I move that the Bill be now read a Second Time.
Private Business. - Royal Hospital for Incurables, Dublin (Charter Amendment) Bill, 1952—Second Stage.
An Leas-Chathaoirleach
I should apologise for my lack of knowledge of the procedure of the House on the last occasion. There was no excuse for me, but I suppose that many a Senator with longer experience of the House than I might easily have fallen into the same mistake. This Bill proposes only one change, but, I suggest, a very fundamental change, in the charter of the hospital. It seeks to remove from the charter the words "without fee or reward". This House is entitled to some clarification of the position and some explanation of what that means. The position at present is that there is a board of governors who elect periodically people to the hospital. Some of these people remain for a very long period. They are suffering from incurable diseases and some remain there for years.
What I am afraid of is that if this clause is removed it will possibly mean that people who cannot afford to pay will not be so readily elected into the hospital as people who can afford to pay. I know that the hospital is for poor people, but there are degrees of poverty, and people may be poor who could afford to pay something, but there are others who are so poor that they could not afford to pay anything.
I am a member of the Dublin Corporation and we subscribe to this hospital. We have increased our contributions over the years and the present contribution is in the neighbourhood of £5,000 per annum. What I am anxious to know is whether removal of this clause means that in future no one can be admitted, unless he or she is willing to pay, and, if he or she is willing to pay, what will the payments amount to. Will they be chosen on the basis of their ability to pay? Suppose there are two patients, one of whom can pay more than the other. Will the one who can afford to pay more be admitted to the hospital rather than the other?
That is the only point I am interested in and I have no other motive in opposing the Bill. I am anxious to protect people, many of whom I know, who are not in a position to pay anything at all. I want to ensure that these people will have the same right of admittance to the hospital as they have now, prior to the suggested abolition of these words. I quite appreciate—I should be ungenerous if I did not say it—the splendid work this hospital is doing and has been doing over the years for the poor of the country. That should be said. I can appreciate also how difficult it is, not alone for this hospital but for all hospitals, to keep things going at present, but my anxiety is to ensure that the removal of these words will not be a hindrance to the poorest of the poor getting into the hospital, as they have been getting in heretofore.
As members of the House are probably aware, this is a private Bill and will have to go, if it passes this stage here, to a Joint Committee of both Houses, where it will have to be very carefully examined. Only if it passes that Committee can it come back to us for further consideration. When I heard that there might be a debate on this stage, I thought it would be no harm to make some inquiries. I did not speak to Senator Colgan, but I heard indirectly some of the points he has made, which seem to me to be very proper and natural points to make.
Accordingly, although I am not a member of the committee of the hospital and, therefore, cannot in any sense speak officially on its behalf, I did make inquiries, and as a result of information given to me I prepared a brief statement. I submitted it to the solicitors for the hospital and asked them to let me know if there was anything that was not strictly accurate in it. They sent it back with one or two minor amendments and I propose to make that statement now, because it will clarify the position. There might be a danger that some members of the public might be unduly alarmed by a discussion here and possibly some of the patients might be afraid of their own position, and whereas I quite approve of the statement being made I feel that it should be at least partially answered, although until the Bill is fully examined it is not possible to answer all the points.
According to the information given to me the position is as follows: The hospital has been carried on under a charter granted in the year 1800 and a supplemental charter dated 1886, both of which provide that the patients shall be tended "without fee or reward." It is not necessary for me to refer to the value of the work of the hospital for poor persons afflicted with illnesses declared by the qualified medical authority to be incurable. This is fully recognised by everybody. There are, I am informed, 236 patients at present in the hospital—100 male and 136 female—all suffering from incurable diseases and all being cared for without fee or reward.
Up to the outbreak of the second world war in the year 1939 the hospital continued to be carried on with efficiency upon the income then available, but as a consequence of the war, while voluntary subscriptions tended to fall, the expenses in all directions increased consistently, as the following figures will show: Provisions in 1938-39 cost £5,205 and, in 1950-51, £9,991; fuel, electric light, etc., cost £2,340 in 1938-39 and now cost £6,360; salaries and wages, which were £4,465 in 1938-39, are now £8,156; and the average cost of maintaining a bed, which was £64 in 1938-39, is now £121.
To meet the large increase in yearly expenses the managing committee was obliged to sell £44,766 of capital. Realising that this drain upon capital could not be allowed to continue if the hospital was not to be forced to close its doors, the managing committee decided to approach the Minister for Health and ask for assistance. A special committee was appointed to wait on the Minister and explain to him the serious financial position in which the hospital was placed. This meeting was held at the Minister's office upon the 21st March, 1951.
Subsequently, on the Minister's recommendation, the hospital received from the Hospital Trust a grant of £20,000, which almost discharged the overdraft due to the hospital's bankers at 31st March, 1951. It was explained to the special committee that in all probability no further grant would be made, and that the managing committee should take immediate steps to place the hospital on a sound financial basis. One of the suggestions subsequently put forward for doing this was that the managing committee should take steps to amend the hospital's charter so that it could admit into the hospital for treatment a number of public assistance patients under the provisions of the Public Assistance Act, 1939, and accept payment for their maintenance and treatment at £4 4s. Od. per week for each patient, which might be defrayed by the public assistance authorities.
The managing committee therefore consulted their solicitors, who advised that in order to carry out the Minister's suggestion it would be necessary to promote a Private Bill in the Oireachtas with the object of amending the charter. The Bill is a simple one and designed only to amend the provisions of the charter so as to make it possible for the hospital in future to take some patients for whom fees will be paid.
I have been assured that it is very far from the intention of the managing committee to discontinue taking non-paying patients. It will, I understand, continue to take as many non-paying patients as the financial position will permit, and it is expected that these will be the vast majority of the inmates. It is obvious, however, that if satisfactory steps are not taken to place the finances of the hospital on a sound basis, it will not be possible for it to continue to function.
It therefore appears to me that the Bill should be regarded as a first and necessary step towards improving the financial position so that the hospital may continue its good work. It is, I think, important to note that, if passed, this Bill will not of itself enable the hospital to take paying patients. Before this can be done, the by-laws of the hospital will have to be amended or replaced by new by-laws. I am informed that before these by-laws can come into force they must have the approval and consent of the Chief Justice, the President of the High Court and the senior judge of the Supreme Court, or at least one of them. We can, I am sure, be confident that none of these eminent judges will approve any new by-laws without full and careful consideration.
It has been suggested that the Bill should contain detailed provisions which would restrict the ways in which these by-laws should be amended in relation to the conditions under which paying patients should be received. This is, of course, a very proper suggestion and may be a matter for consideration in Committee or when the Bill is reported to the House, but I would point out that there are obvious advantages in leaving it to the hospital to amend its by-laws to meet circumstances as they may arise, subject of course to judicial approval. No one wishes the funds of the hospital spent on the promotion of a series of Private Bills and this might easily occur if there was no power to alter the by-laws to meet altered circumstances.
Apart from the possibility of the reception of public assistance patients— and, of course, it is not certain—there are other classes of patients which might be admitted without in any way altering the main object of the hospital which is to take patients without fee or reward. It is not possible to visualise all the possible circumstances, but the following are a few examples of what could conceivably occur in the future:—
(a) A Government Department or other public or local authority might be authorised to pay for the maintenance in the hospital of some particular class of patient.
(b) A public or private concern might undertake to pay for the maintenance of some employee or employees. Under present regulations the hospital could not take that patient.
(c) A private individual by his will or otherwise might make a donation to the hospital on condition that a particular patient, or a patient from a particular locality, was admitted to the hospital.
(d) Social legislation might be introduced providing for the payment of substantial pensions to persons who were inmates in the hospital, and it might be reasonable that a proportion of these pensions might be made available for their maintenance in the hospital.
That, I understand, could not be done under present conditions.
The House will agree that this is a matter which should be allowed to go to a committee for full investigation. I have gone to some trouble to make an investigation, but I am making this case on no responsibility except my own.
The Senator is most unfair. Much of what he has said is quite controversial and I could have made points in Committee; I should have said a whole lot more.
An Leas-Chathaoirleach
I take it that the Bill is getting a Second Reading?
Yes, a Second Reading.
Question put and agreed to.