With regard to the officers referred to in Section 5, are the members of the medical staff connected with the hospital included?
St. Laurence's Hospital Bill, 1940—Committee.
Sections 1 to 4 inclusive agreed to.
SECTION 5.
Question proposed: "That Section 5 stand part of the Bill."
This matter seems to come properly under Section 5, as the section provides for the establishment and the constitution of the board, and gives the Minister very wide powers to alter the constitution of the board, as well as the appointment of all the members. I take it that the board will have complete power over the staff of officers and servants mentioned in Section 12. The Minister appoints the board and the board appoints the staff. Could the Minister say precisely what power this board, which Section 5 establishes, will have? Will it have complete control of the medical staff, the appointment of visiting and house physicians, hall porters and nurses?
The board will appoint all the officers, the medical staff, servants and employees, subject to the sanction of the Minister. As the Bill is drafted, all appointments are subject to Ministerial approval, but the Minister is given power to exclude (by Order) any appointments that he desires to exclude from the class that would require Ministerial sanction. These exclusion Orders will come into operation, in consultation with the board, after the Bill becomes law.
The position is that the Minister gets complete control of the hospital, in so far as he appoints the board, and appointments made by the board may, in effect, be deemed to be appointments by the Minister. The Minister has power to veto appointments by the board. With regard to this hospital the Minister will have more power over it than he has over hospitals under local bodies, which are subject to a code, and have to submit appointments to be made by them to the Local Appointments Commissioners. The Minister will be given complete control of all appointments to this hospital, medical, surgical, nurses, clerks—if there are any clerks—radiographers, radiologists and hallporters, so that this scheme, which we are putting into operation by constituting this board gives the Minister for Local Government and Public Health control over the hospital. In other words, it puts him back to the privileged position that the Local Officers and Employees Act, which constituted the Local Appointments Commission, was intended to abolish.
My mind is working very much on the same lines as that of Senator Hayes. There has been some doubt—the Minister may say that there is no doubt—in the public mind as to the position of this group of hospitals. In the past, I understand, the board was appointed by the Lord Lieutenant of the day, but the buildings were owned or controlled by the Board of Works, or whatever was the corresponding body. In all essential matters, the board of governors had full power. They had not that power over the buildings, because they were not their property, but there was power of management. Subject to correction, the board was autonomous. This whole thing is being altered now and my contention is that we are practically setting up a State hospital. The board are entirely, the creatures or instruments of the Minister. He appoints them and dismisses them and has to approve of all appointments. That is why, in its essence, we are now setting up—I think I am right in saying—the first State hospital in the country. It is important to get this point quite clear in view of matters I have to bring up later in connection with this Bill and, generally, on my motion, and I think the Parliamentary Secretary should deal specifically with the point: is this, or is this not, in all essentials, a State hospital?
I am surprised to find that there is any confusion of mind as to the status of these hospitals either to-day or at any time previously. These hospitals are definitely State hospitals—always have been—and the Minister is not seeking any power in this Bill which he does not enjoy at the present time. The board of governors has always been appointed by the Minister, and the Minister is seeking no more control over the board of governors—in fact, less—than he has under the existing law. Before the setting up of this State powers which are now vested in the Minister for Local Government were enjoyed and exercised by the Lord Lieutenant. He appointed the board of governors and, in fact, he was under no obligation to appoint a board of governors at all. He could govern the hospitals in any way he thought fit. He could run the hospitals from his office in Dublin Castle. He could appoint a person or he could appoint a board.
The practice in the past has been to appoint a board of governors, and to delegate certain powers of management to them. He could remove any member of the board at will; he could reconstitute the board at any time he thought well to do so. I am surprised to find that Senators are not aware of that position—if, in fact, they are not aware of it. But the Bill does not seek any power which the Minister does not enjoy at present. So far as Ministerial control is concerned, so far as the status of this group of hospitals as State institutions is concerned, the position is absolutely unaltered. If it were a matter of controlling the institutions by a Department of State, it was altogether unnecessary to have this Bill at all.
Will the Parliamentary Secretary deal with the point that the Minister enjoys more power with regard to the staff of these hospitals than he enjoys with regard to the staff of a county home, for instance?
That is a different matter. This is a State hospital.
Is it not a fact that he does enjoy that power?
He enjoys absolute power so far as this institution is concerned.
There is a general scheme for appointments to the public service and for appointments to the local services. Under this measure, which we are now reenacting—assuming it is law already —the Minister enjoys a power of patronage which he does not enjoy with regard to local bodies in the country and hospitals under their control. I think that is an extremely bad scheme, particularly if the Parliamentary Secretary is going to exercise it, because he is a politician more than anybody who ever got into the office before.
The question Senator Sir John Keane asked is an explicit one: "Is this a State hospital?" The Parliamentary Secretary answered that by saying that it is a State hospital. He forgets that the claim of the present Minister to exercise any control is inherited from the Lord Lieutenant, and that the British Government repudiated in definite terms any claim to this hospital as a State hospital. The British Government definitely denied that it was a State hospital, and refused to have any responsibility for the liabilities of the board of governors. I am aware that the hospital did not accept the point of view as the Parliamentary Secretary stressed the other day. The Parliamentary Secretary and the Minister are not claiming their authority from the board of the hospital, but from the British Government and the Lord Lieutenant. As the Parliamentary Secretary told us the other day, the Minister is exercising the powers of the Lord Lieutenant, and is, therefore, claiming to exercise functions which the Lord Lieutenant and the British Government repudiated absolutely and determinedly. They stuck to their repudiation of the claim that it was a State hospital, in spite of the protest of the board that it was a State hospital and that the State had some responsibility for it. The Parliamentary Secretary should not overlook that fact when giving a categorical answer to the query Senator Sir John Keane put up.
The Parliamentary Secretary is not overlooking any fact.
I want to be clear on this. I am not concerned much with the legal, or what I might call the constitutional, aspect of the past or future of the board. I am concerned with the fact that I understand that in the past, whatever the indirect powers of the Lord Lieutenant might be to remove governors, in practice the Lord Lieutenant did not exercise a veto on the appointment of the medical staff, or the other staffs of the hospital. I understand now that the Minister intends to keep in his own hands the approval of all appointments. There is a definite and distinct difference. Will the Parliamentary Secretary say whether or not I am correct in drawing a very clear distinction between the past and the contemplated future?
Senator Sir John Keane says the Lord Lieutenant did not exercise a veto. I am not in a position to contradict him. I am not aware whether he did or did not. What I am well aware of is: that the Lord Lieutenant had the statutory right to exercise a veto. During the past 20 years, since these institutions come under the control of the successors to the Lord Lieutenant in this State, a veto has not been exercised on the appointment of any member of the staff. But the right to exercise that veto is there, and that right has been maintained.
I should like to know under what enactment or section of any Act the Lord Lieutenant had a right to exercise a veto. So far as I understand, the Minister's right was only indirect through the power to remove the governors. If I am wrong, will the Minister enlighten me as to the section of any Act under which the Minister has the right to act as the Minister now proposes to act?
Perhaps I had better quote again—I quoted it already I think—the relevant section of an Act for the better Regulation of the House of Industry Hospitals and other Hospitals in Dublin supported wholly or in part by Parliamentary Grants—an Act of the 29th July, 1856. Section 4 of that Act states:—
"The Lord Lieutenant shall, subject to the approval of the Commissioners of Her Majesty's Treasury, and to the provisions hereinafter contained, regulate and determine the number and description of officers and servants to be kept for the said House of Industry Hospitals as he may think fit, and the salaries to be paid to them respectively, and the Lord Lieutenant may from time to time appoint or remove such officers and servants and upon every vacancy by death, removal, or otherwise, in any such office may appoint some other person to such office, and may fill up or not, as in his discretion he may think fit, vacancies among such officers and servants."
I would like to get this clear. The Lord Lieutenant had power to appoint the board. The board made other appointments. The Lord Lieutenant may or may not have exercised a veto with regard to appointments that were made. One would assume that the Lord Lieutenant did not, because the board was his creature. He had the power to remove the board. Therefore, he merely gave somebody power to act for him in making the appointments and it would be assumed that he would not contest the appointments because he had already selected the board. If the board was appointing people that he did not care for, he could get rid of the board. Reference is made there to the Act of 1856. When this State came into existence, the Government on whom devolved power previously legally held by the Lord Lieutenant or by the Crown or by others, were heir at law to wide powers of patronage. At a later stage, the Government brought in legislation to implement a line of policy—the abolition of patronage to a very large extent. There was patronage, I should say, in the giving of jobs in local government bodies and in the Government service itself. You are going back and saying: "Here is the position in 1856 and the Government is heir to that position." The Government was heir to many other positions. Since then, the Government has willingly denuded itself and has denuded local government bodies of this power of patronage. There may be a number of exceptions to that but, as far as I have followed the debate on this Bill, there one glaring exception to it in the case of this particular hospital.
I believe there are appointments to the board that can only be explained on the ground of mere Party affiliation. I am not sure of that, but I heard things that lead me to believe that. The Government appoints its board—it is really only the creature of the Government, as far as I understand—and that board is to have power which the Government by a solemn act has taken away from itself and from local government bodies here, namely, the appointment of people in positions merely at its own will. The Government, at expense to the taxpayers of this country, has set up appointments boards, and so on, in order to see that people will be selected for positions in relation to their peculiar qualifications for such positions, and not on the whim of somebody who is temporarily vested with power. It seems to me, therefore, rather irrelevant, certainly to Senator Hayes' point, to go back to what was the position in 1856. In 1856 there were enormous powers of patronage in this country, which were mitigated considerably before this State came into existence, and were, by special legislation, practically eliminated altogether by the Bill setting up local appointments boards and the Civil Service Commission. Here, the Minister is very carefully keeping to himself this power of patronage in the appointment of the board, and, through the operation of the board, the power of patronage in regard to professional appointments in this hospital. If I am wrong, I should be happy to be corrected.
I think we have got common ground that this is a State hospital.
No.
Well, it is under the complete control of the Minister.
It was denied that it was a State hospital by his predecessors.
On the basis that the Minister appoints the board, and approves and dismisses, is it not a State hospital, under the complete control of the Minister?
It gets no money from the State.
In essence, I think it may be agreed that this is a State hospital. I think we have to pursue closely the point raised by Senator Hayes: why does the Government take special powers of patronage in the case of these appointments different from what is exercised in the case of other Government appointments? Why are not its appointments made through the ordinary machinery of the Local Appointments Commission?
The only answer I can make to the last "why" of Senator Sir John Keane is that the Government that was in office in 1926, when the Local Officers and Employees Act was passed, did not apply it to the House of Industry Hospitals. Senator Hayes may be able to explain why they did not.
He does not know anything about it. He was not a member of the Government.
He was a member of the Party in power at the time.
He was not a member of the Party nor of the Government. As we are going back to 1856, we should be more accurate about 1926. He was a member of neither one nor the other.
I am glad Senator Hayes repudiates all responsibility for what the Cumann na nGaedheal Government did during their term of office. But, coming to the suggestion—what I would consider the rather improper suggestion—by Senator Fitzgerald, to the effect that the Government has packed this board with political nominees—do I understand Senator Fitzgerald to suggest that?
I said that I had heard there were appointments which, as far as I saw, could only be explained by association with a Party.
Senator Fitzgerald heard that there were such appointments and Senator Fitzgerald makes that suggestion here without taking any steps whatever to satisfy himself as to the truth or otherwise of the suggestion.
I submit, Sir, that I have taken steps in the most effective way, by asking the one person who could answer it, namely, the Parliamentary Secretary.
Senator Fitzgerald has taken steps to make a very ugly political insinuation, for which he has no grounds whatever.
I am ready to be corrected.
But that, of course, is what one might expect from Senator Fitzgerald.
I am ready to be corrected.
The fact is that the board had to be reconstituted because a number of appointments had been made to the board that had not been made in accordance with law. Every single member of the old board who was in this country or who was alive was invited to become a member of the new board, and every member who was available for membership of the new board was appointed by the present Minister. It was only the consequential vacancies, through death or otherwise, that were filled.
The Parliamentary Secretary has not answered my point.
The Parliamentary Secretary has not dealt quite specifically with this question of the differentiation in the method of appointment. He said that because, in the past, the appointments to this hospital —which was in a rather hybrid condition—were not subject to the Local Appointments Commission, they need not be in the future. Surely, it is quite within the competence of the Minister now to insert in this Bill a provision that all future appointments shall be made in the same way as, I think I may say, all other Civil Service appointments, or appointments of a similar character, are made.
Arising out of Senator Fitzgerald's remarks, would I be justified in asking the Parliamentary Secretary if the chairman of that board spoke in a very complimentary manner of the new members appointed by that board?
He did; but that would not impress Senator Fitzgerald.
Certainly, the Parliamentary Secretary's answer was not an answer to me, and did not impress me. It dodged my point.
The Local Officers and Employees Act was passed in 1926, and the Parliamentary Secretary wonders why it did not include a specific reference to these particular hospitals. I did not draft the Bill. I had nothing whatever to do with it, and the Parliamentary Secretary, I take it, is well aware of that. The Ceann Comhairle does not draft any Bills. I take it the Parliamentary Secretary is well aware that the present Ceann Comhairle does not draft any Bills that the Government bring in. I did not draft the Local Officers and Employees Bill. I was not consulted about it, and did not know anything about it, but the reason why this hospital was not included, obviously, was that the Government did not regard it as a place in which State appointments were being made.
But here, in this particular section, whatever way the present board is constituted, there is complete power in a Minister—the Minister for the time being, whoever he may be—to appoint the board and to alter the constitution of the board under sub-section (4) "at any time and in such manner as he thinks fit". Thus the Minister gets under this section, copper-fastened, and with every loophole closed, whatever powers, and other powers, the Lord Lieutenant possessed in 1856.
What other powers?
Whatever powers the Lord Lieutenant possessed in 1856. This Minister, or the Minister's successor, is getting every power to make the board whatever he likes. It is quite a correct use of the English language to say that this board will be the creature of the Minister. Of that there can be no doubt whatever. It is a simple statement of the truth.
The creation of the Minister, perhaps.
What I mean is, that if the present Parliamentary Secretary desires to make this board into something which will do his own will, he can do it. I have no doubt whatever that if the Parliamentary Secretary sees any chance of giving a job to a supporter, he will not neglect that chance. In this particular section there is ample power to have a board which will be the creature, as well as the creation, of the Minister, and which will do the kind of job the Minister wants it to do. There can be no doubt whatever but that this board, which will be the creation of the Minister, will enjoy more power and patronage than, say, any board constituted under a county council. As Senator Fitzgerald has said, when this State was set up the Government inherited the patronage possessed by the British Government, their predecessors in title. They divested themselves of those powers in respect of the Civil Service by the Civil Service (Regulation) Act of 1924. They went a step further in 1926 by passing the Local Authorities (Officers and Employees) Act, which set up the Local Appointments Commissioners, a body which is still at work. But all the posts in this group of hospitals, including those of doctors, surgeons, nurses, clerks, porters and messengers will be subject to the board which will itself be subject to the Minister and be entirely his creation. In other words, if we assent to this particular section we are, as far as patronage is concerned, putting the clock back and putting patronage into the hands of a Minister, going back from 1926 to 1856, which is a long journey.
Perhaps we could settle this matter by putting a direct question to the Parliamentary Secretary. Would he be averse from putting a section in the Bill providing that all appointments will be through the Appointments Commissioners? An affirmative answer to that question would get over the whole difficulty.
Surely the easiest way for Senators to test this matter is by putting down an amendment for Report Stage. That would be much better than having this kind of discussion. We have Senators jumping up and asking questions, with the Parliamentary Secretary giving the same answer all the time. Why not put down an amendment, have a proper debate and then, if necessary, a vote on the amendment?
Will the Parliamentary Secretary assent to an amendment, in the terms indicated by Senator Foran, if it is put down for Report Stage?
I think there would be a technical difficulty about that. The Local Appointments Commission is a statutory body. It deals only with local appointments. This is a different type of hospital from the local or county hospital. The governors are nominated in a different way from the way in which local bodies are constituted. The Minister takes responsibility for the appointment of this board. Therefore, I do not think that, whatever means may be taken to obviate the dangers of patronage which some people seem to have found in this section, bringing in the Local Appointments Commissioners will get over the difficulty. Speaking as one who knows very little about these things, I do not think that the Local Appointments Commissioners, as at present constituted, could take on this particular job.
I think I can set Senator Mrs. Concannon's mind completely at rest on that point by saying that if we were to insert in this section, or in any other appropriate place in the Bill, an amendment giving power to the Local Appointments Commissioners to make these appointments, that power could surely be legally exercised by them. This, in fact, is a hospital under the direct control of the Minister for Local Government and Public Health. The Local Appointments Commissioners deal with appointments, normally, which require the sanction of the Minister for Local Government and Public Health. Therefore, this is a completely analogous case, and would appear to be something with which the Local Appointments Commissioners could deal. I agree with Senator Foran that an amendment to that effect would, of course, settle the whole problem. I can understand Senator Robinson's great anxiety to shorten debate, but it is only certain kinds of debate that the Senator would like to shorten. That is the trouble. The debate could be shortened now if the Parliamentary Secretary would tell the House that he is in agreement with Senator Foran and myself.
I do not think it would be desirable to depart from the system of appointment that at present operates. The board makes the appointments under the present law, and the board will make the appointments under the Bill when it becomes an Act. Certain appointments, in fact any appointments, can, as I have already stated, be excluded from the scope of Ministerial sanction. It is intended, when this Bill becomes an Act, to draft exclusion orders so as to give maximum autonomy to the board of governors in the matter of appointments. Only the more important appointments will be subject to Ministerial sanction. I do not think there is any good ground for depriving the board of the privilege of selecting its own officers and staff. In the past, that system has worked well. In the last 20 years, there has never been any interference with its selection of staff. We have heard, and quite properly, tributes paid by Senators to the excellence of the staffs of these hospitals as well as to the excellent work done in them. I would be very slow indeed to take from a board that has done its business as well as the board of governors of these hospitals has done its business, the power of selecting its own staffs in the future, a power which it has satisfactorily exercised in the past.
I do not think the Parliamentary Secretary has got over the difficulty by his last statement. Undoubtedly, the board will be created by the Minister, and, as some Senators have already said, will do the Minister's will. He will see to that by the appointments that it makes. This section leaves it open to people like Senator Fitzgerald to make allegations of the kind that he has made. In the Minister's own interest, and in the interests of ordinary every-day regulations, these hospitals ought to be put on the same basis as other similar institutions, so as to have the whole thing beyond reproach, and so that it cannot be said that people obtained appointments because of their political associations or affinities. The Minister should give some encouragement to an amendment for the Report Stage, that all appointments of a certain kind shall be through the Appointments Commission.
Question put, and declared carried.
SECTION 6.
Question proposed: "That Section 6 stand part of the Bill."
Sub-section (2) says:
"...every member of the board shall hold office until he dies, resigns or is removed from office."
Does this make any provision for members who may not attend reasonably regularly at meetings of the board? I see that, in sub-section (4), the Minister may at any time remove a member from office, but it is not definitely stated whether the Minister would take any notice of members who may not attend to their duties. Let me state that my remarks have no reference whatever to the attendance of members of the present board. I know nothing about that, but I have some experience of other boards and would like the Parliamentary Secretary to look into the matter, so that those who do not attend reasonably regularly would not continue to be members.
I am very glad that Senator Healy has raised this point. As one who has considerable experience of public boards, I think he will agree with me that there is always a full attendance whenever there is an appointment to be made. In this case, the Minister has all the power and all the canvassers would be abroad. When there is an appointment on the agenda, there will be a full attendance, and only then. The place can run itself in the meantime. In view of what Senator Healy has said, it is all the more important that the Appointments Commission should have a say in the appointments.
Regarding Senator Foran's last remark, about the Appointments Commission, I am only suggesting that the Minister should take power to deal with those who do not attend board meetings reasonably regularly.
I think the point is covered by sub-section (4):
"The Minister may at any time by Order remove from office all or any of the members of the board."
If a member of the board were not making a reasonable effort to discharge his duty and live up to his responsibility, the Minister could remove him.
Would the Parliamentary Secretary consider the advisability of removing from office a person who does not give a reasonable percentage of attendances at meetings of the board?
That would be a matter for Ministerial discretion.
Question put and agreed to.
Sections 7 to 10, inclusive, agreed to.
SECTION 11.
Question proposed: "That Section 11 stand part of the Bill."
This is a rather technical section, and I do not understand it. If I were sufficiently industrious, I might try to find out its meaning. Would the Parliamentary Secretary explain briefly what it involves?
It means that the board shall not remove any person from office without the consent of the Minister. Later, provision is made for the exclusion by Ministerial Order of certain appointments from the scope of that restriction.
Does that mean that the board can dismiss all but excluded officers?
The board cannot dismiss any officer or servant, or alter their remuneration, unless such officer or servant is excluded from the category of officers or servants completely under Ministerial control.
That category of exclusion rests with the Minister, so it means, in effect, that the positions of officers or servants are entirely at the will of the Minister.
It means that there is the degree of protection for officers and servants of the board that the board cannot get rid of them for some flimsy reason. They must, at least, have the Ministerial judgment brought to bear on the case for their removal.
Question put and agreed to.
SECTION 12.
Question proposed: "That Section 12 stand part of the Bill."
I would like to ask the meaning of the word "officers". Does it include the medical staff?
I should say so.
That is, visiting physicians, surgeons, specialists, and so on?
That is my reading of it.
Of course, it would be a matter for the courts, eventually.
Question put and agreed to.
Section 13 agreed to.
SECTION 14.
Question proposed: "That Section 14 stand part of the Bill."
I thought it was usual in pensions schemes to have the executive Minister associated with the Minister for Finance. Would that not apply in this case, or are no State funds involved at all?
There are no State funds involved now.
Question put and agreed to.
SECTION 15.
I move amendment No. 1:—
In sub-section (1), line 43, to delete the word "proper" and after the word "accounts" to insert the words "in a form to be prescribed by the Minister".
I have put down this amendment in order to raise, in general terms, this question of the method of keeping hospital accounts. I have been examining fairly closely the statistical information provided by the Hospitals Commission in their reports; and, if I may say so, a very creditable effort has been made towards the segregation of the purely financial accounts in relation to each unit. The items are brought out in the case of the occupied bed, the domestic services, medical services, dispensary charges, and so on. However, an enormous difference is revealed is these figures. Where one hospital is spending £27 for certain provisions, another may be spending £50. It makes one rather suppose that there is no close and specific direction as to the manner in which these accounts are kept. Of course, I know that they are all right as regards the financial integrity of the transactions, and I do not suggest any question as to that. I suggest there may be considerable difference in the method applied in the allocation of payments.
I have always been a great believer in the use of accounts for the purpose of administrative control, and I am perfectly satisfied that no accounting method hitherto adopted, no mere segregation of the financial accounts and cash payments under these headings, will ever be of any real value for the purpose of executive control.
In order to get full value out of control, and to get the full benefit of accounts to the management, you must have some form of cost accounts, and units of responsibility. For instance, the X-ray department in a hospital is a unit of responsibility, and you should aim at having all the expenses of that department segregated, stock taken at the beginning and end of the period, and results shown more or less on a commercial system, so that you can tell what is the cost of that unit. The same thing applies to operations; you would attempt to get the cost per operation. I apologise to the medical gentlemen present for getting so near to their technical side of the question, but I do not intend to go any further, and I think my suggestion is quite within the province of the layman. In the out-patients' department, there is a very large amount of expenditure. I would suggest in some cases a vastly improved control in respect of outpatient costs. In order to get any accounting control in that department, you must segregate all expenditure. That does not apply only to expenditure on salaries; you must allocate in some way to that unit all the drugs and material used there.
The next point is that you cannot suddenly go to an accountant and say: "I want you to put in straightaway a system of costing suitable to a hospital." You have to approach this matter by stages; I might say by a system of trial and error. You could put in a tentative method of costing, and if you are wise you will put in a fairly simple skeleton method at first. As a result of experience, that system could be modified and developed. You would have regard to any extra staff involved in compiling the figures, and so on. I am perfectly satisfied that the only way in which you will ultimately arrive at a proper costing system on a uniform basis for hospitals is by some hospital specialising and working along those lines.
This is a State hospital under the Minister's Departmental supervision, and the object of my remarks is to ask the Parliamentary Secretary to ensure that there is a real, methodical, systematic attempt made towards building up a proper system of hospital accounts—it would take about three or four years to do it—which, when it is found to be feasible in operation, could be universally applied to all similar hospitals. In that way, you would get figures which would show anybody who is interested the relative costs of different hospitals, and place in the hands of governors and managers a most valuable instrument of control.
I need hardly say that this is not entirely my own idea. This method of accounting by units of responsibility is recommended in a standard book on hospital management by a gentleman named Stone, who was secretary to King Edward's Hospital. It is a common-sense method; it is the only way in which accounts can be of any value for the purpose of control. As I said, my object in raising the point is to ask the Parliamentary Secretary seriously to consider whether he cannot, from the inception of this new hospital, introduce under accountancy advice some method that will ultimately lead to a working system of costs, which, when proved in operation, could be universally applied to hospitals, and would provide valuable comparative figures as to hospital costs.
I have no objection at all to the principle embodied in Senator Sir John Keane's amendment, but I doubt if it is necessary to put a statutory obligation on the board to keep their accounts in a form to be prescribed by the Minister. It is not necessary that I should tell the House that this particular hospital is very well managed; in fact, it is one of the best, if not the best, managed hospitals in Dublin. We have not experienced any difficulty whatever in securing the full co-operation of the board in any reforms that are deemed to be in the interests of the institutions. I have no doubt at all that we can get that co-operation in regard to the form in which the accounts are to be kept, without putting a statutory obligation on the board. As I say, I have no objection to the principle, but there is just one drawback. If the Minister prescribed by Order the form in which the accounts are to be kept, experience will show—as Senator Sir John Keane will be the first to admit —that it is necessary from time to time to modify the Order. That would mean a new statutory Order every time any change in the system of accountancy might be deemed to be desirable. In fact, preliminary steps have been taken to have established in this and in some other hospitals, but particularly in this one, a system of costings segregating the different units, and I believe that in the course of time a system will be evolved which probably can be uniformly applied. The Hospitals Commission have been devoting their attention to this matter, and have taken it up with most of the voluntary hospitals. It has been a tedious and difficult process to get anything approaching uniformity, but I think we are on the road towards it now, and that we can get it by negotiation and interchange of views rather than by statutory Order.
Apparently the Parliamentary Secretary does not see my point. The last thing I want is a statutory Order.
The amendment says: "In a form to be prescribed by the Minister." I am afraid the Minister could only prescribe by statutory Order.
I see. Well, I am prepared to withdraw the amendment if that is the difficulty. What I want the Parliamentary Secretary to appreciate—I doubt if he is convinced of it in his own mind—is the enormous value of proper hospital costings. His attitude is: "We are doing something in that direction now, and we will get somewhere some day." I think the Minister has a unique opportunity now. Here he has a hospital under his own control; it is very different from other hospitals, where he would have to go in and be more or less interfering. If he appreciated as I do the enormously valuable, almost pioneer work that he could do in this matter, he would say to me: "I am in full agreement with the Senator's object. I intend to use all my power and influence, although I do not want statutory Orders, to get as soon as I can a system of costings introduced and developed to such an extent that, when it works satisfactorily, it can be available for other hospitals, and be applied to them if they so wish." I need hardly say that when a system of costings is working satisfactorily any hospital would be only too glad to apply it. As I have said, a system like that can only be developed by experience. Would the Parliamentary Secretary say that he is in general agreement with my suggestion, and with my general approach to this subject, and that he will make this hospital a sort of pioneer institution in this matter of costings?
I may say that I am in full agreement with the approach of Senator Sir John Keane to this matter and that I shall take the question up with the board of governors when this Bill becomes law.
May I point out that a few years ago a very wise suggestion was made by the Hospitals Commission that a hospitals association which could study exactly such matters as this and other questions such as combined purchasing should be established. The various voluntary hospitals were willing to join that association and many of the rate-supported hospitals were also anxious to join. It would be quite impossible for the voluntary hospitals to finance this association on their own, but with the larger income that would be provided if the rate-supported hospitals were willing to join the association, there was every prospect that the association would be a very valuable help to every hospital in the city and the country. Unfortunately, the Minister decided that he would not permit the rate-supported public hospitals to contribute any funds by way of subscription to the association. The very wise recommendation of the Hospitals Commission was choked in the Custom House by the Minister's decision. I agree with the Parliamentary Secretary that what Senator Sir John Keane has put forward as regards costings would probably be more amicably arranged if the hospitals could come to some decision between themselves. I know there are difficulties, but I think Senator Sir John Keane is on the right line. Yet I am afraid the great danger is that a stumbling block will arise in the Custom House as it did five or six years ago.
I do not think that any useful system of costings could be operated through the medium of a body such as a hospitals association. I take it that was the Senator's suggestion?
Yes.
I think that any work of that kind must be carried out, developed and brought to perfection by one responsible expert. It must be on a trial basis. Then after it has been proved, it can be applied to other institutions. If you were to try to work it through a hospitals association you would be likely to create a large amount of confusion.
I should like to inform Senator Sir John Keane that I happen to be a member of a board of one of the voluntary hospitals in this city and that the very system which he is now advocating has been in operation there for a couple of years. It is nothing new. There is one voluntary hospital which has adopted the system that Senator Sir John Keane is advocating.
I do not know what hospital the Senator has in mind.
I shall let the Senator know.
I have no doubt that certain hospitals have carried out a certain amount of rudimentary work on this question of costings, but it is very hard to give an opinion whether what they are doing is adequate. I say it is a very technical matter. It has to be handled by one responsible institution, by a person who believes in it and who is very anxious to bring the system into a state of practical operation.
Amendment, by leave, withdrawn.
I move amendment No. 1a:—
In sub-section (2), line 49, to delete the words "establishment date" and substitute therefore the words "first appointed day."
This is merely a drafting amendment.
Amendment put and agreed to.
Question proposed: "That Section 15, as amended, stand part of the Bill".
I should like to know whether the expression "duly qualified accountant" is a usual expression in a statutory provision. It seems on the face of it rather loose. I should be sorry to have to decide what is a duly qualified accountant. What has the Parliamentary Secretary in mind in using that expression?
I grant that the term is rather loose but it is more in the nature of a suggestion to the board that they should satisfy themselves that the person appointed is fully qualified to do the job.
Question put and agreed to.
Sections 16 to 20, inclusive, agreed to.
SECTION 21.
I move amendment No. 2:—
Before sub-section (2) to insert a new sub-section as follows:—
(2) The Minister, before acquiring such land, shall obtain the advice of the board as to its suitability as a site for the new hospital, and shall not act in opposition to the advice of the board.
It will be noted that this section gives the Minister very full powers. The Minister may for the purpose of providing a site for a new hospital acquire, either by agreement or compulsorily, land in or near the City of Dublin. It gives him power to act entirely on his own authority with the statute behind him, to put the hospital wherever he thinks fit, in or near the city.
The object of my amendment is pretty clear, namely, to put some slight limitation on the Minister, to which I think he would probably submit even if the amendment were not inserted in the Bill. The amendment suggests that the Minister, before acquiring such land, shall obtain the advice of the board as to its suitability as a site for the new hospital and shall not act in opposition to the advice of the board. I think that would be a wise check on any Minister. Some Ministers may not be so wise as other Ministers as time passes and it would be well to put some limitation on the absolute power which the section as it stands proposes to give to the Minister. I hope the Parliamentary Secretary will be willing to accept the amendment. It should not really limit a proper discretion by the Minister because such discretion could not be exercised unless the site were such as the members of the board would approve. This question of the site has been the subject of considerable debate both in this House and in the Dáil. I do not propose to take up much of the time of the House in discussing it now, but there are some points to which I think it is right to draw attention. In the debate on the Second Reading, I put a specific question to the Parliamentary Secretary. I asked him if he could tell us what advice, if any, the Hospitals Commission had given to the Minister on this question of a site. We know from the published reports of the Hospitals Commission that they were in favour of establishing the new hospital in place of the old Richmond Hospital on the present site and that they expressed the opinion that the present site was adequate and suitable —I think I am quoting the exact words —for the establishment of such a hospital. In my question, when we were debating this point, I asked the Parliamentary Secretary if he would inform the Seanad whether the Hospitals Commission had withdrawn the advice which appeared in one of their earlier reports and whether they have now given a recommendation in favour of removing this site.
I noticed a very interesting feature of the debate in the Dáil which took place a considerable time ago. It was stated by a Deputy—a member of the Minister's Party by the way—that every Deputy representing Dublin was against the removal of the site from its present position. That statement was made by Deputy Cooney, who used these words:
"I can assure the Parliamentary Secretary that all the Dublin Deputies, of all groups, are keenly interested in this hospital being built on the site of the present Richmond Hospital."
I suggest to the Parliamentary Secretary that the Dublin Deputies, representing the general opinion of the people of Dublin, are entitled to express an opinion, an opinion to which much weight should be given, as to a suitable site for the hospital. In the Dáil it was made clear by Deputy Cooney, and by members of all Parties, that they did not think a movement from the present site would be for the convenience of the people of Dublin, particularly for those living in the neighbourhood, or for the improvement of the hospital, which would suffer by removal to a less accessible site. Many of the Dublin Deputies gave their opinion on that matter. I refer to one in particular, because I think there was, perhaps, no member of either House who had a more intimate or a more loving knowledge of Dublin than the late Deputy Thomas Kelly. He expressed the opinion that the hospital should not be removed from its present site.
On the question of the site, we had the recommendation of the Hospitals Commission, and we do not know whether that has been withdrawn or not. We have the opinions of Dublin Deputies, persons who have a more familiar knowledge of the place than would be possessed by members of the Dáil or Seanad who are not resident in Dublin, as to the convenience of the people likely to use this hospital. In the debate on the Second Reading I asked the Parliamentary Secretary if he would give us any reason why the site for the hospital should be removed. The only reason he gave was in very general terms, that there was a general opinion among town planners and people of that sort that the hospital should be on the outskirts of the city rather than in the centre. He said, referring to me:
"I am sure Senator Rowlette knows 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."
I agree with the Parliamentary Secretary that that was the tendency a few years ago, but that tendency, quite apart altogether from the war, was beginning to be questioned, and there was a good deal of difference of opinion as to whether it was wise. I think a decision should not depend on a general statement like that. I think that all the circumstances of the case should be carefully taken into consideration before arriving at a decision.
In the last debate I gave various reasons, which were supported by other Senators, why, in the particular case of the Richmond Hospital, such a move would be inadvisable. The Parliamentary Secretary did not give us his views on that, other than on the lines of the general statement to which I have just referred. The position at the moment is that the board of the hospital has, in the past, objected. What the present board wishes, I am not in a position to know. I am informed that the staff of the hospital unanimously passed a request to the Minister not to take steps to alter the site of the hospital. Some of the members of the staff are members of the board, and some are not. I understand that that information, given to the Parliamentary Secretary, has not been in any way withdrawn, so that we have a body of informed opinion, informed both from the medical side and from the point of view of the public, against any proposal to move the site. On the other hand, the Parliamentary Secretary stated here that the Minister was very unwilling to proceed with the building of a hospital on the present site, a site which, in the view of the Hospitals' Commission a few years ago, was both suitable and adequate.
I should like to ask the Parliamentary Secretary a question regarding a matter which has been puzzling many of us for two or three years, and that is why this Bill was suddenly stopped in its rather hampered course through the other House and put in cold storage for two and a half years or thereabouts. It was considered in the Dáil in the month of May, 1940, and it was not until the autumn of 1942 that the Dáil was asked to resume its consideration of the Bill. What was the reason for holding up the Bill in that way? I do not know whether the Parliamentary Secretary will give us any information on that point.
Leas-Chathaoirleach
Perhaps the Senator will raise that point on the Final Stage of the Bill? Is it not a matter for the Fifth Stage?
Whatever the Chair orders, but this may have a special relevancy to the point I am discussing. There may have been a good reason for holding up the Bill, but I do not think that this or the other House has had any explanation of that long period of inertia. What I propose in this amendment seems to me to be an entirely reasonable request to make. I suggest that it should be accepted that the board of governors should have some say in the matter of selecting a site. That will be assured by having this amendment inserted in the Bill. I do not think the Parliamentary Secretary will find that the board of governors, the old board or the present board, will be unreasonable in that matter. If they do not agree to the suitability of a proposed site, surely their judgment is as much to be relied upon as that of the Minister or his staff? I think it is quite reasonable that the people who have carried on this institution for more years than I can recall should have a voice as to where the new hospital is to be situated. Their main interest is in the institution itself and in making it useful to the people of Dublin and to the people of the country, as it has been for some 150 years. I hope the Parliamentary Secretary will accept the amendment.
In connection with this matter I have a perfectly open mind, but I would like to remind the Seanad that several hospitals in Dublin are seeking sites for new institutions in the suburbs or in the open areas around the city. For instance, Grangegorman Hospital has selected a site in Santry; the Cork Street Fever Hospital Board has purchased a site at Blackditch, Ballyfermot; a site for a new T.B. hospital has been purchased in the same locality, and a site for a new T.B. sanatorium has been purchased on the way to Lucan, near the old tram station. As I have said, I have an open mind in this matter, but I think Senator Rowlette will agree that the surroundings of the present site of this hospital are not the most elevating. I might mention that St. Vincent's Hospital has also purchased a site for a new building out on the Merrion Road. So that, every day, the inclination is to endeavour to procure sites for hospitals in the open air. Apart from that, we must realise that our city is fast expanding in the north-west—towards Cabra, for instance— where a number of buildings have been erected recently. In that connection, and with reference to the remarks made by Senator Rowlette regarding a Deputy who referred to this matter in the other House, I do not know whether it would have any effect on the Senator's mind to know that the Deputy concerned happens to be a representative of the North-West Dublin area. However, what I want to point out is that the inclination here in the City of Dublin, so far as the different hospital boards are concerned, is to secure sites for hospitals in the open air.
My approach to this matter is rather different from that of Senator Rowlette. I do not feel competent to offer an opinion as to whether a hospital would be a better hospital if it were situated in a populous centre or in the suburbs. I feel that that is a very open question, but there are financial considerations to be taken into account, and in that connection I should like to have more definite information. When this Bill passes, is it mandatory on the Minister to build the new hospital on a new site, or is it merely permissible? Even from the point of view of the Sweepstakes there may be no money. There may be no money to provide for such hospitals, except the money provided by the taxpayer. However, apart from such a contingency, is the Minister under a statutory obligation to acquire a new site and re-build, or can he leave the question stay as it is, and repair or re-build the existing premises? I consider that this is a very important point, because it does not merely affect the proposed St. Laurence's Hospital, but it impinges on the whole question of hospitalisation in this country, and I should like to have a specific answer on this question.
I should like to support Senator Rowlette's amendment. I think the amendment reads to the effect that the Minister, before acquiring land, shall obtain the advice of the board as to the suitability of such land as a site for the new hospital, and shall not act in opposition to the advice of the board. Now, I think that the real thing there is the advice of the board of the hospital, and I think that the old Richmond and its associated hospitals are in a different position from the other voluntary hospitals in Dublin from that point of view. The suggestion is that the Minister is taking powers to himself to do away with the board, and to transfer the site of these associated hospitals, I believe, out to Cabra. That is what I understood from reading the debates in the Dáil. Now it seems to me that Senator Rowlette's amendment is perfectly reasonable. Its purpose is to let the Minister consult the board and be advised by them.
It would appear that because the Hospitals Sweepstakes have been in existence for some time and moneys have been subscribed for the purposes of hospitalisation, the Government are taking control of the voluntary hospitals in Dublin. That, at least, is the fear of the people concerned. These people feel that this is what you might call the thin end of the wedge, and that, simply because, under the old régime here, the Richmond Hospital and those associated with it had certain connections with the then Government—such as that the Government, or the Lord Lieutenant, had the right to nominate members to the board—this is the reason for the present Government taking control. It appears to me that that is the fear in the minds of the people concerned. Accordingly, I think it would be an evidence of good faith on the part of the Government if they would accept this amendment, the purpose of which is that the Government would consult with the existing Board of Governors, or any future board of governors, of the hospital, as to the site of the hospital or otherwise.
I do not think this amendment is necessary at all, because I think that the advice of the board, inevitably, will be sought by any Minister when discussing any change. In any case, I do not think, in view of the previous discussion here, that the question of agreement would be necessary, because the argument that was advanced here before was that the board would be the creation of the Minister, and, if that were so, I feel pretty sure that it would consent to the Minister's point of view. Apart from that, however, I cannot understand why medical opinion in this House seems to be so much in favour of the hospital concerned remaining where it is. Unfortunately, I have had experience of visiting the Richmond Hospital fairly frequently, and if there is any hospital in Dublin which is absolutely inaccessible, either by any means of transport or on foot, it is the Richmond Hospital. If I were on O'Connell Bridge, let us say, and were asked whether I should prefer to go to the present site of the Richmond Hospital or to Cabra, which, I understand, is the proposed site, I should certainly prefer to take the route to Cabra, because the present site of the Richmond Hospital is almost inaccessible by any means of transport, either available to-day or in the recent past, or, apparently in the near future. The hospital in its present position is almost inaccessible, and I would be prepared to walk the distance to Cabra rather than to approach the Richmond Hospital in its present position, because it is dangerous to traffic at the present time; it is also dangerous to pedestrians, and unless the whole district were to be subjected to a new town-planning scheme, it appears to me that the hospital is in a very inaccessible position for doctors, nurses or patients.
Candidly, I cannot understand why there is such opposition from medical representatives in the House to the proposed change, particularly in face of the fact that, according to world opinion generally, the preferable site for a hospital would be in the neighbourhood of a city rather than in the heart of a city. Then, as far as the buildings themselves are concerned, the greater portion of them is derelict, while other portions are almost derelict. There is only one of the three associated hospitals which appears to be in a proper condition from modern standards, and one would not like to see that abandoned, but it seems to me that the other portions are either derelict or semi-derelict. That is all I want to say with regard to the amendment. I think the amendment is unnecessary, and I do not think that the opinions that were expressed so adamantly by medical representatives in this House were justified because of the conditions that exist, or justified because of professional opinion, so far as the building or reconstruction of hospitals is concerned.
The amendment sets out that
"the Minister, before acquiring such land, shall obtain the advice of the board as to its suitability as a site for the new hospital, and shall not act in opposition to the advice of the board."
If the amendment were passed, not only would the Minister be under a statutory obligation to consult the board as to the suitability of the proposed site but to accept the site selected by the board. That position cannot be accepted at all. I doubt if it is appropriate that we should have a detailed discussion as to the merits of building in the country or building in the centre of a thickly populated district, inasmuch as the measure before the House does not select a site. The measure merely gives the Minister power to acquire a site, and why we should have all this detailed discussion as to where the hospital is to be placed ultimately, before the Minister or anybody else has any statutory power to acquire a site, is something I cannot understand very clearly, and neither did I understand very clearly why the discussion took the same trend in the Dáil. As I say, the Bill provides that the Minister shall be empowered to acquire a site.
Might I point out to the House that it is not proposed to close the existing hospitals immediately, nor is it proposed to close the existing hospitals when the new hospital is built, equipped and ready for the reception of patients. It is proposed to continue the existing hospitals until such time as the bed shortage in the City of Dublin has been fully met. Anybody with any knowledge of this problem will, I think, agree that there is no likelihood, for a very long period of years, of the bed shortage in Dublin hospitals being fully satisfied. Consequently, we may assume that the existing institutions will continue for a very long number of years.
I find it hard to believe that Senator Rowlette is in full earnest when he suggests that not only should the Minister be bound by statute to consult the board as to the suitability of a site which he proposed to acquire, but should be bound to accept the expressed views of the board on the matter. In other words, we are going to reverse the normal process. The Minister appoints the board of this hospital, which is a State hospital. Every brick and every stone of the existing institutions belong to the State and the Minister has full power to remove the board at any time, to reconstitute it or to alter its constitution, and yet it is suggested that the Minister is to be placed in a subordinate position to that board. I think the suggestion is nonsensical and I could not consider accepting it.
It might interest the House, and perhaps surprise some members, to learn that the suggestion of building in the country originated with the board of governors of the House of Industry Hospitals. As far back as 1936, the board of governors submitted a proposal to the Department that they should be allowed to provide an auxiliary hospital in the country.
Auxiliary, yes.
To provide an auxiliary hospital in the country. They represented that a similar arrangement had been found satisfactory in London and elsewhere; that there would be a saving in site costs, cost of construction and cost of administration; that there would be more rapid convalescence in the country branch of the hospital; that the country would provide a suitable place for convalescing patients who should not be left to convalesce in tenement dwellings; and that the removal of chronic patients from the city hospital would facilitate nursing. These headings are lettered A, B, C, D and E. Here is heading F: The scheme would be elastic, and it would be possible to provide more beds in the country branch, when required, to meet the future growth of Dublin. The present scheme is a very slight modification of the scheme submitted to the Department by the board of governors in 1936. The existing hospitals are being continued. It was suggested that an auxiliary hospital rather than a new hospital would be built in the country, but all the advantages which were put forward by the board of governors in favour of having a branch institution in the country will be available as soon as the new hospital is provided.
Senator Keane raised the question of whether it is mandatory upon the Minister to provide a hospital. If the Senator will refer to Section 21, he will see that the Minister may, for the purpose of providing a site for the new hospital, acquire, either by agreement or compulsorily, land in or near the City of Dublin. The Minister is not under a statutory obligation to acquire land. The Bill merely empowers the Minister. It is an enabling section, to empower the Minister to acquire a site. We might have a very long discussion on the arguments in favour of going out to the country, and on such arguments as could be advanced as to why an effort should be made to build this institution in a thickly populated area of the city, but I do not think it is appropriate to the Bill inasmuch as the Bill does not select a site.
I have also stated more than once— I stated it in this House on the Second Reading—that the Minister will consult the board. I stated that the Minister would consider the views of anybody who had views to express on this important subject. If the Senators from Dublin City are particularly interested in this matter, when the Minister is given power to acquire a site, it is open to them to make representations to the Minister. Those representations will be considered and the views of everybody who submits views will be considered, but the ultimate decision must rest with the Minister. There may be differences of opinion—there very probably will be— but it is right and proper that if there is a difference of opinion the Minister should finally determine the issue, and that it should not be determined by somebody else, in the light of the fact that this is admitted by everybody now to be a State hospital, under the full control of the Minister, and that the property will be vested in the Minister as trustee for the State.
I think the Parliamentary Secretary has answered my point. The impression he has left on my mind is, that this Bill empowers him to acquire a site and to build a hospital somewhere else. In the meantime, if he sees fit, he can continue the existing hospital and can recondition the existing buildings. Is that correct?
That is so.
I have been very interested in the discussion that has taken place. I cannot say that I am altogether surprised at the refusal of the Parliamentary Secretary to accept this very modest amendment, but some of the remarks which I have heard interested me a good deal. I am glad that Senator Healy came, I think unintentionally, to my relief in pointing out that Grangegorman Hospital was endeavouring to leave its present site, which would leave an adequate space for five Richmond Hospitals. He pointed out that the authorities of many hospitals in Dublin were anxious to leave the city and to get sites in the country. That depends upon the kind of hospitals concerned. Patients in Grangegorman have no special advantage in being in the city; it would be an advantage if they were in the country. The same is true of tuberculosis hospitals, and of infectious disease hospitals such as Cork Street. An important point about Cork Street is that it is not open to visitors, except when patients are in extremis. Consequently, the inconvenience to friends and relatives of patients in such a hospital would not be increased by the movement from Cork Street to a country site. Senator Healy did not make any distinction between hospitals for different classes of diseases. That is an essential point when considering the convenience of the patients. There is also the question of staff, education and tuition to be considered.
I would like to relieve Senator Sir John Keane's mind with regard to the Sweepstakes. The Sweepstakes are reviving. It was a pleasure this morning to be able to announce that the receipts were well over those of the Sweepstakes held last year. The last three or four Sweepstakes have shown a steady improvement in receipts, but nothing, of course, like the astronomical sums realised a few years ago, a great proportion of which went to the relief of the rates and also a great proportion to the relief of taxes. I do not know if we are going to get back to the time when we received large sums of money, but it is encouraging that the Sweepstake receipts are gradually improving in spite of the hard times. I was very interested and entertained by Senator O'Donovan's views on walking. I believe a young man like Senator O'Donovan would prefer a nice country walk if he had to visit a hospital to see a sick friend, rather than going around by the dangerous streets that lie between the quays and Richmond Hospital. I should point out that there is a very straight road from the quays, if the Senator chose to take it.
Not a straight road.
I have often been along it. I do not know if it has become crooked since my last visit. Is it the same, however, for a woman who has to carry a sick child, or who has to be back home in time to get her husband's dinner or to attend to household duties? Senator O'Donovan said that he would prefer to walk, but the poor people who make use of the Richmond Hospital have not money to spend on bus fares to country districts. I suggest that if Senator O'Donovan was not quite so loyal in his attachments, he would not have put forward such an argument but, if he will permit me to say so, would have advanced one with more commonsense.
The most important question, from my point of view, was raised by the Parliamentary Secretary. I noticed that he did not pay any attention to the question I asked him and, I presume, is unwilling to answer. I asked if the proposal to change the hospital was made on the recommendation, or against the recommendation, of the Hospitals' Commission. We know what the recommendations of the Hospitals' Commission were, but we do not know whether or not they were changed or whether the Minister has overruled them. The Parliamentary Secretary could have strengthened his case if he had seen fit to be frank in reply to that question. I also asked him if he could tell us why this Bill had been kept on the shelf for 2½ years.
The Leas-Chathaoirleach suggested that that might be raised on the Fifth Stage.
Very good. We may take it then that the Parliamentary Secretary will give an explanation.
Not necessarily. That is a different matter.
The Leas-Chathaoirleach makes a suggestion and the Parliamentary Secretary lays it down that he is not allowing himself to be bound by it. Of course, that is one way of refusing information to the House.
Leas-Chathaoirleach
I did not propose to bind the Parliamentary Secretary to any extent by suggesting that the matter could be raised on the Fifth Stage.
I am not making any charge against the Chair. The Chair made a suggestion that I understood to be for more regular order. I am content to raise the matter on the Fifth Stage. For the first time in the debate in this House, and in the Dáil, the Parliamentary Secretary has fallen back on a request made by the board of the hospital as long ago as 1936. That has no relation to the present proposition. The Parliamentary Secretary said the present proposition was closely allied with it. There is no relevance. They asked that an auxiliary hospital—not an alternative hospital—should be built in a country place. For what purpose? For the use of convalescent and chronic patients. Anybody who knows anything about hospitals would agree with that. Some Dublin hospitals have convalescent homes, either attached to them directly, or associated with them, in some cases under the care of religious Orders who run hospitals. There is a close connection between such institutions. That is an admirable arrangement. Nothing could be better. Convalescent patients have the opportunity of convalescing more rapidly by getting to country surroundings. I think every physician and surgeon practising in Dublin, as far as possible, makes use of such homes whether they are attached to the hospitals or run by other charitable bodies. Speaking for myself, every week I recommend patients who are fit to leave a general hospital, to go to convalescent homes, and try to make arrangements, very largely through the charity of religious Orders.
The proposal before us is to build a new hospital. We all know that it is impossible to build a new hospital at the present time. That is the only safeguard for the present Richmond Hospital, assuming that the Minister remains firm and carries a vote of this House against the amendment. We all know that the proposal must be held up for some years and that some of us will never live to see it carried out. I do not think it is right to suggest that the recommendation of the Richmond Hospital authorities to make their existing hospital more useful by having a country annex—because that is what it came to—or auxiliary hospital has any relation to the proposal to remove the old hospital to a new site and keep a few wards or a few out-patients departments going on the present site.
The Parliamentary Secretary made another remark which I thought at first was a bit helpful. He was unwilling to accept that the Minister should be bound in any way by the advice of the governors, but he remarked that the governors might submit their views and, no doubt, they would be given attention. That seemed very good, but he spoiled it by the next sentence, when he said that anyone could submit views and that these views would get fair attention.
Surely, the governors are in a better position to submit views on the suitability of a site than anybody else— any Tom, Dick or Harry. I do not think that it was really very helpful to say that the governors may submit views, that they have the same right to submit views as anybody else. A busy-body may submit the view to the Minister that the hospital should be built on the top of Howth Hill, or some place else, and that view will be considered with the same care as the considered views of a responsible body of men—such as the governors of the hospital.
Be serious.
The Senator should have shown a better example. I am sorry the Parliamentary Secretary takes the view that what I have suggested in the amendment should not be considered. I should like to ask him one more question. Would he be willing to accept the amendment if the last clause were omitted?
No.
Amendment put.
The Committee divided: Tá, 10; Níl, 22.
Tá
- Conlon, Martin.
- Counihan, John J.
- Douglas, James G.
- Doyle, Patrick.
- Fitzgerald, Desmond.
- Hayes, Michael
- Keane, Sir John
- McGillycuddy of the Reeks, The.
- O'Connell, Thomas J.
- Rowlette, Robert J.
Níl
- Byrne, Christopher M.
- Campbell, Seán P.
- Colbert, Michael.
- Concannon, Helena.
- Foran, Thomas.
- Goulding, Seán.
- Hayes, Seán.
- Healy, Denis D.
- Johnston, James
- Lynch, Eamonn.
- MacCabe, Dominick.
- McEllin, Seán.
- Magennis, William.
- O Buachalla, Liam.
- O'Donovan, Seán.
- O'Dwyer, Martin.
- O Maille, Padraic.
- O'Neill, Laurence.
- Nic Phiarais, Maighréad M.
- Quirke, William.
- Robinson, David L.
- Stafford, Matthew.
Tellers:—Tá: Senators Doyle and Rowlette; Níl: Senators Goulding and O'Donovan.
Amendment declared lost.
Sections 21 and 22 agreed to.
SECTION 23.
Question proposed: "That Section 23 stand part of the Bill."
I would like to raise a point on Section 23. Is it usual to give a Minister unrestricted powers to sell property? I think that Parliament imposed all kinds of restrictions on the Government leasing property. I do not know what the distinction is.
It was Article 11 of the old Constitution.
Does Senator Hayes think I am wrong?
It was Article 11 of the old Constitution.
Exceptional safeguards were imposed in the matter of leasing property. They were subject to being tabled, and so on. Should not similar restrictions apply to the sale of property by a Minister? I would like to have that point dealt with.
There is similar power in relation to the disposal of surplus land acquired for housing or public health purposes. The Minister, in order to be able to acquire a desirable property, may have to acquire more land than is actually necessary for the site of the hospital, and the purpose of the section is to enable the Minister to dispose of any surplus lands or land that he may have to acquire above what would be necessary for the hospital site.
I do not think that quite answers my point. The Constitution imposed all kinds of safeguards in respect of the Government leasing land. Why should not similar safeguards apply in the case of the sale of land? That puzzles me.
I am not prepared to enter into a debate on that. I am explaining to the Senator why it may be necessary to acquire more land than will be required for the purposes of the hospital. A man may have an estate for sale. He may be prepared to sell the whole of his little estate if you are prepared to buy, but may not be prepared to sell a portion of it. It may be good business to acquire the whole of the property, notwithstanding the fact that less of it would do but, if you do acquire the whole of the property and it is not necessary for your purpose, it is necessary that you should have statutory power to dispose of the surplus.
Yes. I see the point about the acquisition of surplus land, but is not the Minister empowered, without any restriction, to sell the site of the existing hospital when it is no longer required?
That is a different matter. That is part of the property that is already vested in the State. The section deals with property that will be acquired for the purposes of the new hospital.
It is very closely allied to the section. Could the Parliamentary Secretary tell me: is he empowered, entirely without restriction, to sell land that is set free, that is not required, on the existing site?
Yes, but the proceeds of such sale have to be lodged to the credit of the Hospitals Trust Fund.
Question put and agreed to.
Leas-Chathaoirleach
On Section 24, there is an amendment in the name of Senator Sir John Keane.
I am raising a point of principle in this amendment and I think it would be more appropriate to deal with the point on Section 29.
Amendment No. 3 not moved.
Sections 24 to 27, inclusive, agreed to.
SECTION 28.
Leas-Chathaoirleach
On Section 28, amendments Nos. 3 (a) and 3 (b) could be debated together.
Tairgim leasú 3 (a):—
In sub-section (1), page 10, to delete the words "Saint Laurence's Hospital" in line 54, and insert instead the words "Ospidéal Lorcáin Naomhtha".
Maidir leis an leasú seo atá curtha síos agam, ba mhaith liom a rá go mb'fhearr liom gan ainm an ospidéil seo a bheith san mBille ach i nGaedhilge amháin. Nuair a chuireas an leasú síos, sé'n rud a bhí ar intinn agam go ndéanfaí an rud céadna i dtaobh ainme an ospidéil agus a rinneadh i mBille an Bhainc Cheannais maidir le teideal an Bhainc. Ní theastuíonn uaim go mbeidh aon achrann faoin mBille seo, go háithride i dtaobh na hainme, agus ar an adhbhar sin, táim sásta glacadh leis an leasú atá ann fá láimh an tSeanadóra Uí Chuirc. Más é toil an tSeanaid, ba mhian liom mo leasú fhéin a tharraing siar.
Níor mhaith liom go dtarraingeofaí an leasú seo ar gcúl. Sílim gur dearmad é an Béarla chur isteach sa mBille seo ar aon chor mar tá focla, ar nós Dáil Eireann, agus níl aon Bhéarla ortha. Ní féidir Béarla a chur ar "Lorcán", mar is ainm Gaedhilge ó thús é agus sílim gur cheart é fhágáil mar bhí sé ag an Seanadóir O Buachalla i dtosach, mar nach dteastuíonn sé ach é bheith i nGaedhilg amháin.
Leas-Chathaoirleach
An maith leis an Seanadóir ceist a chur? Senator O Máille objects to the withdrawal of amendment No. 3 (a).
I think it is not necessary to have the English equivalent, or supposed English equivalent. We have words like Dáil Eireann and there is no translation of them. This amendment would not affect the meaning of the Bill in any way. The sooner we have more Irish words, especially, proper names, the better. Proper Irish names cannot be correctly translated into English and I think one name would be quite sufficient to meet the case.
Leas-Chathaoirleach
Is the amendment being withdrawn?
Could we hear the Parliamentary Secretary on the amendment?
May I ask what is the purpose of these political histrionics, of putting in one word in Irish and then suggesting that there is not even an English equivalent for it? I do not see what is being aimed at. It would be quite logical to say that the whole Act should be in Irish. The whole Act will appear in Irish on the Statute Book, since there will be an Irish translation of this Bill. The only official publications without a word of Irish are the Income Tax forms one receives. I can never find a word of Irish in them, but in every other Government publication you find somewhere, in the title or on the margin, a word in Irish. Frankly, the whole thing is ridiculous. This is calculated to make us look ridiculous—to have one word in Irish stuck in, and then suggesting that there is no English equivalent for it.
In reply to what Senator Sir John Keane has said, my idea was to prevent the Seanad from making itself ridiculous, since you can have no proper translation of an Irish word like "Lorcán". To translate "Lorcán" into "Laurence" simply makes the whole thing ridiculous.
Is it going to be translated from Lorcán into Laurence? The Bill was drafted in English. There were old pre-Christian names of pagan origin. When Christianity came in, those names were correlated with Biblical, or specifically Christian, names. The name "Lorcán" was pagan. When Christianity came in, it was correlated with the name Laurence, after Laurentius, an early Christian saint. The original name in this Bill, as well as I remember, was St. Laurence O'Toole. Perhaps some of the Gaelic experts can tell us whether, at his Baptism, Lorcán O Tuathail, in being called Laurence or Lorcán, was called after a specifically Christian saint whose name was Laurentius. Now we are being told that you cannot have an English equivalent for an Irish name. I do not purport to be a historian with regard to the Irish saints, but I think, if investigation is made, it will be found that this is just St. Laurence simpliciter who has priority in the Breviary, the original Saint Laurence. If it was Lorcán O Tuathail, I think you will find that he had the name in respect of a saint whose name was Laurentius, of which the English is Laurence, and to which, at a later stage, the Irish name Lorcán was arbitrarily correlated. I do not think there is any point in the argument that you cannot find an equivalent in English for this word.
Neither Senator Fitzgerald nor myself has access to the records where St. Laurence O'Toole's birth certificate is to be found.
I think he was a Christian saint.
St. Patrick was a greater authority than Senator Fitzgerald, and he did not condemn everything that was pagan. I maintain that the names of those saints may have been Latin. English was not much used in Ireland at that time. I still maintain that we would be making ourselves ridiculous by giving an old Irish name an English translation.
Why not propose an amendment calling the hospital St. Laurence O'Toole's Hospital?
"Lorcan" is a translation of the original "Laurentius", and not of the old pagan name, Lorcán.
In any case, Lorcán is racy of the soil.
A small point occurs to me in connection with the Title of the Bill. I think the more correct Title would be St. Laurence Hospital and not St. Laurence's. For one thing it would be more euphonious, and from the point of view of usage it would, I think, be more correct. For example, we do not say St. Lawrence's River. We say St. Lawrence River.
I am not competent to deal with the Irish and historical aspect of this question, but I agree with Senator Mrs. Concannon in regard to the English Title of the Bill.
I agree with Senator Mrs. Concannon and with Senator Douglas that, from the point of view of euphony, the Title should be St. Laurence Hospital. I think there is an obvious historical draw back in regard to the Title of this measure. We are taking away the name of an English nobleman who gave his name to one of these hospitals, the Richmond, and putting that of another, St. Laurence, the Earl of Howth.
Amendment No. 3 (a), by leave, withdrawn.
On behalf of Senator Quirke, I move amendment No. 3 (b):
In sub-section (1), page 10, to delete the words "Saint Laurence's Hospital" in line 54 and insert instead the words "Ospidéal Lorcáin Naomhtha, or in the English language, Saint Laurence's Hospital."
Would the Senator be agreeable to alter the amendment to read "St. Laurence Hospital"?
Yes.
Leas-Chathaoirleach
Is the Parliamentary Secretary prepared to accept the alteration?
Perhaps it would be better to leave it over for Report Stage.
Agreed.
Amendment No. 3 (b), by leave, withdrawn.
Section 28 agreed to.
SECTION 29.
Question proposed: "That Section 29 stand part of the Bill."
I want to bring before the House a question of principle which embarrasses me very much, and would probably embarrass me even more if I were the Minister. Whatever the past status of this hospital, I think we are all pretty well satisfied now that it was, in essence, a State hospital. When the sweepstakes came along, they were intended, I think, primarily for voluntary hospitals, but I accept that as time went on the principle was applied that all sick poor should benefit from sweepstake funds. I am not going to labour the point that whereas there was no intention in the original scheme to benefit State hospitals, they ultimately received the benefits of it, and that so far as the sweepstakes are concerned, all hospitals, rate-aided—subject to a certain proportion—general and State, can participate.
What I do not like about it is that the Minister takes power to pay for this hospital out of sweepstake funds. At present I venture to say there are no adequate funds to pay for the building of any new hospital. There are, roughly, £8,000,000 capital in the possession of the hospitals' trustees, and virtually the whole of the interest on that sum is required to finance deficits. The last deficits, I think, amounted to £210,000, and 3 per cent. on the capital amounts to £240,000; so that you are practically getting to a position—and the deficits are almost certain to increase this year—in which the whole of the available money is required to finance these deficits. You could begin to dissipate the capital, but I do not think anybody contemplates that; so that if you are to find capital for rebuilding, you must wait for the sweepstakes to revive, or find it from State funds. I do not propose to pursue that point.
The position is that the Minister, being human, cannot be a fair judge, and it is not fair to give the Minister power to deal on his sole initiative and responsibility with that fund. It is only human that he should give priority to his own hospital, to the State hospital, and I am profoundly dissatisfied that there is not some protection in the Bill for other hospitals which have an equal right to rebuild when the time comes. I hope the Parliamentary Secretary will tell the House what his intentions in this matter are because he is at present an absolute dictator over the Hospitals Sweepstake money. He can take advice from this person or from that person, but when it comes to the last resort, he can say, without anybody questioning him, that a sum of, for instance, £1,000,000 available in the Sweepstake Fund for rebuilding shall all go to build the St. Laurence Hospital and that other schemes can wait until further moneys become available. It is a profoundly unsatisfactory system to have the Minister an interested party in one participant in that fund. I hope the Parliamentary Secretary will reassure us and, if he sees fit to do so, give some statutory protection against that very alarming possibility.
The position is as outlined by Senator Sir John Keane. The Minister under the Bill will have complete power to give priority to this hospital. There is no getting away from that. It is doubtful if, in the near future, it will be possible to build any of the larger hospitals in Dublin which are in contemplation. I do not think the Senator desires to have a discussion on that matter, inasmuch as we have a specific motion dealing with the whole problem of the hospital situation in Dublin, on which details of the position and the prospects will probably have to be discussed, but I think the House can assume that all the hospitals will get fair treatment. It is natural to assume that there may be a leaning towards the institution which belongs to the State; on the other hand, it is hoped that it will be possible to provide the four Dublin hospitals, of which this is only one, as soon as the emergency has passed and building materials are again available.
If I were to continue to develop the argument as to how it is proposed to make moneys available for that purpose, I should be anticipating the discussion which must take place later on on Senator Sir John Keane's motion, but I do believe that, if the emergency were over the sweepstakes would revive. We have heard from Senator Rowlette to-day that, even during the emergency, there has been a growing improvement in the sweepstakes, and that the sweepstake at present being held has been substantially more successful than recent sweepstakes, and in fact than any since the beginning of the emergency.
There is, however, no alternative to taking the risk that the Minister will give priority to this institution. After all, this institution, while it is a State hospital, will serve exactly the same classes of the community as the voluntary hospitals or any of the other institutions in the City of Dublin or throughout Ireland serve. While it is a State hospital, it is not being reserved, and it is not intended that it should be reserved, for the medical treatment of State officials, such as Guards, civil servants, or Senators, if they come into the category of State officials. If it were being reserved for servants of the State, there would be more substance in the line of thought suggested by Senator Sir John Keane, but in fact the hospital will continue to serve in the future, as it has in the past, mainly the poor of the City of Dublin.
I am somewhat confused by the discussion between Senator Sir John Keane and the Parliamentary Secretary. Under the second sub-section of Section 29, there is no discretion left to the Minister, except in respect of one small point. Senator Sir John Keane's criticism was that it was invidious and difficult for the Minister to use a free discretion where a hospital, in which he was more directly interested ministerially than in another, was concerned, but, in sub-section (2) "the Minister shall"—it does not say "may"—"make from time to time to the board, out of the Hospitals Trust Fund," grants for a particular purpose. Whether that is for better or worse, from the point of view of Senator Sir John Keane, I do not know, but there is no discretion there, except in the interpretation of the word "reasonably"—"which, in the opinion of the Minister, have been reasonably incurred."
The Parliamentary Secretary has not relieved my anxieties in the very least. He has admitted that the Minister can give priority to this hospital. Further, in seeking to justify such action, if it were taken, he says: "What does it matter giving priority to this hospital? It is the poor who will benefit." I cannot accept that. Other hospitals have equal claim on those sweepstakes, and I think that they would have very solid grounds for grievance if they found that £1,000,000 or £500,000 which had been accumulated had suddenly been bitten off entirely by the Minister. I shall be dealing with this matter again on the general motion. The whole thing is profoundly unsatisfactory. There is uncertainty as to the magnitude of the fund in the future. There is uncertainty as to the gambling propensity in the future. There is uncertainty as to whether the State can maintain this whole method of sweepstake legislation. Once the Minister starts building this hospital he is committed to it. He has to finance it out of sweepstakes moneys; he seems to have no alternative unless there is amending legislation. We will find all the sweepstakes moneys, or a substantial portion of them, going to this one hospital, and the other people can wait. They will be dependent entirely in the future on the uncertainty of gambling, and all the rest of it. I think there should be in the Bill some form of words providing that, before embarking on a scheme, regard must be had to the claims of other hospitals in respect of their schemes, because there are other schemes in being, as the Parliamentary Secretary knows. I can see very clearly that this particular scheme will get priority, and the other schemes will have to wait indefinitely. There are further consequences of that which, as the Parliamentary Secretary has suggested, are not appropriate to this discussion, and which I will develop at a later stage. Would the Parliamentary Secretary be averse to putting in some form of words which would direct the Minister to have regard to the schemes that other hospitals have—the authorised schemes, I might say, of other hospitals—before he decides to commit himself to the Saint Laurence scheme?
I am afraid I shall have to ask the House to trust the Minister in this regard. No restriction has been put on the Minister's discretion in the matter of priority under the Hospitals Trusts Act. Since he became responsible for the disbursement of those funds, it has been open to him to give priority to any institution that he thought well of giving priority to. I do not think the Minister has abused that power. It might be suggested, if people wanted to be particularly polite, that some future Minister might abuse a power which the present Minister would not abuse. The only answer I can give to that is that any future Minister, having had sufficient Parliamentary power behind him to become Minister, can take any statutory powers that he requires for the purpose of giving him the right to exercise the priority he might desire. I would not be favourably disposed towards the suggestion of Senator Sir John Keane that we should put a statutory obligation on the Minister carefully to weigh the claims of all other claimants on the Hospitals Trust funds before taking any steps towards the provision of this new hospital. I would assure the House, if it were necessary, that the claims of all the hospitals which are anxious to extend or to provide new institutions will be fairly considered. There does not appear to be any great anxiety on the part of any of the voluntary hospitals to push on with the preliminary steps towards the provision of further accommodation or the provision of new hospitals pending the termination of the present international crisis. In fact, it is difficult to get the governing bodies of some of those institutions even to proceed with the preliminary plans. At any rate, I think it would be an innovation that I should have to resist if the Minister's discretion were to be curtailed in the manner suggested by Senator Sir John Keane.
The argument used by the Parliamentary Secretary in resisting this amendment seems to me so extraordinary and so objectionable that I do not think it ought to be allowed to pass.
There is no amendment. I raised the matter on the section.
On the question raised, the Parliamentary Secretary explained that, if the Minister did not have the discretion, he could always get it; that if he was sufficiently strong in the Dáil to be appointed Minister he must have a subservient majority, and, therefore, could get the powers to do what he wished to do in any case. That, to my mind, is a complete denial of democracy and a complete denial of parliamentary government.
Might I interrupt the Senator for a moment? Might I explain to the Senator that I referred to the possibilities under a future Minister?
I do not for a moment suggest anything about the present Minister. The Parliamentary Secretary said that, under our Parliamentary system, a future Minister could do that. I am suggesting that that idea is an entirely false one in regard to our Parliamentary system. It presupposes that, because a majority in the Dáil elect a Minister that majority has no individual rights at all; that they will always blindly support him, and that there is no such thing as any kind of freedom inside any Party. If that be true, it means that Parliament, at its best, is a rather poor debating society. I do not myself believe that we have reached that stage, and I hope we will never reach it. Even though very often we have the Whips put on in a way that I think is unnecessary, I think—or I hope, at any rate—that there is a considerable amount of individual opinion, even though it is expressed only at Party meetings. The idea suggested by the Parliamentary Secretary which, of course, applied only to a future Minister, seems to me to be utterly unparliamentary.
My criticism of Section 29 is not that it leaves too much discretion to the Minister but that it leaves no discretion at all; it is mandatory on him to dispose of the money in a certain way. This, as far as I know, is an entirely new feature in regard to any of the legislation governing the Hospitals Trust funds. I may be wrong about that, but I cannot remember any other case in which the Hospitals Trust funds were ordered to be disbursed for the benefit of any particular hospital. The Parliamentary Secretary has defended the present discretionary powers of the Minister. Of course, they are secured to him completely by Statute. I do not always agree with the Parliamentary Secretary, but I think he was quite within his rights in claiming that, speaking generally—he did not say "speaking generally"; I put that in—the Minister has not shown any favouritism in his distribution of funds between the various hospitals. The distribution has been very fairly carried out. I think it is an objectionable principle that a statute should be brought in to limit the power of the Minister in the exercise of that discretion, to override whatever discretion he may have or whatever advice he may have got from the Hospitals Commission and that certain institutions shall be entitled to receive funds in that way.
I cannot see that the Parliamentary Secretary is very logical. He says that no restrictions have been placed upon the Minister in the past and asks why should any be placed on him now. When the Hospitals Act was passed, the rebuilding of the State hospital was never in contemplation. If it were felt that the State hospital, in the sole discretion of the Minister, had a right to get funds in priority to any other hospital, I think that the matter would have to be raised on the original Hospitals Act and I should be very surprised if something were not done to prevent that happening. On the Report Stage, I propose to bring in an amendment to establish the point I am now urging. It would appear that, as the section now stands, once this hospital is started, no other hospital can participate in the capital funds of the sweepstakes until this hospital is completed. Other institutions which may have equal claim may have to wait for years and years. My view is that none of the rebuilding schemes should be started until the capital is in sight. We should be satisfied to go on with the existing institutions until they can all rebuild or until the capital is available and it can be distributed on a fair and equitable basis. I shall consider some form of words for the Report Stage which will meet the anxieties I see and which I hope the House shares.
Question put and agreed to.
Sections 30 to 35, inclusive, agreed to.
SECTION 36.
On behalf of Senator Quirke, I move amendment No. 4:—
"In sub-section (1), line 11, and also in lines 13-14, to delete the words "of Public Works in Ireland."
This is a drafting amendment.
Amendment agreed to.
Section 36, as amended, agreed to.
Sections 37 to 41, inclusive, and the Title, agreed to.
Bill reported with amendments.
How does the Title stand now?
Leas-Chathaoirleach
It can come up again on the Report Stage.
Report Stage ordered for Wednesday, 17th February.
Business suspended at 5.55 p.m. and resumed at 7 p.m.