the Minister for Local Government how this one-third surplus is to be made available to the various local bodies? It is set out specifically in the Bill that none of this money will go to the alleviation of rates. I think the Minister for Local Government will have great difficulty in preventing that. It may not be spent specifically on things in a particular year for the saving of rates in that year, but obviously if it goes to capital investment it normally would fall under the head of public charges and would in future years eliminate the necessity for expenditure on the part of local bodies. Therefore, in subsequent years it would go towards alleviating the rates. I suggest that the Committee of Reference should be appointed to act with the Minister for Local Government as regards the distribution of that one-third. I am against the principle of any Minister having sole authority as regards the distribution of any particular fund like that.

Senator Vincent referred to the fact that human nature is human nature. It is, and just at the moment I doubt very much if it would be fair to expect that the Minister for Local Government would have any soft spots in his heart for certain areas in this country. Of course if it is going to be distributed on an area basis, or on a county basis, or on any basis that would work out equitably, then there is no more to be said. It automatically would go that way, but there is no such condition in Section 6. The section seems to me to imply that the Minister will have arbitrary control of that money, and I do not know that the Seanad will altogether approve of that. In conclusion, I desire again to stress the desirability of having the Committee of Reference co-operate with the Minister in the distribution of that one-third.

Mr. Foran

I think it will be generally agreed that up to now these sweepstakes have been of great advantage to the hospitals, but we are now at the point where I think it is proposed to take a wrong turn. Through this Bill the State proposes to take advantage of the sweepstakes for the relief of rates. I think that is a mistake. If the State is in earnest in that matter at all then it ought to go the whole hog and make this a national undertaking. Under Section 6 of the Bill the Minister has power to spend money upon the prevention of disease. I hope he will give consideration to the suggestion I am going to make. I contend that the slums are a great source of disease and are largely responsible for the overcrowding of hospitals in the country. Every party and every section of people have deplored the fact that we have such hideous slums and have promised to do what they can to abolish them. Some small attempts have been made to do away with the slums, but these efforts have been so small that the slum areas instead of decreasing are increasing.

My suggestion to the Minister is that he ought to ear-mark some portion of this money to be used as free money for housing in order that the people can get houses at an economic rent. It would require many millions to make an impression on the slum problem that we have in this country. I know no party, whether they be in Church or State, that is prepared to put up the money required to do anything substantial in that connection. I believe that in these sweepstakes we have an opportunity of getting free money that would enable us to make a big effort to abolish the slums. By doing that we would be building up, so to speak, a healthy people and doing away with the need for the nineteen hospitals that Senator Gogarty referred to. He says that there are too many of them and he ought to know. I differ with the Senator in this way: he said that no human being has lost his life through want of hospital accommodation. It has been my experience on a number of occasions to see men, almost fatally injured at the docks, taken to hospital. Those taking them there were told to bring them home, that there was no room for them.

There are some people who may argue that sweepstakes are immoral. I say they are less immoral than slums. People who have scruples as regards gaming or gambling must accept responsibility for the prevalence of the awful slums that the poor people in this country are compelled to live in. At some time the requirements of the hospitals will be met through these sweepstakes. I think that under them an early opportunity ought to be taken to secure portion of the money for free housing. I would like to explain my point in detail. We all know that the Dublin Corporation and other public bodies throughout the country are building houses, but owing to the interest charges that they have to meet on the money borrowed for that purpose the houses cannot be let at an economic rent. Let me refer to the latest development that has taken place in connection with the very laudable housing scheme that was carried out at Marino. Splendid houses were built there, but what has happened? In order to pay the rents charged the tenants of these houses are compelled to take in other families with the result that we have substantial and enormous overcrowding in these modern houses. That must go on so long as these people are obliged to pay 17s. a week for their houses.

I know the slum problem pretty well. I have heard authorities talk about it all my life, but up to the present I have seen very little diminution so far as the slums in this city, at any rate, are concerned. I think that under these sweepstakes opportunity ought to be taken to ear-mark a portion of the money to be applied towards the abolition of slums in the country generally. I contend that can be done under Section 6 of the Bill where the Minister is given power to ear-mark money for the prevention of disease. I think that Senator Gogarty or any other medical man in the country will agree with me that the slums are almost entirely responsible for disease in the country and for the overcrowding of our hospitals.

Mr. Bagwell

Like a good many other Senators, I look upon Section 6 as an important part of the Bill. How it will be administered in practice will depend almost entirely on the Minister. Although I cannot speak with authority, like some other members of the House, perhaps it is just as well that the Minister should know how the matter strikes a man like myself who has been in no way associated with the initiation of the sweepstake movement or with any particular hospital or set of hospitals. I am just interested in the subject generally. I find myself very largely in agreement with much of what Senator Gogarty said. Much of what he said has been before my mind, but after hearing him I am all the more strongly convinced that there is great danger of waste in spending a large amount of this money in equipping rate-aided hospitals. The advantage of concentration in the effort to deal with disease must, I think, appeal to Senators, particularly in complicated matters of surgery and medicine. Concentration in dealing with these cases is very important, because a man who has only one case of a kind once a year or over several years cannot possibly give the same amount of relief to human misery as a man who is constantly treating them and thereby becomes an expert.

I think it would be a great pity if a large amount of the money was spent in equipping those rate-aided hospitals in such a way as to encourage them, so to speak, to attempt treating cases which really had better go to the centre where the expert is to be found, to the man who has great experience in dealing with cases of a special kind. As far as I can see, the Minister is not compelled under the section to spend the whole of that money. A great deal of discretion is left to him. I hope he will bear in mind what has been said about the danger of dissipating the money in directions in which it may not do as much good as if it were spent at a centre where we know the greatest skill is to be found.

Mr. Comyn

This debate has taken a very wide range. It has gone from surgeons to slums, and from slums to hospitals. I propose to deal with the Bill before the House, and I am sorry to say that on a fundamental point I differ from the Minister. In my judgment the Bill introduces a new principle of the first magnitude. I oppose it, as I opposed the original Bill, which is now the Principal Act. The original measure empowered sweepstakes to be run in aid of voluntary hospitals. I did not oppose it on any moral ground. I opposed it on the ground that in so far as the money would be collected in Ireland, it was a most expensive way of raising revenue, and in so far as the money would be collected abroad, it was eminently calculated to create difficulties with other countries. I have never doubted for a moment that the scheme for a lottery or sweepstake would be the tremendous success it has been, but I think I am borne out by the facts when I say that so far as our relations with other countries are concerned this is a matter which is likely to cause irritation.

Cathaoirleach

I think the Senator said at the opening of his speech that he was going to confine himself to the principle of the Bill.

Mr. Comyn

And I am. Therefore, I say that even in relation to sweepstakes for the voluntary hospitals it was a matter that was not politic. I say now that in relation to hospitals which are poor law hospitals, the evil is much greater. Here you have the Government not merely lending the prestige of their authority to sweepstakes, but you have them really participating in the proceeds of these sweepstakes. The Minister, I think, has very fairly stated the position in regard to that. No doubt, under the terms of the section the money to be devoted to these rate-aided hospitals is not to be in aid of the rates. I accept what the Minister said. He said that these moneys do not directly relate to rates. They do not directly relate to present rates.

I also agree with him when he said that the work to be done is work that ought possibly to be done out of the rates. Therefore, what you have is a sweepstake, advertised all over the world, in aid of the public rates of this country. I think that adds to the impolicy of the original Act.

I do not oppose this measure on any personal ground, nor do I oppose it on any moral ground. I oppose it on public grounds and on grounds of policy. I desire to say that since the original Act was passed I have on every occassion made the closest and the strictest inquiry that I could into the administration of the sweepstake. I want to say this: that so far as I could see it was conducted with absolute honesty, and, not merely with honesty, but with a kind of generosity and decorum that is certainly to be admired. I have had tickets in the sweepstake. I have tickets in every sweepstake. I am by nature a gambler as much as anybody else. I went to see the draw. Not merely was it conducted honestly, but it was conducted with a sort of solemnity. It was like a pagan sacrifice, with a revolving goddess and all the devotees in that darkened room looking with eager eyes and hoping that fortune might shine on them. It was splendidly done. It was the most decorous performance that I have seen in the City of Dublin for many years. But still I am more opposed to it than ever, because if this thing goes on, if the Ministers of other States are not irritated beyond endurance, and if these hospital sweepstakes or sweepstakes for any other purpose organised in Dublin, are allowed to continue, then this city will become the gambling centre of the English-speaking world. That is what is going to happen.

Cathaoirleach

The Senator instead of discussing the Bill before the House is now criticising the principle of sweepstakes.

Mr. Comyn

I have nothing more to say.

Mr. O'Farrell

Personally I look upon the general provisions of this Bill as being all right and in some cases desirable. I do object, however, to the very undesirable and in my opinion vicious principle which has been introduced in this Bill through the medium of Section 6, namely the utilisation of the proceeds of sweeps for the relief of rates. That is what the section amounts to, no matter what attempts may be made to explain it away. The Principal Act was justified only on the grounds that it proposed to raise funds for hospitals in debt and that were maintained by voluntary subscriptions. Voluntary subscriptions cannot be increased at the behest of those who control these voluntarily maintained institutions. Hence the proposal to raise money for them by sweeps was the only method available. In regard to poor law hospitals they may be badly equipped and badly staffed, but that is because the authorities responsible for the financing of them will not levy the rate necessary for their upkeep, because they have no real interest in hospitals at all, or because they will not risk unpopularity by raising a rate sufficient for the purpose. Everyone knows that all important operations are performed in the different hospitals in the City of Dublin, and that will go on no matter how the little local hospitals are endowed.

Probably most of the patients in these hospitals come from the districts that are most reluctant to raise a rate sufficient to maintain their own district hospitals in a proper state of efficiency. It is this sort of mentality that Section 6 panders to—devoting one-third of the total money available to the upkeep of these hospitals, and hence to the reduction of the rate necessary for their proper upkeep.

It is certainly a novel procedure to find a body like Hospitals Trust, Ltd. collecting money all over the world and handing over a large proportion of it to a Minister of State, who himself takes no responsibility for the collection, for division among the local hospitals throughout the country. We are told that this money is not going to be used for the relief of rates. In actual working out, that is mere eye-wash. After the first year it will be impossible for the Minister to ensure that the grant which he gives to a particular hospital will not be used, to a large extent, for the purpose of relieving rates. He may seek to use his powers in the case of any local authority which offends in this respect. But what will the effect be? You may have a repetition of the Mayo comedy, where everybody has given up reading because somebody's nominee was not appointed to a particular job. You may have even the Government bigwigs in the constituency, as is happening in another place to-day, finding themselves torn between public duty and parochial popularity, and the Minister's action will be absolutely nullified. Moreover, this new development is going to make it well-nigh impossible to make the scheme a success in those countries from which the great bulk of the money is coming at present. Certain States have been singularly tolerant of what has been a flagrant violation of their laws up to the present. Now, we are going, knowingly and deliberately, to throw down another challenge to them—to tell the world that we are going to raise money in other countries for derating purposes here. This will eventually drive those Governments to administer the law in such a manner as will bring the citizens to their senses. You will, in that way, be drying up the source from which this stream of gold has come up to the present. The next proposal will probably be that we run a sweep for the payment of old age pensions and ‘relieve the State of that burden, or run a sweep for the upkeep of lunatic asylums, the cost of the upkeep of which generally falls on the public rates. I can quite understand Deputies being exceedingly generous with money that does not belong to them. We should take a different view. A Deputy can only afford to look so far as the next general election. He has, of course, the local Press, the local authorities in his constituency, and, above all, the local ratepayers to consider. If he can relieve them of a burden, from whatever source the money may come, he is carrying out what is considered a good political deal for himself. If this House can do anything to justify its existence, it would be to prevent such a policy as this creeping into a Bill of this kind, seeing that the ultimate result of it must be to deprive this country of a considerable amount of money which might otherwise be obtained, and which could be spent on one of the greatest causes possible—the development of medicine and the relief of human suffering. I do hope that we shall not endorse that particular section of the Bill when it comes to be dealt with in Committee. Senator Gogarty and others have pointed out that, in any case, the local hospitals will never be able to deal with major operations, never be able to deal with the vast proportion of the work which is being done here at present. The adoption of this principle is simply going to create difficulties in other countries where the money is being raised, and, in the long run, we will find that the bone over which we are now fighting shall have disappeared altogether.

Mr. Toal

I hope that the Minister will not pay any attention to the attempt that is being made here to centralise everything and to ensure that the rural population will get no benefits from sweepstakes or anything else. Attempts have been made to show that the rural population will use this money for the relief of rates. I was very much surprised to hear the last speaker proceed on the lines he did, knowing, as he does, the great hardships that we suffer in the matter of hospital accommodation in the country. No man knows better than he does the number of railway officials who have suffered owing to the want of hospital accommodation. Time after time accidents have occurred at railway stations, and if proper hospital accommodation had been available locally, the lives of the unfortunate men might, perhaps, have been saved. But they had to be carted off to the City of Dublin or Belfast, or some other large centre before they could obtain relief. The provision in this Bill is an attempt to equip county hospitals, not for the relief of rates, but to enable major operations to be performed in them. Take the county in which I reside. There have been hundreds and hundreds of major operations performed there. They have been performed only under difficult circumstances and without proper equipment. An attempt is being made now to equip that county hospital with x-ray and other apparatus so that the performance of serious operations will not be attended with so much difficulty. The money will be spent on capital improvements and not on relief of rates. We are always prepared to subscribe the necessary funds from the rates for the maintenance of the hospitals, but in poor districts we are not in a position to supply the up-to-date equipment which the hospitals in the City of Dublin possess.

It would appear from statements made here to-day by a number of Senators that everything should be centralised in Dublin. Surely the people of Dublin should be satisfied with the amount of money that is pouring into the city day after day from the rural areas. The whole flow of money seems to be towards the City of Dublin. Yet representatives of the City of Dublin will not tolerate the raising of their voices by Senators or Deputies seeking for fair play for the rural districts, which have done so much to place the City of Dublin in the position it occupies to-day. I think it comes very badly from Senators to try to prevent the poorer districts from getting the accommodation that is necessary in their hospitals by means of these sweepstakes. They should realise that a great deal of the money of Dublin is coming from the rural areas and the provincial towns, and they should not try to collar and capture all the money available. I hope the Minister will not give any attention to the attempt made here to centralise everything in Dublin.

Sir Thomas Grattan Esmonde

I supported the original Bill to establish sweepstakes on account of the emergency in the case of the hospitals. I shall not support this Bill, because it introduces a dangerous principle— sweepstakes to pay rates. I warn this House, and I warn the Government, that this principle will have further effect, which I do not think will be for the good of the country.

The McGillycuddy of the Reeks

I had not intended to intervene in this debate at all, but it appears to me that Section 6 is a very serious one in connection with the entire sweepstake scheme, and I should like to add my voice to the chorus of disapproval. There are two points to be considered. In the first place, the Minister has powers which are not precisely laid down. No doubt, he will administer them properly, but I think that sub-section (a) is extremely loosely worded. The second point, and the more important one, is that the money to be applied shall not be in substitution of rates. It is extremely difficult to do that. Let us assume that a particular hospital is not up to the standard of some of the other hospitals in the country. The Minister, in dividing this money, gives to that hospital something over and above the normal cost of maintenance during the last five or six years to bring it up to that standard. That is nothing but relief of a rate which should have been struck in the years before and was not struck. According to the Poor Law Report, several of these hospitals were in a disgraceful state. Suppose one of these hospitals in former years wanted to be placed on a proper basis. It could have applied to the Minister for a loan and would have got, no doubt, a grant equal to the amount of money it borrowed. If it did not do so, and if a grant is made now out of this money, no matter what you call it, that grant goes in relief of a rate which should have been struck before and was not struck. I think that the whole of that paragraph should be struck out on the Committee Stage of this Bill.

Sir Edward Coey Bigger

I think the Minister deserves credit for bringing forward this amending Bill, because it gives the House an opportunity of considering the whole matter in the light of the experience gained since the Principal Act was passed last year. Section 3 provides for the appointment of a Committee of Reference for the purpose of this scheme and the sweepstake to which it relates. Section 5 lays down the duties of the Committee which is required to report to the Minister as to the proportions in which the two-thirds of the available surplus should be divided between the governing bodies of the hospitals concerned. Then it goes on to state:

for the purpose of making the report to the Minister under the foregoing paragraph of this section, such Committee of Reference may visit all or any of the premises of any of such hospitals and shall be entitled to inspect and examine such premises and the fittings and equipment thereof, and shall also be entitled to call for and be furnished with full information in relation to the management and the financial position of any such hospital and to see and examine all accounts of the receipts and expenditure of the governing body of any such hospital and also all or any books and other documents containing any record of such receipts or expenditure.

Although these matters may be supposed to cover the essential requirements of the hospital, there are many others of equal importance which are not mentioned, such as the adequacy of the medical and nursing staffs, the number of free patients, whether the hospitals provide for extern patients, etc. To carry out such an inquiry would require trained persons, together with one or more accountants. It might be of some service—which I very much doubt—if the sweepstakes were to be a permanent source of revenue to the hospitals. But the Principal Act only runs for three years, and most of this time would be taken up by the Committee before it could report. It would cost a great deal, and it would raise all sorts of difficulties but would produce nothing tangible or nothing that could be of any real assistance.

I do not blame the Minister for this proposal, but I do blame his adviser. I do not know who he was, so I can speak without being personal. I cannot help saying, however, that he knows nothing about what he has suggested, and could have had no experience of such work. The committee of every hospital should know what improvements and additional equipment and apparatus they require, and they would resent being told what they should do. I spent ten years visiting and reporting on the hospitals in this country, and have visited every hospital in Ireland, even to the small cottage hospitals, so that I ought to know what I am talking about.

The hospitals all differ from one another in various ways. What is necessary in one hospital may not be required in another. One hospital may require their operation theatre to be enlarged or improved, or their sanitary arrangements improved. Another may require the accommodation for their nursing staff to be enlarged or the cooking or laundry arrangements to be improved. It appears to me that it would be infinitely better and more satisfactory to everyone if a small committee of, say, seven or eight persons was appointed to go fully into the matter and draw up a scheme on which the division of the two-thirds would be made. There should be representatives on this committee from Cork and Limerick. Some years ago the Irish portion of the Prince of Wales's Fund was distributed between all the voluntary hospitals in Ireland by a committee, of which the Master of the Rolls, Rt. Hon. Charles O'Connor, was Chairman. The Rt. Hon Laurence Waldron was also a member, together with representatives from Cork and Belfast. This committee considered the best lines to go on and unanimously agreed to a formula, with the result that the fund, amounting to many thousands of pounds, was distributed without a single complaint.

If the sweepstakes for the next three years are as successful as they have been, there would be available about £4,000,000 for the Free State hospitals. This amount would be sufficient to reorganise the whole hospital system. There are too many hospitals in Dublin, and some could be amalgamated. There are three hospitals in Cork and three in Limerick, all of which treat the same class of patients. It would be a great benefit if some of them were also amalgamated.

There is another matter which should be carefully considered and, if possible, provided for—that is, the need for better hospital accommodation for those with moderate means who cannot pay the usual professional and nursing fees charged in private nursing homes. Some of the hospitals might wish to provide such accommodation, in which case they might receive special grants. As the amount of money available is far more than was ever anticipated, it should be applied to bringing about lasting improvements for the benefit of the whole of the Free State. Such an opportunity for reorganising the whole hospital system may never occur again, and it would be a disaster not to take advantage of it.

Section 6 provides that one-third of the available surplus shall be paid to the Minister for Local Government and shall be applied by him in such manner as he shall think fit in or towards the provision, improvement or equipment of institutions. It will be noticed that this section is drafted on quite different lines from Section 5, although both are dealing with the available surplus. This section shows a different mentality and outlook, which is absent as regards the two-thirds surplus.

I feel sure the Minister for Local Government will bring about a vast improvement in the county infirmaries and will use the money to the best advantage. The poor law hospitals have been mentioned several times, but I hope the Minister will spend money on county infirmaries, which are old institutions. I also deprecate the equipping of hospitals for doing large major operations. Large major operations should be done where there is the best skill. It is not merely a matter of picking out an hospital; it is the skill more than all of the surgeons and the person who has experience in dealing with such cases. As far as possible those cases should come to Dublin, Limerick, Cork or Waterford, four county boroughs in the Free State. Each of those boroughs should be provided with proper hospital accommodation and made really up-to-date institutions. There are three hospitals in Limerick, not one of them properly fitted up or equipped.

There are very few hospitals in Ireland which do not receive contributions from the State or the local authorities, and in this way the Minister for Local Government has a certain amount of responsibility regarding them, and I think he should be more closely associated with the whole scheme. I suggest the formation of larger committees and that the whole matter should be gone into fully before any money is expended at all. The whole hospital system of the Free State can be reorganised and coordinated. Special provision could be made for amalgamating some of the hospitals and, if necessary, adding to existing hospitals, or building new ones to take the place of those amalgamated. Provision could be made to add accommodation to some of the hospitals for patients of moderate means.

When I speak of co-ordinating hospitals I refer particularly to the colonies, Canada and Australia, where large hospitals are linked up with smaller ones, and they have a perfect system of sending operations from the smaller to the larger hospitals where they can get proper treatment and attention. I do not see why a county infirmary should be equipped with an x-ray or other expensive apparatus. It takes persons of skill to keep this apparatus in order. There should be special provision made for the amalgamation of some of the hospitals and, if necessary, adding to the existing hospitals or building new ones. Provision should also be made for patients whose means are restricted. We may never have such an opportunity for improving our hospital system, and it will show a great want of organising and administrative ability if it is lost.

Mr. Barrington

I come from the country. I represent some of the county hospitals on the Hospitals Committee here in Dublin. I must join in the general chorus of condemnation which I think Section 6 has met with in this Seanad. The discussion seems to have been following the supposition that country hospitals at the present time could not come in. That is not so. I represent one hospital, the County Limerick , which has participated in several of these sweeps, and if this Bill is framed in such a way as to admit any hospitals which it was desirable to admit, I think there would be no necessity for this Section 6. Section 6 is open to a great many objections. It will in all probability provide a certain amount of money which will be used in the country hospitals, and I think that what Senator Sir Edward Coey Bigger has said about the co-ordination of the hospitals would meet the case. If these country hospitals are permitted to come in under the existing Bill and are permitted to share in the way we have shared in the past I think the case would be met.

Mr. O'Doherty

When the original Act was before the House I supported it without any qualms whatsoever, and on that occasion, if I remember rightly, the Government refused to accept any responsibility for the measure that they had introduced on the ground that it would vitiate public life. But the position has altered. The Government have brought in this Bill, which I support with the exception of Section 6. Not merely do they accept responsibility for this Bill but they accept part of the money raised for de-rating hospitals. I am opposed to that, for, as many of the speakers pointed out, it is a bad principle. Like Senator The McGillycuddy of the Reeks, I fail to see how the administration of that section can be carried out.

The organisation of medical services in the country has been pushed very well indeed, I must say as a layman. It comprises the appointment of medical officers of health in different counties. I do not know what co-ordination exists among them, but I visualise the possibility of these men having under their control in their areas such hospitals as would reflect credit on their administration. I take, for instance, a medical officer of health in a particular county who advocates the setting up of x-ray apparatus in a particular hospital. As far as I am aware, the Local Government Department does not insist on the local body striking a rate to instal any equipment that the medical officer recommends, and if they refuse to strike that rate the hospital will not get the apparatus it needs. Say, on the other hand, that in another county the medical officer recommends the setting up of such equipment and a rate is struck and the equipment installed. In a few years, under this section, certain counties will be well equipped pursuant to the suggestions of the present medical officers of health, but other counties will not be so well off. Then the Minister for Local Government will be forced into the position of giving to these counties that would not strike the rate a portion of this surplus in order that the hospitals may be well equipped and brought to the same standard. I contend in so doing he will be relieving the rates, and the section as at present framed must eventuate in the relief of rates in certain areas.

Under paragraph (a) of sub-section (2), the Minister for Local Government is placed in the position of laying down such conditions as he thinks fit to impose without any reference to these conditions. I suggest to the Minister that the Bill would have an easy passage through this House if the section were struck out altogether, or to take out of it that principle against which there is such opposition as was evidenced here to-day. If this Bill is put to the House, I intend to vote for the Second Reading, but I intend to oppose Section 6 at every stage.

Mr. Johnson

When the original Act was introduced I opposed it, and I think my chief opposition was on the ground that it was practically asking this State to throw the burden of maintaining such hospitals upon subscribers in other lands. This State was established as the result of a long agitation in the cause of self-reliance or, in other words, Sinn Féin, and that imposes upon the community in the country the condition to look after its own poor. The establishment and wide development of the sweepstake system means practically a throwing-off of that responsibility and imposing on the people of other countries the task of providing the money which will maintain and sustain the hospitals in this country. The scheme has been entirely successful, more successful than anyone anticipated, and I am wondering whether we have not raised a gold-plated Frankenstein which is going to cause more trouble than the value of the benefits.

One of the immediate causes of the initiation of the scheme was the fact that the hospitals were in need; that there was little prospect of raising the money by the ordinary process of voluntary contribution, and that the governing boards of hospitals, and the doctors particularly, were opposed to anything in the nature of State assistance, because they feared that State moneys would involve the interference by the State authorities in the management of their affairs. Time and time again it was stated that they must not allow State assistance because of the risk of State intervention in the management of the hospitals, and on the introduction of the original Bill it was insisted, time and time again, as has been pointed out by the Minister, that he was not taking any responsibility for the hospitals, or for the scheme. He was going to do his best to ensure that the scheme would be fraud-proof, but that was the extent of his responsibility.

Now we come to the amending Bill, in which we find two sections, Nos. 5 and 6, both of which involve a very definite interference by the Minister or two Ministers in the affairs of the hospitals which are to be supported by the sweepstakes scheme. What are the doctors saying about this? I wonder has the Minister consulted with the doctors and the governing bodies of the hospitals in introducing this Bill, and have they renounced their old opposition to State intervention? I noted the Minister speaking of the importance of having some check upon the way moneys are spent, and therefore, he was proposing to set up a committee which, according to Section 5, would examine the way the hospitals were conducting their affairs, inspect their premises, the fittings and equipment, thereof, and report to the Minister. After receiving that report the Minister would determine the proportions in which two-thirds was to be divided amongst them. This is a point that I am not positive about. It would appear to me that according to the original Act the proportions were to be prepared and agreed to by the Minister in the first instance, and under Section 3 of the Bill it provides that when the scheme is sanctioned by the Minister he will appoint three members of the committee, so that we will have a scheme which contains the provision regarding the proportions in which the hospitals will receive the proceeds. We will have that scheme sanctioned by the Minister, and afterwards the Minister is to appoint a committee to examine into the affairs of the hospitals. I draw his attention to that; it appears that there is a contradiction.

I am not quite at one with my colleagues with regard to Section 6 and the new principle regarding rate-aided hospitals, because the whole of the Bill implies that the money that is to be received in future for the new schemes is going to be held by the Minister until he is satisfied that the hospitals are conducting themselves in a way he would think wise, and I do not see any very great distinction between the moneys received in this way under this Bill for the private hospitals, voluntary hospitals, and moneys received in the same way and paid over to the Minister for Local Government for distribution by him. It seems to me that the distinction between persons going to public hospitals administered under the poor law, or asylums, and people going to private hospitals which are run by private management committees but which have moneys at the discretion of the Minister for Justice is very thin indeed, and I can only suggest that if we are prepared to sanction Section 5 we ought to be prepared to sanction Section 6. The two ought to be made one, and instead of bringing two Ministers into it one would suffice.

I do not think there should be a rigid distinction between the Minister for Justice having a say in the management and control of the private hospitals and the Minister for Local Government having control of the public hospitals, which are both to be financed, in part at any rate, out of the money subscribed by the people of other countries. I do not know whether Senators are aware that a proposal was made in 1922 for the setting up in this country of a casino or kursaal. It was being promoted, and the hope was very confidently expressed by some that the Provisional Government at the time would give its benediction to the scheme. The inducement was that a proportion of the takings of this gaming house, to which the visitors were to be attracted from across the water, was to be handed over to the State to provide money for hospitals. It may also be remembered that that scheme was frowned upon, opposed, and finally collapsed on the ground that it was inadvisable for this State to depend upon this method of raising money. We are several years older and apparently the keen, acute conscience of that time has been somewhat dulled and we are not so much averse now to financing our philanthropic institutions, our necessary social institutions, by an appeal to the cupidity of people in other lands. If we are doing that, if we are proposing for the next three years to raise hundreds of thousands of pounds, perhaps millions, for the purpose of financing public hospitals in this country, it would seem to me that we should not draw any fine distinction between hospitals that are going to be managed under poor law institutions and hospitals that are managed by private governing bodies, both of which are receiving their funds from the same sources and both of which are submitting to a Governmental inspection and intervention in the management of their affairs.

I would like to express agreement with the general tendency of the argument submitted by Senator Sir E. Coey Bigger, and what seems to be the inevitable conclusion of all this discussion and this scheme of hospital financing—that is to say, that we have definitely parted from the notion that hospitals are private institutions run for private interests, whether these private interests are money-making or training grounds for doctors, or whether any persons can come together and decide to set up a hospital and then go to the public for support. I think it is quite evident that there has to be a new method. That new method must involve public financial assistance and some assurance that the moneys provided are going to be spent in accordance with a definite plan and design. I do not for a moment think that the hospitals ought to be conducted as a Government department would be conducted. I do hope that the poor law hospitals will come under a new kind of control and supervision.

I think there ought to be some general scheme of organisation so that the whole of the hospitals, whether under poor law authorities, as at present, or under private management, would have some kind of relation, one to the other, and be run in such a way that they will assist one another and cater for the ills that human flesh is heir to. It can only be done in something like an organised fashion, because it is evident from all one reads that one of the great needs is scientific equipment, which costs a great deal of money and very close training and care. That requires, especially in a sparsely-populated country, something in the nature of plan and organisation, and it therefore involves something in the nature of centralisation. I hope it will not be lost sight of that the scheme of this Bill involves Governmental check, Governmental intervention and interference with the management of the hospitals which are to receive moneys out of this fund. Once the hospitals accept that proposition they have given away for ever their old insistence upon the necessity of maintaining hospitals as purely private institutions.

Mr. Fitzgerald-Kenney

The words with which Senator Johnson closed his speech were that this Bill establishes Governmental interference in the management of hospitals. It does nothing of the kind. It simply says a committee will decide how a certain sum of money shall be divided amongst certain hospitals in proportion to their needs. It does not bring any Government department into the management of the hospitals. Senator Johnson also talked a great deal about a casino, and he said that at one time the national conscience would not allow a casino, but now it allows sweepstakes. I see the utmost difference between a casino and a sweepstake. I need not labour the point now. I think it is perfectly obvious; but if Senator Johnson cannot see that distinction by himself unaided, I will not be able to make it clear to his comprehension. Of course, there is all the difference in the world between a casino into which persons go and gamble to an unlimited extent —they are encouraged to go in and gamble—and a sweepstake. Apart altogether from the gambling, one must take into consideration the surroundings and the atmosphere of a casino. Gambling at a casino would be completely different from, let us say, a person like Senator Comyn spending 10/- on a sweepstake ticket. If the Senator's revolving goddess revolves the wrong way and he gets nothing he goes away disappointed, but he is not as mentally or morally damaged as he would be if he were to spend the night, say from 10 o'clock until 5 o'clock the next morning, indulging in the delights of a casino. Of course, I know the Senator would not do that.

Mr. Comyn

Or chancing his luck on a revolving table.

Mr. Fitzgerald-Kenney

Senator Vincent said he hoped the hospitals would set aside a capital sum. I hope they will. I ventured to say in the Dáil that I thought a hospital which was getting money out of the sweepstakes and did not lay aside a sufficient sum that would produce annually at least half its voluntary income would be acting extraordinarily foolishly. I think the hospitals took on a very great gamble when they started sweepstakes. When they decided on getting support from sweepstakes, to a very large extent they destroyed for all time voluntary subscriptions. Although they have not completely destroyed the voluntary subscriptions, I am sure they will have cut them down by one-half, and they should have a capital sum laid aside to meet the depreciation in voluntary subscriptions which is bound to follow and which has already to a very large extent followed upon the establishment of hospital sweepstakes.

Senator Connolly asked me about the accounts of the Hospitals Trust, Ltd. I have nothing whatever to do with the Trust, and I have nothing to do with the working of the hospital scheme in any way. The Hospital Committee planned their own scheme; they did everything necessary for the running of the scheme, and they sent accounts to every member of the Oireachtas, to Senator Connolly just as they sent them to me. All that is done under Section 6 of the original Act. If Senator Connolly is not satisfied with these accounts, I have no more to do with them than he has. Senator Connolly asked whether this money would be distributed by the Minister for Local Government on a county basis. That would be impossible, because some of the county hospitals, such as Louth and Waterford, have received large sums because they have come in amongst the hospitals which benefited under the voluntary side of the scheme, as I may call it, and naturally they could not now expect to share with those counties the infirmaries in which have received no benefit; they could not expect to share with the counties where there are infirmaries and union hospitals which received no benefit so far.

Senator Foran referred to slums; he said that there should be some relief given to the slum areas, and he thought that that would be most desirable. I quite agree that the slum problem is a very serious problem; it is a problem that everybody wishes to see solved. But this Bill is for the benefit of hospitals, and if there were to be sweepstakes for the benefit of the slums it would mean the introduction of an entirely new principle and a new Bill would have to be introduced. I may say that whole lot of institutions which are not hospitals have endeavoured to be included in this Bill. People who are interested in a great number of things, such as Jubilee nurses and other excellent bodies of that nature, have also been anxious to participate. It must be clearly understood that this is a hospital scheme and it can only be applied to hospitals.

Section 6 was attacked by Senators O'Farrell, Esmonde and The McGillycuddy of the Reeks, and I think it was defended by Senator Toal. If one reads that section I think one will see, in the first place, that complete discretion is given to the Minister for Local Government and Public Health. It is not necessary that the money he provides for the benefit of hospitals should go to any particular class of hospital. He is given unfettered judgment, but the money shall not be given to hospitals where, in effect, the giving of it would be in relief of local rates. We have heard a great deal of attacks upon county infirmaries and local hospitals. We have been told that no patients ought to be treated in local hospitals; they should all come to a central hospital. That may be a most beautiful theory, but the persons who put it forward are, to my mind, absolutely complete theorists and nothing else. We know that at present people are being treated in county hospitals. The overwhelming majority of county patients are being treated in their own county hospitals, and we know that that practice will continue. We know that they are going to be treated there, and the question we have to decide is: Are they going to be treated in proper surroundings and with adequate equipment?

To say that there should be only one hospital in all Ireland and that that hospital should be in the County Dublin is going rather a long way. That would mean that a person suffering from a serious disease requiring an immediate operation would have to be brought without delay to Dublin. That person might be living forty to fifty miles from a railway station. He would have to be conveyed to the station, and then brought to Dublin. Imagine the suffering that person would undergo before he would be operated on, and take into consideration also the great delay in transit. The suggestion of a central hospital conveys the impression that it would be improper and undignified for any local surgeon who is not a complete specialist to operate on the patient. That does not commend itself to me. We are told that this is really a relief of rates. It is not a relief of rates. We know in fact, that the rates will not be lessened by one halfpenny by the passing of this Bill.

Mr. Douglas

Not the present rate.

Mr. Fitzgerald-Kenney

The rates will not be lessened in the least. We know that there are county hospitals in need of modern equipment. Everybody who knows the country is aware that that is a fact, and is also aware that there is no likely source from which the hospitals could get sufficient money to instal this equipment. The question is: Should they get it from any source? We say: "Yes, let them get it from the Hospital Sweeps Fund just as the voluntary hospitals got money from the Fund." If Senator O'Farrell wished to press his point to its logical conclusion, he might rule out almost all the Dublin hospitals, and any hospitals that ever received this aid. Facts are what I am interested in, not mere theories. We know as a fact that these hospitals that are largely, some of them entirely, maintained out of the rates, are in need of improvement, and we know that they will never have that improvement unless money comes from some outside source. It is to give them that money that we make this proposal.

Question—"That the Bill be now read a Second Time,"—put.

Cathaoirleach

I think the question is carried.

Sir Thomas Esmonde

I will ask for a division.

Cathaoirleach

How many Senators desire a division?

Senators Esmonde and Comyn rose.

Cathaoirleach

I declare the question carried.

Sir Thomas Esmonde

We have made our protest.

Committee Stage fixed for Wednesday, 1st July, 1931.