Léim ar aghaidh chuig an bpríomhábhar

Seanad Éireann díospóireacht -
Wednesday, 20 Jan 1943

Vol. 27 No. 8

Saint Laurence's Hospital Bill, 1940—Second Stage (Resumed).

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

At the end of the last session of the Seanad I was discussing what seemed to me the essential principle in the St. Laurence's Hospital Bill, and I had just come to the point that one of the principal points apparently underlying the Bill, and provided for in the Bill, is the transfer of the hospital to another site. That is a matter to which I think the Seanad should give very close and very careful attention. The Dublin medical school is on somewhat different lines from any other medical school in these islands in the sense that it has sprung up and prospered and has done well in a number of separate institutions. I am speaking now of the Dublin medical school as a whole, and not of any particular school. The history of the Dublin hospitals is similar in many ways to the history of hospitals in some other centres, notably, for instance, in London, in that the hospitals were founded at different times and in different centuries by the charitable public almost altogether. There are some exceptions. The hospital we are particularly dealing with in this Bill is not one of those which have sprung up as charitable institutions primarily. It started its life as a Government institute, and the Government, both before the Treaty settlement and since, has had a considerable control over the hospital.

I suggested on the last occasion the Bill was before the House that one of the objects of this Bill or one thing that springs out of the Bill from even a cursory examination of it is that the Government is tightening its control in many particulars above what was practised at any rate in the past—whatever might have been the legal position of the Government in relation to the hospital. When medical schools as distinct from hospitals came to be founded they were founded quite distinct from the hospital and had little or no connection with the hospital. That is a position which is peculiar, I think, to Dublin. It does not arise in Belfast to anything like the same extent because there are only two major general hospitals in Belfast and the teaching courses at both of them are recognised by the university in Belfast.

Here in Dublin there are ten general hospitals and the clinical course given in each of them is recognised officially by the three medical schools which exist in Dublin at present. None of them is under the control of a medical school but there is a happy association between the work carried out by the hospitals and that by the medical schools. One result of that is that the whole course of medical education is not given at one site or in one locality.

Students attending one of the medical schools—University College, Trinity College or the College of Surgeons— can attend any of the hospitals for their clinical courses. They choose the hospital according to family associations, convenience to their residence or other considerations of that kind. In London the case is quite different. The medical schools there have arisen as annexes or extensions to the hospitals or vice versa, and the hospital and medical school are either in the same building or are immediately adjacent to each other so that there is only one location which is concerned with the student's education. Here the student is attending some of his lectures at a medical school—the three of them are situated fairly centrally—and he is attending for his clinical instruction at a hospital which may or may not be convenient to the school, but which is generally fairly convenient to a residential district. It may be convenient both to the residential district in which he lives and to the hospital.

A great deal of the anxiety that has arisen from the apparent determination to change the site of the Richmond Hospital is due to the knowledge that such a change is likely to interfere greatly with the convenience of students attending the hospital and to interfere greatly with the classes in the hospital. Hospital lectures begin at 9 o'clock and it is not easy for a student to attend a hospital which is several miles distant from his residence.

In choosing his residence, the student has to take into account its proximity to the hospital, and also its proximity to the medical school which he is attending. If the Richmond Hospital, to give it its common name, is transferred from a fairly central position to a position in the suburbs or in the neighbouring countryside, it is likely to interfere greatly with the possibility— I said "convenience" a moment ago, but it may extend even to the possibility—of students attending a class in that hospital, and the class is likely to diminish very much. Liveliness, or the life of the teaching, depends very much on having a sufficiently large class to encourage the teacher. There is nothing more depressing for a teacher than to have to address a small class, or nothing more depressing for students than to feel that they are in a small class. I do not say that very large classes are desirable, but certainly, for clinical teaching, unless there is an active and fairly numerous class attending the hospital, the teaching in that hospital will suffer, and the attraction of that hospital to leading men, surgeons and physicians, seeking staff posts, which are always unpaid, is likely to diminish if they have not a class to encourage them. I do not overlook the fact that the income of the visiting physician or surgeon depends to a large extent on fees received from students. He is not paid anything by the hospital. He gets certain fixed fees from the students. These fees are set out in the syllabus and the student or his parent knows what the fees are going to be during the student's normal course.

For both these reasons, an active and fairly numerous class is necessary to ensure that the hospital will retain a thoroughly competent staff, the best staff available. No doubt the members of the staff get other advantages. They are teaching students who are going to be the practitioners of the country in after years. The good word of the students is one of the things that will help members of the staff towards a good practice in future, a consideration that no teacher can afford to neglect. Again, the fact that they are attending patients in a hospital with a good reputation maintains their reputation with the public generally. From that point of view, the fact that the school may be gravely damaged, possibly almost destroyed, by a movement of the hospital to a site which is not convenient for the attendance of classes is one to which the Seanad should give close attention.

There is another point of view, which is the essential one as regards the hospital. That is that the hospital must be within a convenient distance of the population which requires its services. The Richmond Hospital is situated in a very congested area of the city but, fortunately, plenty of space is available for building an extension to the existing hospital or building a new hospital. It is not part of a slum but a slum area comes right up to the door of the hospital. It is in a very thickly populated area but there is plenty of space available immediately beside the hospital for an extension of the building.

It has been urged, and urged with a good deal of reason, that hospitals would be better situated in the open country, in country air, than in fairly closely crowded quarters of the city. There is a great deal to be said for that, and the idea has been put into practice in some cases. Some of the old London hospitals have been moved out into the country or to suburbs just outside the city. The same thing was done in Birmingham. A beautiful open site was chosen within about three miles of the centre of the city, but in that case the medical school had preceded it. The medical school, which had been formerly situated in the city itself, was moved to a building adjacent to which the hospital was built. From the point of view of the hygiene of the hospital that was admirable. One factor which did not work favourably for education was that there was not available residential accommodation for students in the immediate neighbourhood. No doubt there is a hostel or residents' house attached to it, but whether that was capable of accommodating all the students, I do not know. Another discouraging feature was that the patients for whom the hospital was intended did not follow it to the suburbs. I had an opportunity of visiting the hospital a few years ago, and certainly in the way of hospital building and planning, I could not conceive of anything much better in present conditions. But, I was informed, the people in the city requiring hospital treatment continued to attend the older hospitals in the city and the new hospital was very much less frequented. The word "abandoned" was used to me, but I think that that was putting the matter too strongly. From two points of view, the movement, though it promised very well, appears to have been a failure— from the point of view of convenience for medical education and from the point of view of the convenience of patients.

From these two points of view, the changing to any distance from the present site of the Richmond Hospital would seem to be undesirable. There is plenty of room around the existing hospital for building. There are the grounds of the old Dublin Union which, I understand, are at present let to a charitable society which, no doubt, could be accommodated elsewhere.

The Minister has made clear that he had a certain neighbourhood in his mind as a site to which he would, so far as his power went, transfer the hospital, leaving, as this Bill provides, some part of the old hospital to continue to be temporarily used as an outpatients' department. That question of keeping the out-patient department in a central situation and moving the beds to a suburban situation raises another point. At first sight, it appears to have much in its favour but it has this in its disfavour—that it makes for the inconvenience of the friends of patients who desire to see them. Patients in a hospital look forward to the weekly or bi-weekly visits of friends and it is important that these friends should have ready and easy access to patients if they are dangerously ill. If a hospital is removed some distance from the centre of population which it serves, there is a considerable drawback in this regard.

This question of the site of the hospital has, of course, been very hotly discussed. It has been a topic of conversation amongst medical and other people interested in hospital problems during the past few years. The Minister, in this Bill, takes power to buy land for the purpose of accommodating the hospital. That, in itself, is a useful provision; because the Minister can better deal with the purchase of land than any other purchasing body, such as the board of a hospital, could. He can deal more efficiently with the matter and make orders which the board of a hospital could not make.

A similar suggestion was made by other hospitals which had plans for establishing a new hospital by the combination of several. There is, however, no control on the Minister in regard to his choice of site. I do not know where the suggestion as to the Cabra site came from. The proposal in the Bill is that the Minister should be empowered to assign funds from the Hospital Sweepstakes, which are under his control at the moment, for the building of this hospital. Most of the activities of the Minister in dealing with the Hospital Sweepstakes funds have been after taking the advice of the Hospitals Commission. I do not know what advice the Hospitals Commission has given to the Minister in this respect. The Hospitals Commission have published very full and useful reports and have published a great many of their recommendations in these reports. I do not think—I have made inquiries from various people on the subject—that they ever recommended that this hospital should be transferred to a site at some distance from the present situation of the hospital. I do not know whether the Parliamentary Secretary is prepared to tell us whether or not the views of the Minister, as expressed, though not embodied in the Bill, follow the recommendations of the Hospitals Commission or whether he made up his mind, within the Department, as to this being the best way of dealing with the matter. Whatever criticism the Hospitals Commission have been subjected to— and any body of men in such a position would be subjected to criticism—they have exercised a very wise discretion in the advice they have given and they have made a very useful survey of the hospital problem in the State. If the Minister has not the advice of the commission behind him, then I think the proposal requires more backing, and that it is not sufficient to throw it into the void, as is done in this Bill, and empower the Minister to purchase land for the building of a new hospital.

I hope the Parliamentary Secretary will be able to satisfy some of the fears aroused amongst many people interested in the hospital service of Dublin and the general social services of the State by the tremendous power given to the Minister in this Bill. I have dwelt largely on what seems to me to be the most dangerous point, but there is hardly a point in the hospital's administration which is not under the thumb of the Minister. Though this hospital has been subject to a certain amount of Governmental control throughout its history, it has mainly been managed by a board of governors, which had power so to manage it, though they had not the full powers embodied in this Bill. I do not think that anybody who has a knowledge of hospital service, as practised in this country, and experience of the people who make use of that hospital service, is enamoured of the proposal to substitute for voluntary service a State-controlled service. In so far as this Bill appears to be a step further in the claim of the Department to control the hospitals in detail, I think the Seanad should hesitate to approve of it.

I do not know how far one can discuss general hospital policy on this Bill. I am anxious, at some time, to raise rather wider issues of hospital administration than could, I think, properly be done in this debate. At the moment, I merely want to ask the Minister to expedite the issue of the reports of the Hospitals Commission. I have not before me the date of the last report, but I think I am right in saying that one report took, at least, three years to produce. These reports lose much of their value when they appear so late as that. Perhaps the Parliamentary Secretary cannot say much about the matter now, but it is very important that those interested in hospital questions should have the reports of the Hospitals Commission more promptly than they have had them in the past.

I do not profess to know much about the position of our hospitals and I, certainly, do not know very much about the details involved in this Bill. The only reason I venture to say a few words is that it seems abundantly clear, after reading the Bill —and very definitely so after listening to Senator Rowlette, who was clear and, as usual, moderate in his expressions—that this Bill is intended, so far as one hospital is concerned, very greatly to increase the powers of the central authority, as distinct from local or voluntary control. It appears to me that during the past ten years or so we have been going too far in that direction. The whole tendency of our State has been to get governmental, which means either bureaucratic or political, control over almost all our institutions.

I think our direction should be the other way. It should be to get the largest number of persons together to work for the good of the country with as little control as possible from the central authority. There is something wrong with the direction in which we are going. We started in that way before the war, and the war has accentuated it. That, I suppose, has been inevitable, but I think our efforts in that direction should definitely be of a temporary character. I look on this development with the very greatest misgivings, so far as it applies to our hospitals, because if you start with it in the case of one hospital it will spread to the others. You will have control from whatever building in which the Department of Local Government is contained. In saying that I do not wish to make any attack on the officials. We do not know who the Minister or the Parliamentary Secretary will be at the time this new hospital is built.

I say that, not because I am in a position to prove that they will necessarily be less efficient than the voluntary system, but because I feel that if you go along in the direction indicated in this Bill you will get a smaller number of people to give their services voluntarily, and inevitably will lose a great deal of voluntary effort so far as hospital work in Dublin is concerned. That work, at present, may be anything but perfect. One hears complaints here and there, but one also hears a great deal of praise for it. The fact, at any rate, is that most of us are proud of the reputation of our Dublin hospitals and medical schools. We are proud also of the large amount of voluntary service given to them by eminent surgeons, eminent physicians, and by a great many eminent civilians. If you are gradually going to substitute bureaucratic control, under the direction of the Government of the day, for those voluntary services, then, I think, judging by the experience of other countries, a great deal of that voluntary work will gradually disappear. In a country like ours, which is a comparatively poor one, I think that is a wrong direction to take. I mention that because I think it applies in a peculiar way to our medical services. I am not competent to say how far it applies to this particular hospital, but I, nevertheless, think it is a step in the wrong direction. The Second Reading of this Bill seemed to me to be the appropriate occasion on which to indicate that point of view.

I would like to have some information from the Parliamentary Secretary in regard to Section 21 which proposes to give power to the Minister to acquire compulsorily a site for this new hospital in any part of the city. In my view there is no necessity for the taking of compulsory powers for that purpose. So far as I understand the position the Minister will be quite free to choose a site in any place he wishes around the city for this new hospital. His area of selection is fairly wide, and hence I do not think it should be necessary for him to take compulsory powers under this section.

As Senator Sir John Keane has said, some of us are not quite clear as to how far we may go in any remarks we may have to make with regard to the Dublin voluntary hospitals in connection with this Bill. Senator Douglas very truly said that Senator Rowlette was very clear and very restrained when speaking on the Bill. That is the trouble with all of us, voluntary hospital workers. It is difficult to be restrained, but we are inclined, when we think about the subject even without speaking on it, to lose our tempers. From the broad point of view, I would like to draw the attention of the House to the fact that the Sweeps, under which this whole scheme is being run, were instituted originally for the Dublin voluntary hospitals.

Under the Cosgrave Government an amendment was made allocating 33? per cent. of the Sweep funds to the rate-aided hospitals. That was a wise proposal. At that time there was in existence a commission which was under strict Government control. The commission consisted of three people: a financier, an architect and a Government representative. Under it everything worked in a perfectly smooth way. Finally, after certain changes had been made, the Hospitals Commission was established. To my mind, both commissions were given the task of tackling one of the greatest problems in Western Europe, namely, the problem of the Dublin voluntary hospitals. That problem is extremely involved. It is difficult for the layman to understand the position of the voluntary hospitals in Dublin. They are all differently constituted. Some of them have grown up around street corners in the course of centuries, some have been taken over by religious bodies, and some have been taken over largely, or in part, by the county, by the City of Dublin, or by the Government. The financial side of the problem is extremely intricate, even to financiers. In spite of the Hospitals Commission report, which it took three years to produce, I want to say that in my view the Department of Local Government and the Hospitals Commission have still only a very faint idea of this problem. I will say no more about that.

As regards the question immediately at issue, Senator Rowlette has pointed out the salient facts. He emphasised the question of clinical teaching, which is a very important one, because, as you all know, the Dublin schools have a very high reputation for their clinical teaching. I do not like to use two adjectives, but I think, in connection with this hospital, that I might. In my view, it is fatuous and infantile to think of transferring a magnificent hospital like the Richmond Hospital, a centre for the treatment of sick and poor patients, to the suburbs, particularly when we think what transport conditions are at present. Take the case of a poor woman in North King Street whose husband has a bad ear-buncle on the back of his neck. If he has to go to a hospital outside the city, and is there for a fortnight or three weeks, she cannot go see him very often. First of all, she will have to get a bus to take her to Dorset Street, and another to Cabra or somewhere else. That will cost her at least 3d. each way. Then the time may come when she will not be able to get a bus. The upshot will be that she will not get her husband sent to hospital, or else may walk across the river and get him into St. Kevin's Hospital. The important consideration should be the convenience of sick poor who want hospital attendance.

I repeat that, to my mind, it is a fatuous thing to change a magnificent hospital like this from its present site, apart altogether from the expense involved. There is another point that may be of interest to the House. Take the case of the Mater Hospital, which is one of the biggest hospitals in Ireland. There we are supposed to have been building a 500-bed hospital over the last ten years. I have built practically half of it myself, spending night after night in the office of the architect. Still there is not a stone upon a stone, and there will not be a stone upon a stone until I am long dead, so why go into this wild scheme of disturbing a hospital which is doing wonderful work and which is one of the best teaching hospitals in the world?

The debate has wandered over a rather wide field and very little of it has, in fact, been related strictly to the Bill before the House. I can appreciate the anxiety of Senators who are particularly interested in the hospital question to avail of any opportunity of raising the wider questions for the purpose of discussion; but, at the same time, a full-dress debate on the wider aspects of hospital policy in Dublin and throughout the rest of the State, is scarcely appropriate to the present Bill.

And, of course, it has not taken place.

I was on the point of saying, when I was interrupted by Senator Hayes, that in so far as I have information at my disposal to deal with the various wider aspects of the hospital situation that have been raised, I propose to deal with them here to-day. If I have not the fuller information that may be necessary to deal adequately with the various points not appropriate to the Bill before the House, we can go into such matters in more detail at a later stage.

Senator Rowlette, in his opening remarks when this Bill was under discussion last week, complained that I did not emphasise the reputation of the existing House of Industry hospitals as a teaching school. I must plead guilty to that. I did not refer to the standing of those hospitals as one of the leading clinical hospitals in Dublin, but that was not with any sinister object in mind. My approach to the Bill, in the statement I put before the House, was inspired by the desire to inform the House on matters of which it might not have much knowledge. I assumed that the House would be fairly well informed— as would anyone interested in hospital conditions in Dublin or throughout Ireland—of the position that the House of Industry Hospitals occupied as a clinical school in the City of Dublin. I believe I am still right in that assumption. At any rate, I want to make it clear that it was not for any other purpose that I omitted to make reference to the standing of this institution as a teaching hospital.

I did not make that suggestion.

The policy of the Government in relation to this hospital is, so far from restricting its activities as a teaching hospital, to enable it to continue to rank among the first hospitals of Ireland, and, perhaps, among the first hospitals of Europe. It is in order that it should be fully equipped to occupy that distinguished position, and continue to occupy it, that it is proposed to provide a new hospital. Senator Rowlette, in the course of his remarks, stated that he did not quite understand what a State hospital means. He reminds us that, 20 years ago, the British Government repudiated the idea that the associated hospitals known as the House of Industry Hospitals were State hospitals. That is true. In 1919, arising out of a demand of the Richmond, Whit-worth and Hardwicke representatives for an increased subvention from the British Treasury, Lord Crawford, speaking on behalf of the British Government in the House of Lords, adopted the attitude that these hospitals were not State institutions. He used that argument, at any rate, as the grounds upon which the British Government refused to increase the grants. He was very quickly brought to task by no less a person than the secretary of the Board of Governors. The question was raised in the House of Lords on the 13th August, 1919, and I think the very next day the secretary of the board wrote to the Irish Times, taking Lord Crawford to task for his assumption that these institutions were not State institutions. In the course of his letter to the Irish Times, the secretary of the Board of Governors, Mr. W. Webster Smith, stated:—

"By the Act of 1856, the government of the hospitals was retained in the hands of the Lord Lieutenant, who alone could nominate governors. The Treasury Pension Regulations were applied to all permanent salaried officers in the hospitals, and every foot of ground and every stone in the hospitals was vested in the Board of Works. These conditions would appear to render the hospitals a State institution, and certainly militate against their recognition by the public as on the same plane as the ordinary charitable hospitals."

A few days later, on the 27th August, a letter in somewhat similar terms from the present secretary of the board appeared in the Irish Times, in the course of which he stated:—

"The House of Industry, whence these hospitals originated and derived their collective name, was established in 1772, by the Act 11 and 12, Geo. III. Ireland, was continued as a Government institution down to the passing of the Act of Union, and, on the passing of that Act, was adopted and maintained as a Government institution until 1856. By the Act of 1856 the hospitals were continued as a Government institution, the absolute control of which was vested in the Lord Lieutenant as the King's representative in Ireland. The property was vested in the Commissioners of Public Works, while provision was made for superannuation allowance for the staff, subsequently regulated in 1859 by the 22nd Vict."

Further on he states:

"Lord Crawford's statement, too, in which he seeks to justify a wrong wantonly inflicted on the poor of Dublin, and on which Mr. Bonar Law unhappily relies, is inaccurate, evasive, and unworthy of one in Lord Crawford's high position..."

While, as I say, it is true that Lord Crawford, speaking on behalf of the British Government, maintained that these institutions were not State hospitals, that attitude was immediately repudiated by the representative of the Board of Governors.

The existing House of Industry Hospitals are State hospitals by Act of Parliament, and not by any new interpretation of any old Act of Parliament. They have been State institutions since they were first instituted and are under the complete and absolute control of the different Departments of State. The Commissioners for Public Works own the buildings, the Minister for Local Government and Public Health, as the successor to the Lord Lieutenant, administers and controls the hospitals and may appoint a board for that purpose; and the Department of Finance, as the successor of the Treasury Commissioners, have to be consulted in all matters relating to increased salaries, pension schemes, and so on. If it were necessary—it scarcely is necessary; I think it was Senator Douglas who appeared to be completely at sea in relation to the nature of these institutions—to quote the different sections of the Act of 1856, the House would see at once that these institutions are entirely under the control of the State and that the Minister for Local Government could manage these institutions without the appointment of a Board of Governors at all. He could appoint one, two or three, or any number of governors, or he could administer the institutions direct from the Department.

Reference was made by Senator Rowlette to what he called a diversion of the Sweepstakes funds to rate-aided hospitals. Such diversion as has taken place has been a diversion by a deliberate Act of the Oireachtas. Listening to Senator Rowlette when he mentioned this matter, one would feel that the suggestion was being made that the present Government were responsible for this diversion. That attitude of mind has been corrected to-day, and it has been made clear by more than one speaker that the Act permitting this diversion of funds was passed on 17th July, 1931. There was general agreement on that policy. Fianna Fáil was the chief Opposition Party at that time and, speaking from recollection, I believe that we were in favour of the Government of the day adopting that policy and that we supported the Bill when it was considered in the Dáil. I do not make that as a definite statement, but that is my recollection. I think that the Oireachtas was almost unanimously in favour of that diversion.

I do not know whether Senator Rowlette suggests that the Oireachtas did something wrong in passing that legislation, enabling the institutions of local authorities to benefit from the Hospitals Trust Fund, but, in the light of the fact that that has been the law for so many years, I do not think it is proper to criticise the Government now in power for administering the law. If the Senator feels very strongly in the matter, perhaps he might consider introducing legislation repealing the Act of July, 1931, the Act that provided for this subvention.

Examining the matter on its merits, I do not agree with Senator Rowlette or any other Senator who holds the rigid view that the voluntary hospitals alone are entitled to the entire proceeds from the Sweepstakes. It was not denied that the voluntary hospitals took the initiative in the matter of organising sweepstakes, but neither can it be denied that, were it not for the protection and assistance the State gave in the matter of sweepstakes, and the monopoly given to the Hospitals Trust, the Sweepstakes could not have achieved the success that they did subsequently achieve. Laying that argument aside, is there any convincing reason why the local authorities, who have to provide hospital facilities for the poor throughout the provinces, should not be assisted in the same way, and to a corresponding extent, as the voluntary hospitals in the City of Dublin are to be assisted? It seems to me that the ratepayers of Dublin City and County and the areas that were intended immediately to benefit from the Hospitals Trust funds, according to Senator Rowlette, have the same legal and moral obligations towards the poor that the ratepayers in the provinces have.

Hear, hear!

I am glad I have evoked some "hear, hears." If that proposition is sound, then there is no substance in the suggestion made with reference to the diversion of portion of the funds to the rate-aided hospitals. It seems to me they are just as well entitled to a share of the Sweepstakes funds as are the voluntary hospitals. In so far as the voluntary hospitals supply a need that might otherwise have to be supplied by the rates of the City of Dublin particularly, and the City of Cork to a lesser extent—in so far as they supply a need that would otherwise have to be supplied by the finances accumulated through the rates, the rates are relieved to that extent. Consequently, there is not very much difference in the long run between subsidising the voluntary hospitals that are serving the needs of the local authorities in certain areas, and subsidising the local authorities that are carrying the direct responsibility in providing these services for the poor.

Apart from that altogether, nobody would suggest that the proceeds of the sale of tickets for any of these sweeps come entirely from the City of Dublin. They do not. Tickets are sold throughout the whole country, throughout the whole of Europe and, indeed, throughout the whole world, and they have not been sold purely for the purpose of assisting the voluntary hospitals in Dublin. They have been sold for the purpose of providing a proper hospital system throughout the whole of this country, to be at the disposal particularly of the poorer classes of the community.

Not in the beginning.

The beginning is a very long time away now.

Was there not something like 33? per cent. to be allocated, according to law, to the voluntary hospitals?

That is not so. Senator Rowlette also suggested that the Hospitals Trust funds have gradually been depleted. That statement is, to say the least of it, misleading. In order that the House may be fully informed on the matter, I shall have to burden Senators with some figures regarding the position of the Hospitals Trust funds. Probably most of you are interested in the matter, anyhow. The amount in the fund on the 31st December, 1942, was £8,199,158 15s. 3d. The highest amount recorded as being in the fund was £8,879,380 6s. 3d., on the 31st December, 1939. There is not a very serious depletion there.

Income was coming in all the time.

That is so, and I am just coming to that point. The fact that the greater portion of that money, that £8,000,000 that has accumulated in the Hospitals Trust fund, has to be retained invested and is not available for constructional work, is because of the rising annual deficits in the voluntary hospitals. If these deficits are to be met, a capital sum must be held invested in order to bring in an income to meet them from year to year, and, if we hold money for that purpose, it is scarcely fair to suggest that we are depleting the funds of the Hospitals Trust.

That has not been suggested, or anything approaching it; it exists in the imagination of the Parliamentary Secretary.

I am glad to hear that. The deficit for 1933 was £50,273 and for 1938 it had become £115,690. For 1939 it was £156,957. These are all prewar years. For 1941, the deficit was £209,009. At 3 per cent., it takes a sum of £6,966,966 to produce £209,009, which means that of the £8,000,000 we have, upwards of £7,000,000 has to be held invested, if we are to pay the annual deficits of the voluntary hospitals.

Could the Parliamentary Secretary tell us if these figures of the deficits are published in any papers?

Deficit figures are published.

Is there any published statement as to the income drawn from this sum of £8,000,000 annually and as to its expenditure?

Surely we ought to have that.

Assuming that it is invested at 3 per cent., £7,000,000 will be required.

The Parliamentary Secretary has said that the deficit began at £50,000 and went up to about £200,000. Surely there ought to be some statement in some annual finance report on that point? I have never seen such a statement.

Does the Senator question the figures I have put before the House?

How can I question them? I have no material.

Surely the Senator will accept the figures I have placed before the House. The Senator is talking about rising deficits and these figures I am giving are furnished to us by the voluntary hospitals. The hospitals claim repayment from year to year, and from year to year the figure has been mounting to the tune which I have shown the House.

All I say is that, in 1939, we should have known that there was so much fruit from this £8,000,000 and that so much went to the hospitals; in 1940, we should have had similar information; and so on.

May I put the point in the form of a question? Does the Hospitals Trust Fund publish any accounts?

They do not. The trustees are responsible for the investment.

The public have not got the information?

Not information as to how the moneys are invested or the annual income from the investment, but we have more than once brought the position in regard to the deficits to the notice of the public because the public seemed to misunderstand the position and an atmosphere has been created—perhaps deliberately and perhaps not—that we were playing about with these moneys and devoting them to some purposes other than the purposes for which they were subscribed. I do not say that any such suggestion has been made in this House, but such suggestions have been made in other places.

On the point raised by Senator Sir John Keane, may I ask whether these statements as to deficits were not published in the reports of the Hospitals Commission up to the time the last report appeared? I am not questioning the Parliamentary Secretary's statement, but I was under the impression that these deficits were set out in the reports of the Hospitals Commission.

The deficits have been published, but that is not Senator Sir John Keane's point. His point is whether the trustees publish particulars of their investments and the income from these investments.

I asked both.

Senator Rowlette, in dealing with the question of the appointment of members of the Board of Governors, suggested that these appointments were automatic, under the old régime, in the good old days when the Lord Lieutenant appointed the Board of Governors. It depends on what you mean by "automatic." The Lord Lieutenant made the appointments, but as to what transpired before he became automatic is more than I would venture to suggest. We could truthfully say that the appointments are automatic to-day. The mantle of the Lord Lieutenant has fallen upon the Minister, God help him, in this particular regard. He now appoints the Board of Governors and I think the appointment is automatic.

He does it in his sleep?

Oh, no; there is nothing done in our Department when we are asleep. In fact, we are wide awake, and if we were not so wide awake, perhaps the appointments would be more popular with Senator Rowlette. I do not know; the Senator may, perhaps, be fully satisfied with them. In that issue, in case there is any doubt as to the suitability or popularity of any of the recent appointments to the Board of Governors, I would say that in a recent discussion with the chairman of the Board of Governors and others, he told me that if he himself had picked the Board of Governors appointed by the present Minister for Local Government, he could not have improved on it.

And he presumably was an appointee of the Lord Lieutenant?

Yes, and the present chairman of the Board of Governors. He went further and told me that he had developed an affection for the new board——

That was very patronising.

——particularly for the new members of it. He was borne out in all that by the vice-chairman, who was also present. I mention these things lest there should be any suggestion that the Minister packed the board or made any unpopular appointments to it. I do not ask the House to accept my estimate of their virtues of suitability; I merely quote for the benefit of the House what the chairman of the Board of Governors himself told me. It was not the practice in the old days that are gone to consult the Board of Governors when vacancies occurred. Neither was it the practice under the previous Government nor is it the practice of this Government. It is open to the board or to anybody interested in the matter to recommend a suitable person when a vacancy occurs; but, of course, if all the recommendations do not agree, they cannot be given effect to.

On the question of the site—a discussion which is of doubtful propriety, too, but the Cathaoirleach is very generous in his interpretation of what is in order and having permitted people to refer to the site, I have no doubt that he will permit me to say a word on it—I should like to preface my remarks on the question by the reminder that this Bill does not propose to select a site. This Bill empowers the Minister to select a site in or near the City of Dublin. That is all it does. Some Senators seem to think it a very dangerous thing to empower the Minister to select a site. The thought has been running through the minds of one of the speakers here to-day that a statutory obligation should be put upon the Minister to seek and obtain the advice of the Hospitals Commission. If such an amendment is put forward, we can deal with it when we meet it, but to my mind it would be a complete absurdity to put a statutory obligation on the Minister to consult a body which is subordinate to the Minister and to the Department of Local Government.

Is there not a statutory duty on the Minister to send to the Hospitals Commission applications which he gets for grants from Sweepstakes funds?

That is a different question altogether.

I do not see the difference.

It is a different matter altogether. We are dealing with powers to acquire a site——

And to spend Sweepstake funds.

——and the right of the Minister to select a site. The Minister responsible will seek and obtain the advice and assistance of anybody deemed competent to advise him on a matter like that. The views of the board will be considered; the views of the Hospitals Commission, if they have any, will be considered; and, if Senator Rowlette has views and submits them, they will be carefully considered. The selection of the site will not be automatic, but all relative considerations will be carefully considered. The views of the board will be obtained, but the ultimate responsibility, and the statutory powers, will rest with the Minister. As matters stand neither the board not the Minister has power to acquire a site. The board's powers are strictly limited to the powers of management. They have no power to acquire land; they have no power to erect buildings; they have no power to take down derelict buildings. Some of the buildings there at present are, in fact, a danger to the public, but they have no statutory powers to remove them. They have no power to carry out repairs to the existing buildings. It is true that the Commissioners of Public Works, as far as the property is vested in them, have power to execute repairs and alterations. In fact, the board, without statutory powers, have acquired adjacent property, and that adjacent property, at the present time, would require rather urgently some skilled attention. The board have no power to deal with that, but if this Bill were law, the board would have the necessary statutory power to deal with such matters.

On the other question, if we must discuss it, as to whether the hospital should be built on the present site, or built on some other site, we might debate for a long time. There is a good deal to be said for and against. In so far as the information at my disposal goes, we could not erect a hospital with 550 or 600 beds on the present site. The space is not available. It has been suggested that we might acquire adjacent land and buildings and, in that way, extend the site. How far that would be practicable is a matter that can be examined, but I may frankly say that the Department is not favourably disposed towards extending on the present site, partly for the reason that the locality is unsuitable, that the space available is limited, and perhaps more than anything else, that by reason of the development of the city, and the housing schemes that have been carried out, the density of population in the city has shifted, and the future development of the city, as we anticipate it, will further transpose the density of population in the city and, in building a hospital that we hope will serve the poor of Dublin for a very long time, one has to try to visualise what the position will be in 20, 30 or 40 years hence, as far as that can be visualised. I mention this matter to indicate that it is not at all a question of selecting a site and getting on with the building. People in a responsible position, having to make that decision, have to take much wider matters into consideration before reaching a decision.

I need hardly mention, as I am quite sure Senator Rowlette knows just as well as I do, that the modern tendency in most European countries is to build hospitals outside cities, in the country or on the brink of it. That tendency has taken practical shape in Italy, France, Czecho-Slovakia, Finland, Belgium, and at the present time is taking shape in Britain. If I were not to weary the House I could quote many authorities of considerable standing and weight to indicate the soundness of that policy. Apart from the public health point of view, the adoption of this policy has been expedited by the experience gained in the present European war, where hospitals situate in centres of population have been demolished overnight, and where the whole hospital system has been paralysed as a result of air attacks. It would be all very well to say that we will never be involved in anything like that. But we have no assurance. We must plan on the assumption that the fate that has overtaken other civilised communities might sometime overtake this civilised community. I should also remind the House on this question of site that, from the point of view of the medical students of the future, and of the desire for teaching facilities that this institution would afford, as well as from the point of view of the sick poor, and their relatives, the Bill provides for the gradual closing of the existing hospitals from time to time as the Minister, after consultation with the board, is satisfied that the need for these hospitals no longer exists.

I suggest to the House it will be, probably, a number of years before a stone can be laid upon a stone for the provision of a new hospital. We cannot hope to begin building until this emergency has passed and until materials are available. We desire to acquire a site in order that the planning of the institution can be carried out, and that when materials become available, the necessary and tedious preliminary work will have been carried out, and we can then proceed with the hospital. Even with this hospital established I firmly believe that there will be still a bed shortage in the City of Dublin, and that the need for continuing the existing institutions will be so evident that it will not be possible to close down any part of existing institutions for very many years ahead, until, in fact, the whole contemplated hospital scheme for Dublin has been completed. Even then I venture to predict—and this is predicting a long time into the future—that there will be still a need for hospital beds in Dublin. I do not know how far Senator Rowlette agrees with me, but I believe that the hospital sense is only in process of developing in this country, and that even ten years ago there was considerable difficulty in inducing people, when ill, to go to hospital for treatment, as they would much prefer to remain at home. They used say to the doctor: "If I am to die at all I prefer to die at home." A more enlightened outlook prevails to-day.

Many more people are anxious and willing to avail of hospital facilities at the present time than even a few years ago. I believe that the outlook in this matter is only in the process of development, and that the future will see a much greater demand for hospital facilities than we see even to-day. If that prediction should be well-founded it is reasonable to assume that the conditions precedent to the closing down of the existing hospitals will not obtain in this country for very many years.

On a point of personal explanation, I want to make it clear to the House that in any remarks I made here I was not briefed in any way by the staff of the Richmond Hospital or any member of it. My remarks with regard to this matter were purely personal.

With reference to the point I raised as to the delay in getting reports from the Hospitals Commission, I hope the Parliamentary Secretary will look into that, because it is almost impossible to discuss and examine our hospital policy in view of the changed circumstances without this very essential information. Could the Parliamentary Secretary say why it is necessary for the Hospitals Commission to take three years to publish reports when a body like the Electricity Supply Board will let us have its report and accounts within a few months?

I would require notice of the question put by Senator Sir John Keane; but, at any rate, I will have the matter looked into, and, if it is possible to expedite the publication of these reports, it will be done. As to the point raised by Senator Barniville, perhaps he misunderstood some of my remarks. At any rate, I did not intend to impute to him that he had been briefed by anybody in making the statement that he made here. But, as he has brought himself under fire, I will say this to him: that his argument that it would be fatuous under the present system of transport to transfer the hospital from its present site out to the periphery of the city does not sound at all convincing in the setting that we have here. There is not any hope of being able to provide this hospital while the present system of transport prevails. It will be very many years before the hospital is provided anyway, and we all hope that the present system of transport will be very much overhauled and modernised before this hospital is available.

Question put and agreed to.
Committee Stage ordered for Wednesday, 27th January.

When will amendments have to be put in?


If possible, by Saturday, but at latest by Monday morning at 11 o'clock.