I move amendment No. 1:—
In sub-section (1), line 41, after the word "committee" and within the brackets to insert the words "or the board of management of a hospital".
The amendment, I hope, will clear up a situation which is puzzling many of us at the moment. The section as it stands empowers the Minister whenever he so thinks fit, to "declare any particular board or committee (other than a pier or harbour authority or a vocational education committee), not less than half the members of which are required to be appointed by two or more rating authorities severally, to be a joint body within the meaning and for the purposes of the Principal Act". The consequence of such a declaration would be that the Minister would be empowered, as he thought fit, to appoint a manager for such a joint body. It strikes one at once that there are certain exceptions made by the Minister to this power. It will not apply to a pier or harbour authority or to a vocational education committee. I understand that the Minister on the Second Reading of the Bill a week ago explained that the reason for these exceptions did not lie in the nature of the work which these bodies performed but that they came under the authority of another Department as well as of his Department and he did not think, therefore, that the Minister of one Department should have such authority over a body that was really responsible to two Departments. One assumes from what he said that he did not consider or did not intend to consider — I do not know whether he had already made up his mind on the matter — any other reason for making exceptions to this power.
I think the House will see that my amendment raises a point which, whichever way it is decided, whetherpro or con, needs to be considered on its own merits. The amendment seeks to insert the words “or the board of management of a hospital” within the brackets, so as to make the board of a hospital also exempt from this power which it is proposed to give to the Minister. I think it is clear that a hospital is a completely different sort of undertaking from the ordinary undertakings that have been committed to the control of managers in the past or for which provision is being made at present. The manager of a local authority must be an excellent man of business. That is the first essential for his work. Apart from being an expert in business methods, he need not be an expert in anything else. He is an expert in business methods and business management, or he ought to be, but he is not an expert in any other particular line of activity. In the case of the management of a hospital, one has to consider that the duties are not merely a matter of business which any man of business ability can perform, but a matter which requires expert knowledge. A person who manages a hospital should have, undoubtedly, an expert and technical knowledge of medical matters. He should be familiar with the work that goes on in a hospital as no layman can be. He should know what have been the practices and the usages of hospitals in the past and what practices and usages have been abandoned as being cumbersome or burdensome or because they were wasteful of time and money. I take it that the man who is likely to be appointed manager under this Bill will be, first of all, a capable business man, a man of ability in administrative and executive work, but the matters which I have mentioned as appertaining to medical work, are matters with which he as a business man can have no familiarity. Therefore, I suggest he is not a person who should be given the management of a hospital and put in a position in which he is deemed to be technically superior to the rest of the staff of the hospital.
It has been said to me that at present hospitals are managed by boards. They are under the control of boards, of course, but the board of a hospital has one or more expert advisers. The largest hospitals which we have in this country unfortunately — I say unfortunately, because if there were not need for them, they would not be so big — are the mental hospitals.
There is a committee in control, but there is a resident medical superintendent. The resident medical superintendent, though not technically the supreme authority in the house, is, undoubtedly, the practical authority over all matters that are purely professional. I do not know how far a board could instruct him on his own affairs, but I do know that it would not be tolerated either by the public, the Department of Local Government, or the Minister. Where a medical superintendent is brought into contact with the lay members of a board, he is almost certain to establish good working methods with them and the board are anxious to establish good working methods with him. They regard him as their expert adviser on professional matters and they get on very well. You have very rarely any instance of friction between resident medical superintendents and lay boards. You find that they work generally in happy comradeship and co-operation.
But, it is an entirely different proposition to consider if instead of putting in a group of men on a board of that kind who will establish amodus vivendi with the superintendent, you put in one man as a supreme authority. There may be certain persons who are difficult to get on with, but if you take any board, you find it is composed of average sensible men. Very often they are men of great administrative ability. There may be some cranky people among them, difficult to get on with, or faddists, but the weight of the board or committee will move on a fairly steady line and they will, practically always, I think, realise that in their medical adviser they have a source of advice from which they should not differ. If you have a single manager as dictator —I do not use the word offensively— as the supreme authority in the place and in a position to give orders to the resident medical superintendent or to a professional staff, you have a different position. Instead of having an expert giving advice to a sensible body of men, you have an expert giving advice to one man, who, on those matters, knows no more than anybody else.
He is not likely to form a sensible opinion, or his attitude is not likely to conduce to the same happy co-operation as exists between boards and their medical advisers. I am not at all suggesting that such happy co-ordination might not in some cases be established, but the mere fact that there are two people concerned and that one is an authority over the other, is likely to lead to a rather arbitrary attitude on the part of the one in authority. There is a certain hierarchy of authority established which is not necessarily the best, and I do not think that the Seanad should encourage the Government to establish a position such as that, in which considerable danger of friction might occur, and considerable embarrassment in the working of the institution. I am not clear yet as to what institutions this clause would really apply if it should become law. I am not sure, for instance, whether the Minister has the power at present over our mental hospitals of appointing a manager. Would the Minister say what the position is?